Continuing Bonds, Attachment Style, and Adjustment in the Conjugal Bereavement among Hong Kong Chinese

ERIC Educational Resources Information Center

Ho, Samuel M. Y.; Chan, Ide S. F.; Ma, Ernie P. W.; Field, Nigel P.

2013-01-01

The present study examined the effects of attachment style and continuing bonds, defined as the extent to which a bereaved individual feels that the deceased remains a part of his/her life, on post bereavement adjustment among 71 conjugally bereaved individuals. It was shown that bereaved individuals with an anxious attachment style tended to show…

Personalized and yet standardized: An informed approach to the integration of bereavement care in pediatric oncology settings.

PubMed

Wiener, Lori; Rosenberg, Abby R; Lichtenthal, Wendy G; Tager, Julia; Weaver, Meaghann S

2018-02-01

The death of a child has been associated with adverse parental outcomes, including a heightened risk for psychological distress, poor physical health, loss of employment income, and diminished psychosocial well-being. Psychosocial standards of care for centers serving pediatric cancer patients recommend maintaining at least one meaningful contact between the healthcare team and bereaved parents to identify families at risk for negative psychosocial sequelae and to provide resources for bereavement support. This study assessed how this standard is being implemented in current healthcare and palliative care practices, as well as barriers to its implementation. Experts in the field of pediatric palliative care and oncology created a survey that was posted with review and permission on four listservs. The survey inquired about pediatric palliative and bereavement program characteristics, as well as challenges and barriers to implementation of the published standards of care. Result The majority of participants (N = 100) self-reported as palliative care physicians (51%), followed by oncologists (19%). Although 59% of staff reported that their center often or always deliver bereavement care after a child's death, approximately two-thirds reported having no policy for the oncology team to routinely assess bereavement needs. Inconsistent types of bereavement services and varying duration of care was common. Twenty-eight percent of participants indicated that their center has no systematic contact with bereaved families after the child's death. Among centers where contacts are made, the person who calls the bereaved parent is unknown to the family in 30% of cases. Few centers (5%) use a bereavement screening or assessment tool. Significance of results Lack of routine assessment of bereavement needs, inconsistent duration of bereavement care, and tremendous variability in bereavement services suggest more work is needed to promote standardized, policy-driven bereavement care. The data shed light on multiple areas and opportunities for improvement.

Bereavement support for family caregivers: The gap between guidelines and practice in palliative care

PubMed Central

Rumbold, Bruce; Howting, Denise; Bolleter, Amanda; Breen, Lauren J.

2017-01-01

Background Standards for bereavement care propose that support should be matched to risk and need. However, studies in many countries demonstrate that palliative care services continue to adopt a generic approach in offering support to bereaved families. Objective To identify patterns of bereavement support in palliative care services based upon the experience of bereaved people from a population based survey and in relation to clinical practice guidelines. Design An anonymous postal survey collected information from clients of six funeral providers in four Australian states (2014–15), 6 to 24 months after the death of their family member or friend, with 1,139 responding. Responses from 506 bereaved relatives of people who had terminal illnesses were analysed. Of these, 298 had used palliative care services and 208 had not. Results More people with cancer (64%) had received palliative care in comparison to other illnesses such as heart disease, dementia and organ failure (4–10%). The support for family caregivers before and after their relative’s death was not considered optimal. Only 39.4% of the bereaved reported being specifically asked about their emotional/ psychological distress pre-bereavement, and just half of the bereaved perceived they had enough support from palliative care services. Half of the bereaved had a follow up contact from the service at 3–6 weeks, and a quarter had a follow-up at 6 months. Their qualitative feedback underlined the limited helpfulness of the blanket approach to bereavement support, which was often described as “not personal” or “generic”, or “just standard practice”. Conclusions Timeliness and consistency of relationship is crucial to building rapport and trust in the service’s ability to help at post-bereavement as well as a focus on the specific rather than the generic needs of the bereaved. In light of these limitations, palliative care services might do better investing their efforts principally in assessing and supporting family caregivers during the pre-bereavement period and developing community capacity and referral pathways for bereavement care. Our findings suggest that bereavement support in Australian palliative care services has only a tenuous relationship with guidelines and assessment tools, a conclusion also drawn in studies from other countries, emphasizing the international implications of our study. PMID:28977013

Holocaust memory reconstruction among bereaved parents.

PubMed

Cohen-Louck, Keren; Saka, Yael

2017-02-01

Many studies have examined the trauma bereaved parents experience. The current study focuses on the role that the Holocaust's memory plays in the bereavement experience of parents who have lost a child in a terrorist attack in Israel. Forty bereaved parents were interviewed, using semistructured in-depth interviews. Bereaved parents related to the Holocaust memory as a meaningful experience in their private bereavement. The parents expressed dialectic feelings concerning their loss, personal victimization on the one hand and personal strength, and growth on the other hand. It seems that memory reconstruction of the Holocaust can be used as a coping resource.

Effects on life satisfaction of older adults after child and spouse bereavement.

PubMed

Bratt, Anna Sofia; Stenström, Ulf; Rennemark, Mikael

2017-06-01

Few studies have compared the impact of different familial losses on life satisfaction (LS). Furthermore, there is a lack of research on the effect of having lost both a child and a spouse among older adults. A random sample of 1402 individuals, 817 women and 585 men, aged 60-96 years from the Blekinge part of the Swedish National Study of Aging and Care (SNAC-B) participated in this cross-sectional study. The first aim was to compare the effects of child or spouse or both child and spouse bereavement on LS and, the second aim, to investigate if there were gender differences within the bereaved groups. The results showed that having lost a child, spouse or both child and spouse had a negative association with LS, although this effect was small. Having experienced multiple losses did not predict more variance than a single child or spouse loss. Gender differences were found within all the bereaved groups with bereaved men having lower LS than bereaved women. Longer time since the loss was associated with higher LS. Bereaved older adults have somewhat lower LS than non-bereaved and bereaved men seem more affected than bereaved women. Future research needs to address older men´s experiences after the loss of a loved one.

Depressive Symptoms in Bereaved Parents in the 2008 Wenchuan, China Earthquake: A Cohort Study

PubMed Central

Liu, Wumei; Fan, Fang; Liu, Jianghong

2014-01-01

This study sought to expand the literature on bereavement and response to natural disasters by reporting the prevalence, severity, and correlates of depressive symptoms among bereaved and nonbereaved parents of the 2008 Wenchuan Earthquake in China. Bereaved (n = 155) and nonbereaved (n = 35) parents from the Xiang’e township in China were interviewed at 18 months (Wave 1) and 24 months (Wave 2) following the earthquake. From Wave 1 to Wave 2, rates of probable depression fell for both bereaved (65.8% to 44.5%) and nonbereaved parents (34.3% to 20.0%). The depression index of both groups also decreased, but only significantly among bereaved parents. Of bereaved parents, those with fewer years of education had more severe symptoms at both waves. Depressive symptom severity of bereaved mothers improved over time, but that of bereaved fathers remained unchanged. Not becoming pregnant again after the earthquake was significantly linked to worse depressive symptoms in both waves, but this was not significant when age was added to the model. Bereaved parents may need more postearthquake supportive services, with fathers, individuals with fewer years of education, and parents who are not able to become pregnant again after the earthquake being particularly vulnerable. PMID:23536328

Is DSM-IV bereavement exclusion for major depressive episode relevant to severity and pattern of symptoms? A case-control, cross-sectional study.

PubMed

Corruble, Emmanuelle; Chouinard, Virginie-Anne; Letierce, Alexia; Gorwood, Philip A P M; Chouinard, Guy

2009-08-01

To assess the DSM-IV major depressive episode (MDE) bereavement exclusion criterion by comparing severity and pattern of symptoms in bereavement-excluded individuals satisfying all other DSM-IV MDE criteria to these same variables in MDE controls. A case-control, cross-sectional study of self-referred individuals seeking treatment for depressive symptoms was conducted. A total of 17,988 subjects met DSM-IV MDE symptom criteria. Of these, 1,521 individuals (8.5%) met all MDE criteria except the bereavement exclusion. They were matched by age, gender, marital status, and educational level with 1,521 MDE controls. Among the MDE controls, 292 had a recent bereavement and 1,229 did not. Severity of depression was measured by the number of MDE symptoms and the Montgomery-Asberg Depression Rating Scale (MADRS) score. Symptom cues of the bereavement-exclusion criterion were analyzed. The study was conducted between September 2003 and May 2004. Bereavement-excluded subjects were more severely depressed than MDE controls without bereavement and similar to MDE controls with bereavement. Two symptom cues, suicidal ideation and worthlessness, and the majority of other depressive symptoms were more pronounced in bereavement-excluded individuals than in MDE controls. Symptom cues of the DSM-IV MDE bereavement exclusion criterion should be modified since they could result in patients failing to be correctly diagnosed and treated. ©Copyright 2009 Physicians Postgraduate Press, Inc.

It is the “starting over” part that is so hard

PubMed Central

Washington, Karla; Oliver, Debra Parker; Shaunfield, Sara; Gage, L. Ashley; Mooney, Megan; Lewis, Alexandria

2013-01-01

Although hospices are required to provide caregivers with formal bereavement support when their loved one passes, most bereavement interventions lack standardization and remain untested. The Dual Processing Model of Bereavement was used as a theoretical framework for assessing the potential of a Secret Facebook Group for bereaved hospice caregivers. Online communication was analyzed and reported outcome measures were compared pre and post intervention. Bereaved caregivers shared abrupt and anticipated triggers resulting in loss-orientation and shared restoration through storytelling, advising, and encouragement. Caregiver anxiety and depression were lower post intervention. This study highlights the promise of Facebook for hospice bereavement support. PMID:24559689

Meaning of bereavement among older African American widows.

PubMed

Rodgers, Laura S

2004-01-01

In spite of the increase in research on spousal bereavement, researchers have not specifically addressed the impact that ethnicity may have on the bereavement experience. The results of this descriptive phenomenological study increase the understanding of spousal bereavement among older African American widows. Storytelling was at the heart of every participant's description of her bereavement experience. Six themes were identified: awareness of death, care giving, getting through, moving on, changing feelings, and financial security. For nurses to effectively intervene in the lives of bereaved older African American widows, they must consider each widow's culture, heritage, and lived experiences, which can be ascertained through eliciting and listening to the widow's life stories.

Sibling Bereavement and Continuing Bonds

ERIC Educational Resources Information Center

Packman, Wendy; Horsley, Heidi; Davies, Betty; Kramer, Robin

2006-01-01

Historically, from a Freudian and medical model perspective, emotional disengagement from the deceased was seen as essential to the successful adaptation of bereavement. A major shift in the bereavement literature has occurred and it is now generally accepted that despite the permanence of physical separation, the bereaved remains involved and…

Japanese Bereaved Family Members' Perspectives of Palliative Care Units and Palliative Care: J-HOPE Study Results.

PubMed

Kinoshita, Satomi; Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Shoji, Ayaka; Chiba, Yurika; Miyazaki, Tamana; Tsuneto, Satoru; Shima, Yasuo

2016-06-01

The study purpose was to understand the perspectives of bereaved family members regarding palliative care unit (PCU) and palliative care and to compare perceptions of PCU before admission and after bereavement. A cross-sectional questionnaire survey was conducted, and the perceptions of 454 and 424 bereaved family members were obtained regarding PCU and palliative care, respectively. Family members were significantly more likely to have positive perceptions after bereavement (ranging from 73% to 80%) compared to before admission (ranging from 62% to 71%). Bereaved family members who were satisfied with medical care in the PCU had a positive perception of the PCU and palliative care after bereavement. Respondents younger than 65 years of age were significantly more likely to have negative perceptions of PCU and palliative care. © The Author(s) 2015.

Themes of grief.

PubMed

Carter, S L

1989-01-01

A thematic analysis of 30 narrative accounts of bereavement revealed nine themes that included five core themes in bereavement--being stopped, hurting, missing, holding, and seeking; three meta-themes about bereavement--change, expectations, and inexpressibility; and a contextual theme--personal history. The themes were compared with three theoretical perspectives on bereavement by Freud, Kübler-Ross, and one defined as existential-phenomenological. Features of bereavement that are dissimilar or unaddressed by the theoretical perspectives were: (a) the quality of grief's changing character, including "waves" and intense pain which may be triggered years after the death; (b) holding, an individual process of preserving the fact and meaning of the loved one's existence; (c) expectations, both social and personal, as to how the bereaved should be overlaying the experience; and (d) the critical importance of personal history in affecting the quality and meaning of individual bereavement.

Bereavement care interventions: a systematic review

PubMed Central

Forte, Amanda L; Hill, Malinda; Pazder, Rachel; Feudtner, Chris

2004-01-01

Background Despite abundant bereavement care options, consensus is lacking regarding optimal care for bereaved persons. Methods We conducted a systematic review, searching MEDLINE, PsychINFO, CINAHL, EBMR, and other databases using the terms (bereaved or bereavement) and (grief) combined with (intervention or support or counselling or therapy) and (controlled or trial or design). We also searched citations in published reports for additional pertinent studies. Eligible studies had to evaluate whether the treatment of bereaved individuals reduced bereavement-related symptoms. Data from the studies was abstracted independently by two reviewers. Results 74 eligible studies evaluated diverse treatments designed to ameliorate a variety of outcomes associated with bereavement. Among studies utilizing a structured therapeutic relationship, eight featured pharmacotherapy (4 included an untreated control group), 39 featured support groups or counselling (23 included a control group), and 25 studies featured cognitive-behavioural, psychodynamic, psychoanalytical, or interpersonal therapies (17 included a control group). Seven studies employed systems-oriented interventions (all had control groups). Other than efficacy for pharmacological treatment of bereavement-related depression, we could identify no consistent pattern of treatment benefit among the other forms of interventions. Conclusions Due to a paucity of reports on controlled clinical trails, no rigorous evidence-based recommendation regarding the treatment of bereaved persons is currently possible except for the pharmacologic treatment of depression. We postulate the following five factors as impeding scientific progress regarding bereavement care interventions: 1) excessive theoretical heterogeneity, 2) stultifying between-study variation, 3) inadequate reporting of intervention procedures, 4) few published replication studies, and 5) methodological flaws of study design. PMID:15274744

Grieving Together and Apart: Bereaved Parents' Contradictions of Marital Interaction

ERIC Educational Resources Information Center

Toller, Paige W.; Braithwaite, Dawn O.

2009-01-01

The researchers adopted relational dialectics theory (Baxter & Montgomery, 1996) to examine the discourse of 37 bereaved parents. Research questions guiding the study were what dialectical contradictions do bereaved parents experience when communicating with their marital partner after their child's death and how do bereaved parents and their…

Bereavement and Companion Animals.

ERIC Educational Resources Information Center

Weisman, Avery D.

1991-01-01

Describes a bereavement counseling program at a humane society and reports findings that confirm parallels between human and animal bonding and bereavements. The act of consenting to euthanasia was particularly disturbing. Most of the bereaved owners reported depths of feeling that were unique and in most cases beyond those experienced in other…

An Exploration of Lesbian Maternal Bereavement

ERIC Educational Resources Information Center

Cacciatore, Joanne; Raffo, Zulma

2011-01-01

Research on parental bereavement has focused historically on single or partnered cross-gendered (heterosexual) bereaved parents. No previous studies have examined the unique experiences of same-gendered bereaved parents. This multiple-case study focused on child death in same-gendered-parent families. The goal of this study was to yield…

Belief in Afterlife as a Buffer in Suicidal and Other Bereavement.

ERIC Educational Resources Information Center

Smith, Peggy C.; And Others

1992-01-01

Examined belief in afterlife and bereavement recovery following death by suicide, homicide, accident, or natural causes. Bereaved persons (n=121) completed scales measuring belief in afterlife, impact of event, perceived recovery, spiritual well-being, emotional pain, and social support. Feeling of recovery following bereavement appeared enhanced…

Continuing Bonds after Suicide Bereavement in Childhood

ERIC Educational Resources Information Center

Wood, Lindsey; Byram, Victoria; Gosling, A. Sophie; Stokes, Julie

2012-01-01

It has been argued that the grieving process after suicide bereavement has unique properties (e.g., J. R. Jordan, 2001). A qualitative study was conducted to explore one aspect of the grieving process--continuing bonds--after suicide bereavement in childhood. Data were collected through semi-structured interviews with 10 suicide-bereaved children…

A Profile of Bereavement Supports in African American Church Congregations.

ERIC Educational Resources Information Center

Moore, Penelope J.; Hazell, LaVone V.; Honeyghan, Edna M.

Bereavement educators, counselors, clergy, and other specialists have observed that African Americans tend to under-utilize end-of-life palliative care services and general bereavement resources. The literature suggests that involving clergy in outreach to the African American community may be a viable strategy for developing bereavement supports.…

"I Carry Her in My Heart": An Exploration of the Experience of Bereavement for People with Learning Disability

ERIC Educational Resources Information Center

Thorp, Nicki; Stedmon, Jacqui; Lloyd, Helen

2018-01-01

Background: Bereavement is a universal experience, yet little research has explored the lived experience of bereavement for people with learning disability (PWLD). Materials and methods: Four PWLD were interviewed about their experience of bereavement. Data were analysed using interpretative phenomenological analysis. Results: Four themes were…

Toward the Development of a Theory of Bereavement Guilt: Sources of Guilt in Bereaved Parents.

ERIC Educational Resources Information Center

Miles, Margaret Shandor; Demi, Alice Sterner

1984-01-01

Identifies five sources of guilt in bereaved parents: cultural role, death causation, moral, survivor, and recovery guilt. A pilot study of 28 bereaved parents provided partial support for the model and suggested an additional category: grief guilt. Rationalizing and sharing were the most common guilt-ameliorating strategies. (JAC)

Recovery Following Bereavement: An Examination of the Concept

ERIC Educational Resources Information Center

Balk, David E.

2004-01-01

Herman Feifel noted that appropriate attention to one's mourning and grieving allowed the dead to die and the bereaved "to redefine and reintegrate oneself into life" (H. Feifel, 1977, p. 9). The author takes this central focus on bereavement outcomes as the springboard for an examination of the concept recovery following bereavement. He examines…

The Danish Bereavement Response in 2015--Historic Development and Evaluation of Success

ERIC Educational Resources Information Center

Lytje, Martin

2018-01-01

In the 1980s, Norwegian researchers pioneered efforts towards developing school support for bereaved children. Eighteen years later, a Danish approach was created based on these foundations. This article explores the Danish school bereavement response plans (b-plans) and investigates their ability to support both teachers and bereaved children.…

COMPLICATED GRIEF AND RELATED BEREAVEMENT ISSUES FOR DSM-5

PubMed Central

Shear, M. Katherine; Simon, Naomi; Wall, Melanie; Zisook, Sidney; Neimeyer, Robert; Duan, Naihua; Reynolds, Charles; Lebowitz, Barry; Sung, Sharon; Ghesquiere, Angela; Gorscak, Bonnie; Clayton, Paula; Ito, Masaya; Nakajima, Satomi; Konishi, Takako; Melhem, Nadine; Meert, Kathleen; Schiff, Miriam; O’Connor, Mary-Frances; First, Michael; Sareen, Jitender; Bolton, James; Skritskaya, Natalia; Mancini, Anthony D.; Keshaviah, Aparna

2010-01-01

Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This paper focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders. PMID:21284063

Beyond Recovery.

PubMed

Wong, Paul W C; Lau, Kenny C T; Liu, Lucia L; Yuen, Gloria S N; Wing-Lok, Poon

2017-06-01

It is a worldwide trend that more households are having pets or companion animals. Hence, there has been an increasing number of animal lovers experience companion animal loss bereavement. This form of bereavement has not been explored in Chinese societies. We conducted a qualitative study using in-depth interviews with 31 animal lovers and recruited through convenience and snowball sampling in Hong Kong. Companion animal loss bereavement appears to share similar features to other forms of bereavement but also has its unique features. The intensity of grief seemed to be affected by factors like the strength of the human-animal bond, lack of empathy from closed ones, being married without children, and euthanasia decision. Although the bereavement was distressful for many of our participants, many of them gradually achieved personal growth from their loss experience. We have identified seven common themes from the interview data and through self-reliance, social-supported, or professional-supported coping behaviors, people bereaved by animal loss can achieve growth from their experience. This study shows that postbereavement growth is possible from pet loss bereavement when appropriate coping strategies are adopted by the bereaved but some professional help may be needed.

Conducting research interviews with bereaved family carers: when do we ask?

PubMed

Bentley, Brenda; O'Connor, Moira

2015-03-01

Interviews with bereaved family carers to examine the end-of-life experience of the deceased are important tools for palliative care researchers, but the ethics of approaching the bereaved when they are grieving and vulnerable is often debated. The aim of this study was to explore the insights of bereaved family carers about the most appropriate time to be involved in a research interview about the end of life and death of their family member. This qualitative study used a social constructionist framework. Twenty-two bereaved family carers of people with motor neurone disease (MND) and cancer were interviewed in Western Australia. Most family carers (86%) feel comfortable being interviewed about the death of their family member within the first 5 months of bereavement, with 43% reporting they could be interviewed within weeks after death. Family carers reported that recall would be better earlier in bereavement and felt it may be helpful to them to talk about their experiences earlier. They said bereaved people should be allowed to decide for themselves when to be involved in an interview. These findings indicate that interviews with the bereaved may be most fruitful for researchers and beneficial to family carers when they are allowed to make the choice about timing for themselves, beginning weeks after the death of their family member.

Experiences and Expectations of Bereavement Contact among Caregivers of Patients with Advanced Cancer.

PubMed

Makarem, Maisam; Mohammed, Shan; Swami, Nadia; Pope, Ashley; Kevork, Nanor; Krzyzanowska, Monika; Rodin, Gary; Hannon, Breffni; Zimmermann, Camilla

2018-05-16

Contact with bereaved caregivers is not standard practice among cancer physicians, and little is known about its impact on caregivers. Our aim was to describe the experiences and opinions of caregivers regarding bereavement contact from healthcare providers (HCP). Semistructured qualitative interviews were conducted with 61 bereaved caregivers. Bereaved caregivers of advanced cancer patients who had completed a randomized controlled trial of an early palliative care intervention were approached one to five years after the patient's death. Caregivers completed qualitative interviews from April 2012 to March 2015 after completion of quantitative measures. In semistructured interviews, bereaved caregivers were asked to describe the contact they received from HCP after the patient's death and their opinions about bereavement contact. We used thematic analysis informed by grounded theory to code and analyze the data. Of 60 caregivers included in the study, 30 (50%) received bereavement contact. There were no thematic differences between trial arms. The themes "contact reflects caring," "contact offers support," and "contact facilitates closure" were prominent among those who were contacted. "Contact is a courtesy," "contact is not always necessary," and "caregiver-initiated contact" were most evident among those who were not contacted. Overall, contact was appreciated by those who received it; for those who did not, reactions included rationalization, ambivalence, and regret. No negative consequences of contact were reported. Bereavement contact is well received and may be missed if not provided. These data support integration of bereavement contact into routine supportive care for caregivers.

Communication Disparity Between the Bereaved and Others: What Hurts Them and What Is Unhelpful? A Nationwide Study of the Cancer Bereaved.

PubMed

Ishida, Mayumi; Onishi, Hideki; Morita, Tatsuya; Uchitomi, Yosuke; Shimizu, Megumi; Tsuneto, Satoru; Shima, Yasuo; Miyashita, Mitsunori

2018-04-01

The importance of communication between the cancer bereaved and others has been emphasized, but little is known about the more problematic aspects of this communication such as "unhelpful communication." The aim of this study was to establish which types of communication are perceived by the bereaved to be unhelpful. We conducted a cross-sectional, anonymous, nationwide survey at 103 certified hospice facilities/palliative care units in Japan. A total of 630 (63%) bereaved responded. Over 60% of the bereaved experiencing such communication considered it to be unhelpful, with the most unhelpful communication being "They emphasized the positive aspects of death." Thirteen items related to communication were separated into two factors ("advice for recovery" and "comments on cancer") by factor analysis. "Comments on cancer" were more unhelpful to them and were more often provided by those around them. With regard to "advice for recovery," losing a spouse was a stronger predictor with a higher odds ratio for communication distress than losing a parent (odds ratio, 5.34; 95% CI, 1.63-17.57). A number of the bereaved have experienced unhelpful communication regarding advice on dealing with bereavement and cancer. To prevent putting an unnecessary burden on the bereaved with such unhelpful communication, it is essential to understand problematic aspects. Even when people have no intention of hurting the bereaved, some communication may do so. Communication with the bereaved is also a core clinical skill required by health professionals, and further efforts are required to support the grieving process. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Bereavement, multimorbidity and mortality: a population-based study using bereavement as an indicator of mental stress.

PubMed

Prior, A; Fenger-Grøn, M; Davydow, D S; Olsen, J; Li, J; Guldin, M-B; Vestergaard, M

2018-07-01

Mental stress is associated with higher mortality, but it remains controversial whether the association is causal or a consequence of a higher physical disease burden in those with a high mental stress load. Understanding causality is important when developing targeted interventions. We aimed to estimate the effect of mental stress on mortality by performing a 'natural' experiment using spousal bereavement as a disease-independent mental stressor. We followed a population-based matched cohort, including all individuals in Denmark bereaved in 1997-2014, for 17 years. Prospectively recorded register data were obtained for civil and vital status, 39 mental and physical diagnoses, and socioeconomic factors. In total, 389 316 bereaved individuals were identified and 137 247 died during follow-up. Bereaved individuals had higher all-cause mortality than non-bereaved references in the entire study period. The relative mortality in the bereaved individuals was highest shortly after the loss (adjusted hazard ratio (aHR), first month: 2.50, 95% confidence interval (CI) 2.37-2.63; aHR, 6-12 months: 1.38, 95% CI 1.34-1.42). The excess mortality rate associated with bereavement rose with increasing number of physical diseases (1.33 v. 7.00 excess death per 1000 person-months for individuals with 0 v. ⩾3 physical conditions during the first month) and was exacerbated by the presence of mental illness. The excess mortality among bereaved individuals was primarily due to death from natural causes. Bereavement was associated with increased short-term and long-term mortality, even after adjustment for morbidities, which suggests that mental stress may play a causal role in excess mortality.

Piloting a Therapeutic Residential for Children, Young People and Families Bereaved through Suicide in Northern Ireland

ERIC Educational Resources Information Center

Braiden, Hannah Jane; McCann, Monica; Barry, Helen; Lindsay, Carrie

2009-01-01

Families bereaved by suicide can experience an extremely intense and complicated grieving process. This can be associated with a range of difficulties and can put bereaved family members at risk of a range of problems. In recognition of this, Barnardo's Child Bereavement Service piloted a two-day residential programme (integrating separate…

Risk factors for suicide in offspring bereaved by sudden parental death from external causes.

PubMed

Burrell, Lisa Victoria; Mehlum, Lars; Qin, Ping

2017-11-01

Parentally bereaved offspring have an increased suicide risk as a group, but the ability to identify specific individuals at risk on the basis of risk and protective factors is limited. The present study aimed to investigate to what degree different risk factors influence suicide risk in offspring bereaved by parental death from external causes. Based on Norwegian registers, individual-level data were retrieved for 375 parentally bereaved suicide cases and 7500 parentally bereaved gender- and age-matched living controls. Data were analysed with conditional logistic regression. Bereaved offspring with low social support, indicated by offspring's single status and repeated changes in marital status and residence, had a significantly increased suicide risk compared to bereaved offspring with high social support. Moreover, low socioeconomic status, having an immigration background, having lost both parents and loss due to suicide significantly increased suicide risk. Several variables relevant to bereavement outcome, such as coping mechanisms and the quality of the parent-offspring relationship are impossible to examine by utilizing population registers. Moreover, the availability of data did not enable the measurement of marital stability and residence stability across the entire lifespan for older individuals. Healthcare professionals should be aware of the additional risk posed by the identified risk factors and incorporate this knowledge into existing practice and risk assessment in order to identify individuals at risk and effectively target bereaved family and friends for prevention and intervention programs. Ideal follow-up for bereaved families should include a specific focus on mobilizing social support. Copyright © 2017 Elsevier B.V. All rights reserved.

Factors Affecting Communication Patterns between Oncology Staff and Family Members of Deceased Patients: A Cross-Sectional Study.

PubMed

Granot, Tal; Gordon, Noa; Perry, Shlomit; Rizel, Shulamith; Stemmer, Salomon M

Perceptions of the role of oncology medical staff in supporting bereaved families have evolved with the transition to interdisciplinary cancer care. We investigated the interactions between oncology professionals and bereaved families. This cross-sectional study involved all oncology medical staff at the Davidoff Center. Participants were given a questionnaire relating to bereavement follow-up. Responses were measured using a 5-point Likert scale. Of 155 staff members, 107 filled questionnaires with <20% missing data and were included in the analysis (α = 0.799; corrected, α = 0.821). Respondents included physicians (35%), nurses (46%), social workers (7%), psychologists (4%), or unspecified (8%); 85% were Jewish, and 60% had ≥10 years of oncology experience. Most respondents thought that contacting bereaved families was important (73%), and that it provided closure for staff (79%); 41% indicated that they contacted >50% of the families of their deceased patients. Contacting bereaved families was considered the responsibility of the physicians (90%), nurses (84%), or social workers (89%). The main barriers to contacting bereaved families were emotional overload (68%) and lack of time (63%); 60% indicated a need for additional communication tools for bereavement follow-up. In a multivariate analysis, profession (physician vs. nurse), primary workplace (outpatient setting vs. other), and self-defined religion were significant variables with respect to the perceived importance of contacting bereaved families and to actually contacting them. Other factors (e.g., age, gender) were non-significant. Perspectives regarding bereavement actions differ significantly across medical professions, work settings, and self-defined religions. Additional guidance and education regarding bereavement actions is warranted.

Conducting Research Interviews with Bereaved Family Carers: When Do We Ask?

PubMed Central

O'Connor, Moira

2015-01-01

Abstract Background: Interviews with bereaved family carers to examine the end-of-life experience of the deceased are important tools for palliative care researchers, but the ethics of approaching the bereaved when they are grieving and vulnerable is often debated. Objective: The aim of this study was to explore the insights of bereaved family carers about the most appropriate time to be involved in a research interview about the end of life and death of their family member. Methods: This qualitative study used a social constructionist framework. Twenty-two bereaved family carers of people with motor neurone disease (MND) and cancer were interviewed in Western Australia. Results: Most family carers (86%) feel comfortable being interviewed about the death of their family member within the first 5 months of bereavement, with 43% reporting they could be interviewed within weeks after death. Family carers reported that recall would be better earlier in bereavement and felt it may be helpful to them to talk about their experiences earlier. They said bereaved people should be allowed to decide for themselves when to be involved in an interview. Conclusions: These findings indicate that interviews with the bereaved may be most fruitful for researchers and beneficial to family carers when they are allowed to make the choice about timing for themselves, beginning weeks after the death of their family member. PMID:25517136

Investigation of Bereavement Period Effects after Loss of Parents on Children and Adolescents Losing Their Parents

ERIC Educational Resources Information Center

Karakartal, Demet

2012-01-01

Important loss (death) in individuals' life may cause various kinds of bereavement reactions. Most of the individuals cope with bereavement effects in various ways and they adapt themselves to the new situation. On the other hand, some individuals may have problems in coping with and analyzing bereavement period effects caused by loss. Parent loss…

A Comparison of Guilt in Bereaved Parents Whose Children Died by Suicide, Accident, or Chronic Disease.

ERIC Educational Resources Information Center

Miles, Margaret Shandor; Demi, Alice Sterner

1992-01-01

Compared guilt experiences of parents (n=132) whose children (aged 1-36) died by suicide, accident, or chronic illness. Guilt was reported by 92 percent of suicide bereaved parents, 78 percent of accident bereaved parents, and 71 percent of chronic disease bereaved parents. Six sources of guilt (Death Causation, Illness-Related, Childrearing,…

Gender, Aids, and Bereavement: A Comparison of Women and Men Living with HIV

ERIC Educational Resources Information Center

Summers, Jacquelyn; Zisook, Sidney; Sciolla, Andres D.; Patterson, Thomas; Atkinson, J. Hampton

2004-01-01

The purpose of this study was to examine the bereavement experience, psychiatric morbidity, and suicidality in bereaved men and women living with HIV. HIV+ women (n =31) who reported a loss in the recent 12 months were case matched to bereaved HIV+ men (n =62) on the basis of lifetime histories of major depression. Study participants were…

[Are oppressive dreams indicators in bereavement?].

PubMed

Purebl, György; Pilling, János; Konkolÿ, Thege Barna; Bódizs, Róbert; Kopp, Mária

2012-07-30

It is widely believed that oppressive dreams are frequent in bereavement--despite the lack of scientific investigations of the subject. The aims of our study were the analysis of dream quality as well as the correlates of oppressive dreams in bereavement. Participants with (N = 473) and without bereavement were compared upon the database of a national representative study (Hungarostudy Epidemiological Panel Survey 2006, N = 4329). Dream contents were assessed with the Dream Quality Questionnaire (DQQ). Depressive symptoms (BDI-S) and the presence anxiety were also investigated. Oppressive dreams occurred significantly higher frequency in the first year of bereavement (men: F = 17.525, p < 0.001, women: F = 8.291, p = 0.004). Oppressive dreams were significantly associated with anxiety (F = 37.089, p < 0.001) and with depressive symptoms (F = 50.562, p < 0.001). Oppressive dreams are significantly more frequent in the first year of bereavement, and may act as indicators of bereavement-linked mental health consequences like depression and anxiety. These are often masked by the symptoms of grief and therefore remain untreated. Our preliminary results could be a starting point for the development of further research aiming to clarify the relationship amongst dream contents, anxiety, and depression in bereavement.

"It is the 'starting over' part that is so hard": Using an online group to support hospice bereavement.

PubMed

Wittenberg-Lyles, Elaine; Washington, Karla; Oliver, Debra Parker; Shaunfield, Sara; Gage, L Ashley; Mooney, Megan; Lewis, Alexandria

2015-04-01

Although hospice agencies are required to provide informal caregivers (family or friends of the patient) with formal bereavement support when their loved one passes, most bereavement interventions lack standardization and remain untested. We employed the Dual Processing Model of Bereavement as a theoretical framework for assessing the potential of a secret Facebook group for bereaved hospice caregivers. A mixed-methods approach was utilized to analyze online communication (posts and comments) in the secret Facebook group, and self-reported outcome measures on depression and anxiety were compared pre- and post-intervention. Sixteen caregivers participated in the secret Facebook group over a period of nine months. The majority of online talk was oriented to restoration, revealing abrupt and anticipated triggers that evoked feelings of loss. Caregivers also shared loss orientation through storytelling, sharing and giving advice, and encouraging others to manage the challenges of coping. Caregiver anxiety and depression were lower after the intervention. This pilot study provides insight into the use of a secret Facebook group to facilitate bereavement support to caregivers. Findings highlight the promise of Facebook for hospice bereavement support. Providers and researchers are encouraged to explore the positive outcomes associated with bereavement support.

A study of bereavement in general practice

PubMed Central

Levy, B.; Sclare, A. Balfour

1976-01-01

Forty six bereaved relatives were assessed by a general practitioner four to eight weeks after the bereavement. In 36 (78·3 per cent) the immediate reaction to bereavement was one of numbness or stupefaction; in seven (15·2 per cent) emotional relief occurred; and in three cases (6·5 per cent) there was no obvious immediate reaction. The numbness reaction was limited in duration to a week or less in 31 of the 36 instances. At four to eight weeks after bereavement 29 (63·0 per cent) of the subjects continued to experience difficulty in coming to terms with their loss. Twenty subjects reported guilt feelings and a similar number expressed aggressive reactions. The bereaved subjects tended to increase their consumption of cigarettes and alcohol, while their appetite and weight tended to be reduced. Thirty six (78·3 per cent) of the subjects reported physical symptoms, notably headache, dizziness, generalised aches, and abdominal complaints. The most prominent psychological features of bereavement were found to be: preoccupation with thoughts of the deceased, idealisation of the lost person, depressive mood, and loneliness. The findings are discussed and reference made to the role of the family doctor in the management of bereavement reactions. PMID:957295

A Qualitative Systematic Review of the Bereavement Process Following Suicide.

PubMed

Shields, Chris; Kavanagh, Michele; Russo, Kate

2017-03-01

Despite the fact that a large number of people are bereaved by suicide each year, the experiences of those bereaved by suicide are poorly understood. It has been suggested that a contributing factor in relation to this lack of understanding has been the use of quantitative methods, which may not be sensitive to the bereavement process and its thematic content. Therefore, the current article outlines a systematic review of 11 qualitative studies that address issues related to the bereavement process following suicide. The results indicate that those bereaved by suicide encounter a range of difficult feelings following suicide including blame, guilt, and emptiness and that these feelings are affected by participants' ability to make meaning of the event. The meaning-making process is a complex one that occurs within a difficult social context in which both those bereaved by suicide and members of the wider community struggle to interact with each other in a beneficial way. Clinical implications of these findings are discussed.

Adapting the transtheoretical model of change to the bereavement process.

PubMed

Calderwood, Kimberly A

2011-04-01

Theorists currently believe that bereaved people undergo some transformation of self rather than returning to their original state. To advance our understanding of this process, this article presents an adaptation of Prochaska and DiClemente's transtheoretical model of change as it could be applied to the journey that bereaved individuals experience. This theory is unique because it addresses attitudes, intentions, and behavioral processes at each stage; it allows for a focus on a broader range of emotions than just anger and depression; it allows for the recognition of two periods of regression during the bereavement process; and it adds a maintenance stage, which other theories lack. This theory can benefit bereaved individuals directly and through the increased awareness among counselors, family, friends, employers, and society at large. This theory may also be used as a tool for bereavement programs to consider whether they are meeting clients' needs throughout the transformation change bereavement process rather than only focusing on the initial stages characterized by intense emotion.

Adolescent survivors after suicide: Australian young people’s bereavement narratives.

PubMed

Bartik, Warren; Maple, Myfanwy; Edwards, Helen; Kiernan, Michael

2013-01-01

While the research literature exploring suicide bereavement has expanded in recent years, this has been primarily quantitative and has focused more on the bereavement experience of parents and siblings. The bereavement experience of young people affected through the suicide death of a friend remains under-conceptualized and not well understood. To develop an understanding of the experiences of young people bereaved by the suicide of a friend. Ten young people participated in a pilot study with in-depth interviews to explore their suicide bereavement experiences. Narrative inquiry methodology was utilized to analyze the qualitative data. The findings indicated multiple grief experiences caused by suicide. Four themes reported are meaning making, feeling guilt, risky coping behavior, and relating to friends following suicide loss. Implications include the need for increased awareness that friends of young people who die by suicide may have significant health and well-being challenges associated with bereavement, and that friends in these circumstances may not readily present at services for assistance.

GPs’ experiences of dealing with parents bereaved by suicide: a qualitative study

PubMed Central

Foggin, Emily; McDonnell, Sharon; Cordingley, Lis; Kapur, Navneet; Shaw, Jenny; Chew-Graham, Carolyn A

2016-01-01

Background Suicide prevention is an NHS priority in England. Bereavement by suicide is a risk factor for suicide, but the needs of those bereaved by suicide have not been addressed, and little is known about how GPs support these patients, and how they deal with this aspect of their work. Aim This study explores the experiences of GPs dealing with parents bereaved by suicide. Design and setting Qualitative study using interviews with 13 GPs in the UK. Method Parents, whose adult offspring had died by suicide between 2002 and 2012, were recruited and gave the name of their GP to be invited for interview. Semi-structured interviews were conducted. The topic guide explored experiences of dealing with suicide and bereavement. Data were analysed thematically using constant comparison techniques. Results GPs described mental health as ‘part and parcel’ of primary care, but disclosed low confidence in dealing with suicide and an unpreparedness to face parents bereaved by suicide. Some GPs described guilt surrounding the suicide, and a reluctance to initiate contact with the bereaved parents. GPs talked of their duty to care for the bereaved patients, but admitted difficulties in knowing what to do, particularly in the perceived absence of other services. GPs reflected on the impact of the suicide on themselves and described a lack of support or supervision. Conclusion GPs need to feel confident and competent to support parents bereaved by suicide. Although this may be facilitated through training initiatives, and accessible services to refer parents to, GPs also require formal support and supervision, particularly around significant events such as suicide. Results from this qualitative study have informed the development of evidence-based suicide bereavement training for health professionals. PMID:27528708

Humor, Laughter & Happiness in the Daily Lives of Recently Bereaved Spouses

PubMed Central

Lund, Dale A.; Utz, Rebecca; Caserta, Michael S.; de Vries, Brian

2008-01-01

The positive psychology movement has created more interest in examining the potential value of experiencing positive emotions (e.g. humor, laughter and happiness) during the course of bereavement. This study of 292 recently widowed (5-24 weeks) men (39%) and women (61%) age 50 and over examined both the perceived importance of and actual experience of having positive emotions in their daily lives and how they might impact bereavement adjustments. We found that most of the bereaved spouses rated humor and happiness as being very important in their daily lives and that they were also experiencing these emotions at higher levels than expected. Experiencing humor, laughter and happiness was strongly associated with favorable bereavement adjustments (lower grief and depression) regardless of the extent to which the bereaved person valued having these positive emotions. PMID:19227000

Long-term Effects of Child Death on Parents' Health Related Quality of Life: A Dyadic Analysis

PubMed Central

Song, Jieun; Floyd, Frank J.; Seltzer, Marsha Mailick; Greenberg, Jan S.; Hong, Jinkuk

2010-01-01

This study examines the long-term effects of child death on bereaved parents' health-related quality of life (HRQoL). Using data from the Wisconsin Longitudinal Study, we compared 233 bereaved couples and 229 comparison couples (mean age = 65.11 years) and examined the life course effects of child death on parents' HRQoL. Variations in bereavement effects were examined by gender and for different causes of death. Bereaved parents had significantly worse HRQoL than comparison group parents, and there was no evidence of gender differences for this effect. With respect to the cause of a child's death, bereaved parents whose child died in violent circumstances had particularly low levels of HRQoL. Multilevel models indicated that marital closeness mitigated the negative effects of bereavement. PMID:20676393

Perinatal Bereavement: A Principle-based Concept Analysis

PubMed Central

FENSTERMACHER, Kimberly; HUPCEY, Judith E.

2013-01-01

Aim This paper is a report of an analysis of the concept of perinatal bereavement. Background The concept of perinatal bereavement emerged in the scientific literature during the 1970s. Perinatal bereavement is a practice based concept, although it is not well defined in the scientific literature and is often intermingled with the concepts of mourning and grief. Design Concept Analysis. Data Sources Using the term ‘perinatal bereavement’ and limits of only English and human, Pub Med and CINAHL were searched to yield 278 available references dating from 1974 – 2011. Articles specific to the experience of perinatal bereavement were reviewed. The final data set was 143 articles. Review Methods The methods of principle-based concept analysis were used. Results reveal conceptual components (antecedents, attributes and outcomes) which are delineated to create a theoretical definition of perinatal bereavement. Results The concept is epistemologically immature, with few explicit definitions to describe the phenomenon. Inconsistency in conceptual meaning threatens the construct validity of measurement tools for perinatal bereavement and contributes to incongruent theoretical definitions. This has implications for both nursing science (how the concept is studied and theoretically integrated) and clinical practice (timing and delivery of support interventions). Conclusions Perinatal bereavement is a multifaceted global phenomenon that follows perinatal loss. Lack of conceptual clarity and lack of a clearly articulated conceptual definition impede the synthesis and translation of research findings into practice. A theoretical definition of perinatal bereavement is offered as a platform for researchers to advance the concept through research and theory development. PMID:23458030

The long-term impact of bereavement upon spouse health: a 10-year follow-up.

PubMed

Jones, Michael P; Bartrop, Roger W; Forcier, Lina; Penny, Ronald

2010-10-01

Jones MP, Bartrop RW, Forcier L, Penny R. The long-term impact of bereavement upon spouse health: a 10-year follow-up. This study is the first to examine the effect of bereavement of a first-degree family member on subsequent morbidity over a 10-year follow-up period. A sample of bereaved subjects (n = 72) were compared with a control group (n = 80) recruited in the same period with respect to morbidity experience during follow-up. Morbidity events were ascertained from the subject themselves, their health care providers and these sources were also compared. Bereavement was associated with an elevated total burden of illness as well as with mental health and circulatory system categories diagnosed according to the International Classification of Diseases - Clinically Modified (ICD-9) classification system. The elevation ranged from approximately 20% for any illness to 60-100% among circulatory system disorders. Although in an earlier study there was a downregulation of T-cell function in the bereaved during the first 8 weeks, there was no evidence that the bereavement was associated with increased morbidity in the respiratory or immune system ICD-9 categories long-term. Past epidemiological research has indicated that bereavement of a close family member is associated with adverse health consequences of a generalised morbidity. Our study suggests an increase in mental health and circulatory system effects in particular. Further research is required to determine whether other systems are also affected by bereavement.

Promoting Neonatal Staff Nurses' Comfort and Involvement in End of Life and Bereavement Care

PubMed Central

Lane, Betty S.

2013-01-01

Background. Nurses who provide end of life and bereavement care to neonates and their families are potentially at risk for developing stress-related health problems. These health problems can negatively affect nurses' ability to care for their patients. Purpose. Nurses need to be knowledgeable about end of life and bereavement issues to provide quality care. This study sought to evaluate the effect of a bereavement seminar on the attitudes of nurses regarding end of life and palliative care of neonates. Design. A convenience sample of fourteen neonatal nurses completed a Bereavement/End of Life Attitudes about Care of Neonatal Nurses Scale after a bereavement seminar designed to provide information on end of life care. A pre- and posttest design with an intervention and control group was used to assess changes in nurse bereavement attitudes in relationship to comfort, role, and involvement. Results. After bereavement seminar, the seminar attendees had higher levels of comfort in providing end of life care than nurses in the control group (t = −0.214; P = 0.04). Discussion. Nurses' comfort levels can be improved by attending continuing education on end of life care and having their thoughts on ethical issues in end of life care acknowledged by their peers. PMID:23606955

Perceived Emotional Social Support in Bereaved Spouses Mediates the Relationship between Anxiety and Depression

PubMed Central

Jacobson, Nicholas C.; Lord, Kayla A.; Newman, Michelle G.

2017-01-01

Background Prior research has shown that anxiety symptoms predict later depression symptoms following bereavement. Nevertheless, no research has investigated mechanisms of the temporal relationship between anxiety and later depressive symptoms or examined the impact of depressive symptoms on later anxiety symptoms following bereavement. Methods The current study examined perceived emotional social support as a possible mediator between anxiety and depressive symptoms in a bereaved sample of older adults (N = 250). Anxiety and depressive symptoms were measured at Wave 1 (immediately after bereavement), social support was measured at Wave 2 (18 months after bereavement), and anxiety and depressive symptoms were also measured at Wave 3 (48 months after bereavement). Results Using Bayesian structural equation models, when controlling for baseline depression, anxiety symptoms significantly positively predicted depressive symptoms 48 months later, Further, perceived emotional social support significantly mediated the relationship between anxiety symptoms and later depressive symptoms, such that anxiety symptoms significantly negatively predicted later emotional social support, and emotional social support significantly negatively predicted later depressive symptoms. Also, when controlling for baseline anxiety, depressive symptoms positively predicted anxiety symptoms 48 months later. However, low emotional social support failed to mediate this relationship. Conclusions Low perceived emotional social support may be a mechanism by which anxiety symptoms predict depressive symptoms 48 months later for bereaved individuals. PMID:28103522

Meaning-based group counseling for bereavement: bridging theory with emerging trends in intervention research.

PubMed

MacKinnon, Christopher J; Smith, Nathan Grant; Henry, Melissa; Berish, Mel; Milman, Evgenia; Körner, Annett; Copeland, Laura S; Chochinov, Harvey M; Cohen, S Robin

2014-01-01

A growing body of scholarship has evaluated the usefulness of meaning-based theories in the context of bereavement counseling. Although scholars have discussed the application of meaning-based theories for individual practice, there is a lack of inquiry regarding its implications when conducting bereavement support groups. The objective of this article is to bridge meaning-based theories with bereavement group practice, leading to a novel intervention and laying the foundation for future efficacy studies. Building on recommendations specified in the literature, this article outlines the theoretical paradigms and structure of a short-term meaning-based group counseling intervention for uncomplicated bereavement.

Early parental adjustment and bereavement after childhood cancer death.

PubMed

Barrera, Maru; O'Connor, Kathleen; D'Agostino, Norma Mammone; Spencer, Lynlee; Nicholas, David; Jovcevska, Vesna; Tallet, Susan; Schneiderman, Gerald

2009-07-01

This study comprehensively explored parental bereavement and adjustment at 6 months post-loss due to childhood cancer. Interviews were conducted with 18 mothers and 13 fathers. Interviews were transcribed verbatim and analyzed based on qualitative methodology. A model describing early parental bereavement and adaptation emerged with 3 domains: (1) Perception of the Child, describing bereavement and adjustment prior to and after the loss; (2) Perception of Others, including relationships with partners, surviving children, and their social network; and (3) Perception of the World, exploring parents' perceived meanings of the experience in the context of their worldview. Domains are illustrated by quotes. Profiles of parental bereavement emerged.

Beyond the concept of recovery: growth and the experience of loss.

PubMed

Tedeschi, Richard G; Calhoun, Lawrence G

2008-01-01

Responding to D. E. Balk (2004) about use of the term recovery to describe bereavement outcome, the authors take the view that this term is inadequate. Among the points raised are (a) the term recovery may imply a response to psychological disorder, whereas bereavement responses are generally normative; (b) recovery does not easily allow for transformative outcomes in bereavement, e.g., posttraumatic growth; and (c) terminology guides the thinking of bereaved persons, clinicians, and researchers in this area, and the term recovery may produce bias toward viewing bereavement as a disordered state. More neutral terms such as change or resolution avoid some of these pitfalls.

Salivary Cortisol and Psychopathology in Adults Bereaved by the September 11, 2001 Terror Attacks

PubMed Central

Pfeffer, Cynthia R.; Altemus, Margaret; Heo, Moonseong; Jiang, Hong

2013-01-01

Objective This prospective study aimed to describe the nature and time course of HPA axis dysregulation and psychopathology among terror-bereaved spouses. Method Twenty-three spouses bereaved from September 11, 2001 terror attacks and 22 nonbereaved spouses were compared using a psychiatric diagnostic interview (SCID), three days of salivary cortisol collection, and a dexamethasone suppression test. Most subjects had repeated assessments at six month intervals during the two year study. Results After September 11, 2001, bereaved compared to nonbereaved had significantly higher rates of posttraumatic stress disorder (PTSD) (68.1% versus 0%) and major depressive disorder (MDD) (45.5% versus 9.5%). Bereaved had significantly higher morning basal cortisol and less afternoon postdexamethasone cortisol suppression than nonbereaved. Among bereaved, those with PTSD without comorbid MDD had significantly greater afternoon postdexamethasone cortisol suppression than those without psychiatric disorders. Conclusions Terror-related spouse death is a severe stressor associated with persistent HPA axis activation, PTSD, and MDD. However, bereaved spouses who developed PTSD and were not depressed had enhanced postdexamethasone cortisol suppression, evidence of heightened glucocorticoid receptor sensitivity. PMID:19967896

Salivary cortisol and psychopathology in adults bereaved by the September 11, 2001 terror attacks.

PubMed

Pfeffer, Cynthia R; Altemus, Margaret; Heo, Moonseong; Jiang, Hong

2009-01-01

This prospective study aimed to describe the nature and time course of HPA axis dysregulation and psychopathology among terror-bereaved spouses. Twenty-three spouses bereaved from September 11, 2001 terror attacks and 22 nonbereaved spouses were compared using a psychiatric diagnostic interview (SCID), 3 days of salivary cortisol collection, and a dexamethasone suppression test. Most subjects had repeated assessments at 6 month intervals during the 2 year study. After September 11, 2001, bereaved compared to nonbereaved had significantly higher rates ofposttraumatic stress disorder (PTSD; 68.1% versus 0%) and major depressive disorder (MDD; 45.5% versus 9.5%). Bereaved had significantly higher morning basal cortisol and less afternoon postdexamethasone cortisol suppression than nonbereaved. Among bereaved, those with PTSD without comorbid MDD had significantly greater afternoon postdexamethasone cortisol suppression than those without psychiatric disorders. Terror-related spouse death is a severe stressor associated with persistent HPA axis activation, PTSD, and MDD. However, bereaved spouses who developed PTSD and were not depressed had enhanced postdexamethasone cortisol suppression, evidence of heightened glucocorticoid receptor sensitivity.

Biological determinants of depression following bereavement.

PubMed

Assareh, Amelia A; Sharpley, Christopher F; McFarlane, James R; Sachdev, Perminder S

2015-02-01

There is considerable variability among people in their response to bereavement. While most people adapt well to bereavement, some develop exaggerated and/or pathological responses and may meet criteria for a major depressive episode. Many studies have investigated the effect of psychosocial factors on bereavement outcome but biological factors have not received much attention, hence the focus of this paper. The biological factors studied to date in relation to bereavement outcomes include genetic polymorphisms, neuroendocrine factors, and immunologic/inflammatory markers. In addition, animal studies have shown the alterations of brain neurotransmitters as well as changes in the plasma levels of the neurotrophic growth factors under the influence of peer loss. Recent studies have also investigated the biological basis of stress resilience, and have found a few genetic polymorphisms and potential biomarkers as protective factors in the face of adversity. Longitudinal studies that include data collection prior to, and also after, bereavement and which chart both biological and psychological measures are needed to develop profiles for the prediction of response to bereavement and personalised interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

War and bereavement: consequences for mental and physical distress.

PubMed

Morina, Nexhmedin; von Lersner, Ulrike; Prigerson, Holly G

2011-01-01

Little is known about the long-term impact of the killing of a parent in childhood or adolescence during war on distress and disability in young adulthood. This study assessed current prevalence rates of mental disorders and levels of dysfunction among young adults who had lost their father due to war-related violence in childhood or adolescence. 179 bereaved young adults and 175 non-bereaved young adults were interviewed a decade after experiencing the war in Kosovo. Prevalence rates of Major Depressive Episode (MDE), anxiety, and substance use disorders, and current suicide risk were assessed using the Mini-International Neuropsychiatric Interview. The syndrome of Prolonged Grief Disorder (PGD) was assessed with the Prolonged Grief Disorder Interview (PG-13). Somatic symptoms were measured with the Patient Health Questionnaire. General health distress was assessed with the General Health Questionnaire. Bereaved participants were significantly more likely to suffer from either MDE or any anxiety disorder than non-bereaved participants (58.7% vs. 40%). Among bereaved participants, 39.7% met criteria for Post-Traumatic Stress Disorder, 34.6% for PGD, and 22.3% for MDE. Bereaved participants with PGD were more likely to suffer from MDE, any anxiety disorder, or current suicide risk than bereaved participants without PGD. Furthermore, these participants reported significantly greater physical distress than bereaved participants without PGD. War-related loss during middle childhood and adolescence presents significant risk for adverse mental health and dysfunction in young adulthood in addition to exposure to other war-related traumatic events. Furthermore, the syndrome of PGD can help to identify those with the greatest degree of distress and dysfunction.

Helping parents live with the hole in their heart: The role of health care providers and institutions in the bereaved parents' grief journeys.

PubMed

Snaman, Jennifer M; Kaye, Erica C; Torres, Carlos; Gibson, Deborah V; Baker, Justin N

2016-09-01

Bereaved parents experience significant psychosocial and health sequelae, suggesting that this population may benefit from the ongoing extension of support and resources throughout the grief journey. The interaction of hospital staff with patients and families at the end of a child's life and after death profoundly affects parental grief, offering a unique opportunity for the medical community to positively impact the bereavement experience. The current study was conducted to explore the role of the health care team and medical institutions in the grief journeys of parents whose child died a cancer-related death. Eleven bereaved parents participated in 2 focus groups. Responses to each of the 3 main prompts were coded and analyzed independently using semantic content analysis techniques. Four main concepts were identified within the parental narratives, including the importance of strong and ongoing relationships between providers and bereaved families, the importance of high-quality communication, the effect of negative experiences between providers and families on parental grief, and the importance of the institution's role in the grief journeys of bereaved parents. Bereaved parents consistently identified the critical role played by medical staff and medical institutions throughout the grief journey. Key components of bereavement support identified by parents should serve to guide the actions of providers as well as provide a template for the development of a comprehensive bereavement program within an institution. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2757-2765. © 2016 American Cancer Society. © 2016 American Cancer Society.

Brief report: Bereaved parents informing research design: The place of a pilot study.

PubMed

Donovan, L A; Wakefield, C E; Russell, V; Hetherington, Kate; Cohn, R J

2018-02-23

Risk minimization in research with bereaved parents is important. However, little is known about which research methods balance the sensitivity required for bereaved research participants and the need for generalizable results. To explore parental experiences of participating in mixed method bereavement research via a pilot study. A convergent parallel mixed method design assessing bereaved parents' experience of research participation. Eleven parents whose child was treated for cancer at The Royal Children's Hospital, Brisbane completed the questionnaire/interview being piloted (n = 8 mothers; n = 3 fathers; >6 months and <6 years bereaved). Of these, eight parents completed the pilot study evaluation questionnaire, providing feedback on their experience of participation. Participants acknowledged the importance of bereaved parents being central to research design and the development of bereavement programs. Sixty-three per cent (n = 5/8) of parents described completion of the questionnaire as 'not at all/a little bit' of a burden. Seventy-five per cent (n = 6/8) of parents opting into the telephone interview described participation as 'not at all/a little bit' of a burden. When considering the latest timeframes for participation in bereavement research 63% (n = 5/8) of parents indicated 'no endpoint.' Findings from the pilot study enabled important adjustments to be made to a large-scale future study. As a research method, pilot studies may be utilized to minimize harm and maximize the potential benefits for vulnerable research participants. A mixed method approach allows researchers to generalize findings to a broader population while also drawing on the depth of the lived experience.

Support groups for children and adolescents bereaved by suicide: Lots of interventions, little evidence.

PubMed

Journot-Reverbel, Katia; Raynaud, Jean-Philippe; Bui, Eric; Revet, Alexis

2017-04-01

Though many different interventions are proposed for suicide-bereaved children and adolescents, few data exist concerning their efficiency. This literature review focused on psychosocial interventions specifically targeting children and adolescents bereaved by suicide to try to provide some validate therapeutic guidelines propositions for clinicians. We only found two articles specifically targeting children or adolescents: both of them seemed to show some efficacy in reducing some psychosocial variables (anxiety, depression…) in suicide-bereaved children but results were limited by methodological problems. This review failed to provide evidence-based guidelines propositions for suicide-bereaved children and underline the crucial need for research in this field. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

The impact of dreams of the deceased on bereavement: a survey of hospice caregivers.

PubMed

Wright, Scott T; Kerr, Christopher W; Doroszczuk, Nicole M; Kuszczak, Sarah M; Hang, Pei C; Luczkiewicz, Debra L

2014-03-01

Many recently bereaved persons experience vivid and deeply meaningful dreams featuring the presence of the deceased that may reflect and impact the process of mourning. The present study surveyed 278 bereaved persons regarding their own perspective of the relationship between dreams and the mourning process. Fifty eight percent of respondents reported dreams of their deceased loved ones, with varying levels of frequency. Most participants reported that their dreams were either pleasant or both pleasant and disturbing, and few reported purely disturbing dreams. Prevalent dream themes included pleasant past memories or experiences, the deceased free of illness, memories of the deceased's illness or time of death, the deceased in the afterlife appearing comfortable and at peace, and the deceased communicating a message. These themes overlap significantly with previous models of bereavement dream content. Sixty percent of participants felt that their dreams impacted their bereavement process. Specific effects of the dreams on bereavement processes included increased acceptance of the loved one's death, comfort, spirituality, sadness, and quality of life, among others. These results support the theory that dreams of the deceased are highly prevalent among and often deeply meaningful for the bereaved. While many counselors are uncomfortable working with dreams in psychotherapy, the present study demonstrates their therapeutic relevance to the bereaved population and emphasizes the importance for grief counselors to increase their awareness, knowledge, and skills with regards to working with dreams.

Perceived emotional social support in bereaved spouses mediates the relationship between anxiety and depression.

PubMed

Jacobson, Nicholas C; Lord, Kayla A; Newman, Michelle G

2017-03-15

Prior research has shown that anxiety symptoms predict later depression symptoms following bereavement. Nevertheless, no research has investigated mechanisms of the temporal relationship between anxiety and later depressive symptoms or examined the impact of depressive symptoms on later anxiety symptoms following bereavement. The current study examined perceived emotional social support as a possible mediator between anxiety and depressive symptoms in a bereaved sample of older adults (N =250). Anxiety and depressive symptoms were measured at Wave 1 (immediately after bereavement), social support was measured at Wave 2 (18 months after bereavement), and anxiety and depressive symptoms were also measured at Wave 3 (48 months after bereavement). Using Bayesian structural equation models, when controlling for baseline depression, anxiety symptoms significantly positively predicted depressive symptoms 48 months later, Further, perceived emotional social support significantly mediated the relationship between anxiety symptoms and later depressive symptoms, such that anxiety symptoms significantly negatively predicted later emotional social support, and emotional social support significantly negatively predicted later depressive symptoms. Also, when controlling for baseline anxiety, depressive symptoms positively predicted anxiety symptoms 48 months later. However, low emotional social support failed to mediate this relationship. Low perceived emotional social support may be a mechanism by which anxiety symptoms predict depressive symptoms 48 months later for bereaved individuals. Copyright © 2017 Elsevier B.V. All rights reserved.

The Understanding Bereavement Evaluation Tool (UBET) for midwives: factor structure and clinical research applications.

PubMed

Hollins Martin, Caroline J; Forrest, Eleanor; Wylie, Linda; Martin, Colin R

2013-10-01

The NMSF (2009) survey reported that bereavement midwife care was inadequate in a number of UK NHS Trusts. Using a small grant from the Scottish government, 3 experienced midwifery lecturers designed an interactive workbook called "Shaping bereavement care for midwives in clinical practice" for the purpose of improving delivery of bereavement education to student midwives. An instrument called the Understanding Bereavement Evaluation Tool (UBET) was designed to measure effectiveness of the workbook at equipping students with essential knowledge. To assess validity and reliability of the UBET at measuring midwives' self-perceptions of knowledge surrounding delivery of bereavement care to childbearing women, partners and families who have experienced childbirth related bereavement. An evaluative audit using the UBET was undertaken to explore student midwives' (n=179) self perceived knowledge levels before and after the workbook intervention. Validity tests have shown that the UBET, (6-item version), could be considered a psychometrically robust instrument for assessing students' knowledge gain. PCA identified that the UBET comprised two sub-scales (theoretical knowledge base - Q 1, 2 & 3 and psychosocial elements of care delivery - Q 4, 5 & 6). Data has shown that the easy to administer and short 6-item UBET is a valid and reliable tool for educators to measure success at delivering education using the "Shaping bereavement care for midwives in clinical practice" work book. Copyright © 2012 Elsevier Ltd. All rights reserved.

Exploring barriers to assessment of bereavement risk in palliative care: perspectives of key stakeholders.

PubMed

Sealey, Margaret; O'Connor, Moira; Aoun, Samar M; Breen, Lauren J

2015-10-14

Palliative care standards advocate support for grieving caregivers, given that some bereaved people fail to integrate their loss, experience ongoing emotional suffering and adverse health outcomes. Research shows that bereavement support tends to be delivered on an ad hoc basis without formal assessment of risk or need. To align support with need, assessment of bereavement risk is necessary. The overall aim is to develop a bereavement risk assessment model, based on a three-tiered public health model, congruent with palliative care bereavement standards for use in palliative care in Western Australia. The specific aim of this phase of the study was to explore the perspectives of key stakeholders and to highlight issues in relation to the practice of bereavement risk assessment in palliative care. Action research, a cyclical process that involves working collaboratively with stakeholders, was considered as the best method to effect feasible change in practice. The nine participants were multidisciplinary health professionals from five palliative care services, and a bereaved former caregiver. Data were obtained from participants via three 90 min group meetings conducted over five weeks. An inductive thematic analysis approach was used to analyse data following each meeting until saturation was reached, and the research team was satisfied that the themes were congruent with research aims. Existing measures were found unsuitable to assess bereavement risk in palliative care. Assessment following the patient's death presented substantial barriers, directing assessment to the pre-death period. Four themes were identified relating to issues in need of consideration to develop a risk assessment model. These were systems of care, encompassing logistics of contact with caregivers; gatekeeping; conflation between caregiver stress, burden and grief; and a way forward. These group discussions provide a data-driven explanation of the issues affecting bereavement risk assessment in palliative care settings. A number of barriers will need to be overcome before assessment can become routine practice. We recommend the development of a brief, pre-death caregiver self-report measure of bereavement risk that may empower caregivers, lead to early intervention, and allow staff to remain focused on patient care, reducing burden on staff and palliative care services.

The provision of family-centred intensive care bereavement support in Australia and New Zealand: Results of a cross sectional explorative descriptive survey.

PubMed

Mitchell, Marion; Coombs, Maureen; Wetzig, Krista

2017-05-01

Caring for the bereaved is an intrinsic part of intensive care practice with family bereavement support an important aspect of the nursing role at end of life. However, reporting on provision of intensive care family bereavement support at a national level has not been well reported since an Australian paper published ten years ago. The objective was to investigate provision of family bereavement support in intensive care units (ICU) across New Zealand (NZ) and Australia. A cross-sectional exploratory descriptive web-based survey was used. All ICUs [public/private, neonatal/pediatrics/adults] were included. The survey was distributed to one nursing leader from each identified ICU (n=229; 188 in Australia, 41 in NZ). Internal validity of the survey was established through piloting. Descriptive statistics were used to analyse the data. Ethical approval was received by the ethics committees of two universities. One-hundred and fifty-three (67%) responses were received from across New Zealand and Australia with 69.3% of respondents from the public sector. Whilst respondents reported common bereavement practices to include debriefing for staff after a traumatic death (87.9%), there was greater variation in sending a sympathy card to families (NZ 54.2%, Australia 20.8%). Fifty percent of responding New Zealand units had a bereavement follow-up service compared to 28.3% of Australian unit respondents. Of those with follow-up services, 92.3% of New Zealand units undertook follow-up calls to families compared to 76.5% of Australian units. Bereavement follow-up services were mainly managed by social workers in Australia and nursing staff in New Zealand. This is the first Australia and New Zealand-wide survey on ICU bereavement support services. Whilst key components of family bereavement support remain consistent over the past decade, there were fewer bereavement follow-up services in responding Australian ICUs in 2015. As a quality improvement initiative, support for this area of family care remains important with rigorous evaluation essential. Copyright © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Grief, Bereavement, and Coping With Loss (PDQ®)—Health Professional Version

Cancer.gov

Grief, bereavement, and coping with loss are common issues in cancer survivors, their loved ones, and caregivers. Get detailed information about grief and bereavement in adults and children and psychosocial and pharmacologic treatment in this clinician summary.

Service failures and challenges in responding to people bereaved through drugs and alcohol: An interprofessional analysis.

PubMed

Valentine, Christine; McKell, Jennifer; Ford, Allison

2018-05-01

This article reports findings from the first two stages of a three-stage qualitative study which considered the role of services, including public, private and charitable organisations, in responding to the needs of adults bereaved following the drug and/or alcohol-related death of someone close. The study, the first of its kind to explore the landscape and role of services in substance use deaths, was conducted over two sites: south west England and Scotland. In stage 1 of the research, adopting both convenience and purposive sampling, data were collected via semi-structured interviews on experiences and support needs of bereaved individuals (n = 106). In stage 2, six focus groups were conducted with a purposive sample of practitioners (n = 40), including those working for the police, coroner's service, procurator fiscal depute (Scotland), health service, funeral service, press, clergy, Public Health England, Drugs Policy Unit, bereavement counselling/support and alcohol and drug treatment services, to investigate how services may better respond to this bereavement. Thematic analysis from both data-sets identified two overarching themes. The first, focusing on practitioner responses, captures how these bereaved people may meet with inadequate, unkind, and discriminatory responses from services. Having to navigate unfamiliar, fragmented, and time-consuming procedures compounds the bereaved's distress at an already difficult time, illustrated by a 'mapping' of relevant services. The second relates to challenges and opportunities for those responding. Service failures reflect practitioners' poor understanding of both substance use bereavement and the range of other practitioners and services involved. Those bereaved are a poorly understood, neglected and stigmatised group of service users. There is a need for services to respond without judgement or insensitive language, and provide information about, communicate and work closely with, other services despite differences in working practices and cultures. These recommendations could positively affect bereaved peoples' experiences, alleviating stress and overwhelm at a particularly vulnerable time.

Effects of a bereavement intervention program on depression and life satisfaction in middle aged widows in Korea.

PubMed

Yoo, Yang Sook; Kang, Hee Young

2006-12-01

This study was designed to examine the effects of a bereavement intervention program on levels of depression and life satisfaction in middle aged widows in Korea. A quasi-experimental design with non-equivalent control-group pretest-posttest was used. The subjects (control group, n = 10; intervention group, n = 17) were bereaved less than 6 months in G City and J Province, Korea. The bereavement intervention program consisted of Dan-jeon breathing, self-help group activities and a health examination. The experimental group attended 10 sessions of a bereavement intervention program. The control group had a health examination without the intervention program. For both groups, the level of depression and life satisfaction levels were measured before and after the experiment. The decrement of depression level in the experimental group was significantly greater than in the control group (p<.001). The increment in life satisfaction in the experimental group was significantly greater than in the control group (p<.001). The results suggested that the bereavement intervention program was effective in decreasing level of depression and in increasing the life satisfaction of widows. Accordingly, a bereavement intervention program can be applied as an intervention to help widows.

The Impact of Suicide Bereavement on Educational and Occupational Functioning: A Qualitative Study of 460 Bereaved Adults.

PubMed

Pitman, Alexandra; Khrisna Putri, Adelia; De Souza, Tanisha; Stevenson, Fiona; King, Michael; Osborn, David; Morant, Nicola

2018-03-31

People bereaved by suicide are at an increased risk of suicide and of dropping out of education or work. Explanations for these associations are unclear, and more research is needed to understand how improving support in educational or work settings for people bereaved by suicide might contribute to reducing suicide risk. Our objective was to explore the impact of suicide on occupational functioning. We conducted a cross-sectional online study of bereaved adults aged 18-40, recruited from staff and students of British higher educational institutions in 2010. We used thematic analysis to analyse free text responses to two questions probing the impact of suicide bereavement on work and education. Our analysis of responses from 460 adults bereaved by suicide identified three main themes: (i) specific aspects of grief that impacted on work performance, cognitive and emotional domains, and social confidence; (ii) structural challenges in work or educational settings including a lack of institutional support, the impact of taking time off, and changes to caring roles; and (iii) new perspectives on the role of work, including determination to achieve. Institutional support should be tailored to take account of the difficulties and experiences described.

The Impact of Suicide Bereavement on Educational and Occupational Functioning: A Qualitative Study of 460 Bereaved Adults

PubMed Central

Khrisna Putri, Adelia; De Souza, Tanisha; Stevenson, Fiona; King, Michael; Osborn, David; Morant, Nicola

2018-01-01

People bereaved by suicide are at an increased risk of suicide and of dropping out of education or work. Explanations for these associations are unclear, and more research is needed to understand how improving support in educational or work settings for people bereaved by suicide might contribute to reducing suicide risk. Our objective was to explore the impact of suicide on occupational functioning. We conducted a cross-sectional online study of bereaved adults aged 18–40, recruited from staff and students of British higher educational institutions in 2010. We used thematic analysis to analyse free text responses to two questions probing the impact of suicide bereavement on work and education. Our analysis of responses from 460 adults bereaved by suicide identified three main themes: (i) specific aspects of grief that impacted on work performance, cognitive and emotional domains, and social confidence; (ii) structural challenges in work or educational settings including a lack of institutional support, the impact of taking time off, and changes to caring roles; and (iii) new perspectives on the role of work, including determination to achieve. Institutional support should be tailored to take account of the difficulties and experiences described. PMID:29614731

Understanding bereavement, grief, and mourning: implications for donation and transplant professionals.

PubMed

Corr, Charles A; Coolican, Margaret B

2010-06-01

This article surveys recent literature on bereavement, grief, and mourning. It offers a review of the state of the art of current understandings of those topics to assist professionals who work in the field of organ and tissue donation and transplantation. The article's goal is to provide well-developed and up-to-date education and knowledge about bereavement, grief, and mourning to supplement the natural skills and experience of donation and transplant professionals in their work with bereaved persons.

An exploratory qualitative analysis of student midwives views of teaching methods that could build their confidence to deliver perinatal bereavement care.

PubMed

Martin, Caroline J Hollins; Robb, Yvonne; Forrest, Eleanor

2016-04-01

Equipping student midwives with confidence to deliver bereavement care to childbearing women is a challenge for midwifery lecturers. To explore qualitative data provided by student midwives who evaluated the workbook Bereavement care for childbearing women and their families (Hollins Martin & Forrest, 2013) to explore their views of potential teaching strategies that could build their confidence to deliver real bereavement care. An exploratory qualitative thematic analysis was used to provide, analyse and report themes identified within data collected in a prior study. Participants were student midwives (n=179) in their second/third year of a midwifery degree program at 1 of 3 universities in the UK were included in the study. Data to evaluate effectiveness of the bereavement workbook as a teaching method was collected using a survey instrument. It was the comments written under questions by participants that were analysed in the present study. Three themes emerged: (1) increasing classroom interaction, (2) the importance of reflecting on emotions, and (3) need for experience. Although this study has addressed delivery of education that relates to midwives, the findings are cross transferable to other healthcare educators, practitioners, and students. Several solutions are proposed that could potentially build student confidence to deliver bereavement care: lecturers should (1) encourage group discussion in the classroom to help build student confidence to emotionally cope during real bereavement events; (2) ensure students gain exposure by encouraging qualified midwives to include them in real bereavement events early on in their training, and (3) develop packages of perinatal bereavement scenarios for simulation and rehearsal in the clinical skills laboratory. Post-implementation, it is recommended that these teaching strategies be evaluated. Copyright © 2016 Elsevier Ltd. All rights reserved.

War and Bereavement: Consequences for Mental and Physical Distress

PubMed Central

Morina, Nexhmedin; von Lersner, Ulrike; Prigerson, Holly G.

2011-01-01

Background Little is known about the long-term impact of the killing of a parent in childhood or adolescence during war on distress and disability in young adulthood. This study assessed current prevalence rates of mental disorders and levels of dysfunction among young adults who had lost their father due to war-related violence in childhood or adolescence. Methods 179 bereaved young adults and 175 non-bereaved young adults were interviewed a decade after experiencing the war in Kosovo. Prevalence rates of Major Depressive Episode (MDE), anxiety, and substance use disorders, and current suicide risk were assessed using the Mini–International Neuropsychiatric Interview. The syndrome of Prolonged Grief Disorder (PGD) was assessed with the Prolonged Grief Disorder Interview (PG-13). Somatic symptoms were measured with the Patient Health Questionnaire. General health distress was assessed with the General Health Questionnaire. Findings Bereaved participants were significantly more likely to suffer from either MDE or any anxiety disorder than non-bereaved participants (58.7% vs. 40%). Among bereaved participants, 39.7% met criteria for Post-Traumatic Stress Disorder, 34.6% for PGD, and 22.3% for MDE. Bereaved participants with PGD were more likely to suffer from MDE, any anxiety disorder, or current suicide risk than bereaved participants without PGD. Furthermore, these participants reported significantly greater physical distress than bereaved participants without PGD. Conclusion War-related loss during middle childhood and adolescence presents significant risk for adverse mental health and dysfunction in young adulthood in addition to exposure to other war-related traumatic events. Furthermore, the syndrome of PGD can help to identify those with the greatest degree of distress and dysfunction. PMID:21765944

Role of family caregivers' self-perceived preparedness for the death of the cancer patient in long-term adjustment to bereavement.

PubMed

Kim, Youngmee; Carver, Charles S; Spiegel, David; Mitchell, Hannah-Rose; Cannady, Rachel S

2017-04-01

A substantial number of family caregivers go through bereavement because of cancer, but little is known about the bereaved caregivers' long-term adjustment. This study aimed to document levels of bereavement outcomes (prolonged grief symptoms, intense emotional reaction to the loss, depressive symptoms, and life satisfaction) among family cancer caregivers 3-5 years post-loss and to investigate how self-rated preparedness for the patient's death predicted those bereavement outcomes. Family members participated in a nationwide survey for cancer caregivers 2 years after the relative's diagnosis (T1). Of those, 109 were identified as bereaved by 5 years post-diagnosis (T2). Of those, 88 continued to participate at 8-year follow-up (T3) and provided valid data for the study variables. Caregivers' distress risk factors were measured at T1, satisfaction with palliative care and preparedness for the death of the patient at T2, and time since death of the patient at T2 or T3. Substantial numbers of family members (18% to 48%) displayed heightened levels of bereavement-related psychological distress years after the loss. Hierarchical general linear modeling revealed that perceived preparedness for the death of the patient concurrently and prospectively predicted better adjustment to bereavement, independent of contributions of other factors studied. Findings underscore the high prevalence of long-lasting bereavement-related distress among family cancer caregivers and the role of preparedness for the relative's death in the level of that distress. Findings suggest that psychosocial programs among caregivers focus on not only caregiving skills per se but also preparedness for the death of the patient. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

The potential therapeutic value for bereaved relatives participating in research: An exploratory study.

PubMed

Germain, Alison; Mayland, Catriona R; Jack, Barbara A

2016-10-01

Conducting research with the bereaved presents an immediate ethical challenge, as they are undoubtedly a vulnerable group, associated with high levels of distress and susceptible to both physical and mental health issues. A comprehensive understanding of the potential therapeutic benefits for bereaved relatives participating in palliative care research is limited, and therefore the ethics of engaging this group remain questionable. This paper describes a secondary analysis of qualitative data collected in the Care of the Dying Evaluation (CODE) project, examining the experiences of patients who died at home. It explores the motivations and potential benefits for bereaved relatives participating in research with reference to the recently developed concepts in bereavement theory. Cognitive interviews were conducted with 15 bereaved relatives and secondary analysis using a content analysis framework was employed to classify the data. The results center around six recurring concepts identified as adaptive in current bereavement theory: an opportunity to share the narrative accounts of the final hours of their relative's life; a search for sense and meaning in loss; an ongoing bond/attachment with the deceased; altruistic motivations; oscillation between loss and restorative orientations; and a sense of resilience. Overall, the participants found that taking part in the research was valuable and that it could be described as offering therapeutic benefits. The need for bereaved relatives to take part in research studies should be encouraged, as they provide an accurate proxy for the patient's experience of end-of-life care while also providing a valuable account of their own perspective as family member and carer. In addition, we highlight the need for ethics committees to be aware of the potential benefits for bereaved relatives participating in research of this kind.

Young people living with parental bereavement: Insights from an ethnographic study of a UK childhood bereavement service.

PubMed

Brewer, Joanne D; Sparkes, Andrew C

2011-01-01

The purpose of this two-year ethnographic study was to explore the experiences of parentally bereaved young people who sought support from the Rocky Centre (a pseudonym), a childhood bereavement service in the United Kingdom. Data were generated from extended periods of participant observation and semi-structured interviews with both staff and service users. In this article we focus specifically on the interviews with 13 young people to elucidate the factors that helped them to live with parental bereavement. Of these participants, four had been recently bereaved and nine had experienced the death of a parent over ten years ago. Seven key themes emerged from the analysis of the interview data: expressing emotion, physical activity, positive adult relationship(s), area of competence, friendships/social support, having fun/humour and transcendence. These themes are discussed in turn, and implications for research and practice are addressed. Copyright © 2010 Elsevier Ltd. All rights reserved.

Sudden-On-Chronic Death and Complicated Grief in Bereaved Dementia Caregivers: Two Case Studies of Complicated Grief Group Therapy.

PubMed

Supiano, Katherine P; Andersen, Troy C; Haynes, Lara Burns

2015-01-01

Caring for a person with Alzheimer's disease is challenging and often has negative health and mental health effects that, for 7-20% of caregivers, persist into bereavement in the form of complicated grief. Complicated grief is a state of prolonged and ineffective mourning. An under-recognized phenomenon in dementia care and bereavement is "sudden-on-chronic death." In these situations, the caregiver is preparing for a gradual dying process from dementia, but the care recipient dies instead from a sudden death. In this study, an application of complicated grief group therapy for bereaved dementia caregivers with complicated grief is presented, and the effect of therapy with two bereaved caregivers who experienced the sudden death of their spouses who had a diagnosis of dementia is described. The unique treatment elements of complicated grief group therapy facilitated resolution of the 'trauma-like" features of bereavement and progression to a healthy grief process.

Risk and Resilience Factors Related to Parental Bereavement Following the Death of a Child with a Life-Limiting Condition

PubMed Central

Jaaniste, Tiina; Coombs, Sandra; Donnelly, Theresa J.; Kelk, Norm; Beston, Danielle

2017-01-01

This paper reviews the theoretical and empirical literature on risk and resilience factors impacting on parental bereavement outcomes following the death of a child with a life-limiting condition. Over the past few decades, bereavement research has focussed primarily on a risk-based approach. In light of advances in the literature on resilience, the authors propose a Risk and Resilience Model of Parental Bereavement, thus endeavouring to give more holistic consideration to a range of potential influences on parental bereavement outcomes. The literature will be reviewed with regard to the role of: (i) loss-oriented stressors (e.g., circumstances surrounding the death and multiple losses); (ii) inter-personal factors (e.g., marital factors, social support, and religious practices); (iii) intra-personal factors (e.g., neuroticism, trait optimism, psychological flexibility, attachment style, and gender); and (iv) coping and appraisal, on parental bereavement outcomes. Challenges facing this area of research are discussed, and research and clinical implications considered. PMID:29120367

Do Oncologists Engage in Bereavement Practices? A Survey of the Israeli Society of Clinical Oncology and Radiation Therapy (ISCORT)

PubMed Central

Shabtai, Esther; Merimsky, Ofer; Inbar, Moshe; Rosenbaum, Eli; Meirovitz, Amichay; Wexler, Isaiah D.

2010-01-01

Purpose. We sought to determine the level of involvement of oncologists in bereavement rituals after a patient dies. Subjects and Methods. Members of the Israeli Society for Clinical Oncology and Radiation Therapy (ISCORT) were surveyed. The survey instrument consisted of questions regarding participation in bereavement rituals for patients in general and those with whom the oncologist had a special bond. Oncologists were queried as to the reasons for nonparticipation in bereavement rituals. Results. Nearly 70% of the ISCORT membership (126 of 182) completed the survey tool. Respondents included radiation, surgical, and medical oncologists. In general, oncologists rarely participated in bereavement rituals that involved direct contact with families such as funerals and visitations. Twenty-eight percent of physicians at least occasionally participated in rituals involving direct contact whereas 45% had indirect contact (e.g., letter of condolence) with the family on an occasional basis. There was significantly greater involvement in bereavement rituals when oncologists developed a special bond with the patient. In a stepwise linear regression model, the only factor significantly associated with greater participation in bereavement rituals was self-perceived spirituality in those claiming not to be religious. The major reasons offered for nonparticipation were time constraints, need to maintain appropriate boundaries between physicians and patients, and fear of burnout. Conclusion. Although many oncologists participate at least occasionally in some sort of bereavement ritual, a significant proportion of oncologists are not involved in these practices at all. PMID:20228130

Psychological health in siblings who lost a brother or sister to cancer 2 to 9 years earlier.

PubMed

Eilegård, Alexandra; Steineck, Gunnar; Nyberg, Tommy; Kreicbergs, Ulrika

2013-03-01

The objective of this study was to assess long-term psychological distress in siblings who lost a brother or sister to cancer 2 to 9 years earlier, as compared with a control group of non-bereaved siblings from the general population. During 2009, we conducted a nationwide follow-up study in Sweden by using an anonymous study-specific questionnaire. Siblings who had lost a brother or sister to cancer between the years 2000 and 2007 and also a control group of non-bereaved siblings from the general population were invited to participate. The Hospital Anxiety and Depression Scale (HADS) was used to measure psychological distress, and to test for differences in the ordinal outcome responses between the groups, we used Wilcoxon-Mann-Whitney rank-sum test. Among the bereaved siblings, 174/240 (73%) participated and 219/293 (75%) among the non-bereaved. Self-assessed low self-esteem (p = 0.002), difficulties falling asleep (p = 0.005), and low level of personal maturity (p = 0.007) at follow-up were more prevalent among bereaved siblings. However, anxiety (p = 0.298) and depression (p = 0.946), according to HADS, were similar. Bereaved siblings are at increased risk of low self-esteem, low level of personal maturity and difficulties falling asleep as compared with non-bereaved peers. Yet, the bereaved were not more likely to report anxiety or depression. Copyright © 2012 John Wiley & Sons, Ltd.

Internet Forums for Suicide Bereavement.

PubMed

Bailey, Eleanor; Krysinska, Karolina; O'Dea, Bridianne; Robinson, Jo

2017-11-01

Bereavement by suicide is associated with a number of consequences including poor mental health outcomes and increased suicide risk. Despite this, the bereaved by suicide may be reluctant to seek help from friends, family, and professionals. Internet forums and social networking sites are a popular avenue of support for the bereaved, but to date there is a lack of research into their use and efficacy. To survey users of suicide bereavement Internet forums and Facebook groups regarding their help-seeking behaviors, use of forums, and perceived benefits and limitations of such use. This study employed a cross-sectional design in which users of suicide bereavement Internet forums and Facebook groups completed an anonymous online survey. Participants were 222 users of suicide bereavement Internet forums. Most participants (93.2%) had sought face-to-face help from sources other than Internet forums, but were more likely to seek help in the near future from informal rather than formal sources. Forums were perceived as highly beneficial and there were few limitations. The generalizability of these results to other internet forums may be limited. Additionally, we were not able to examine differences between forums in terms of quality or user-reported efficacy. Finally, the data reflects the subjective views of forum users, which may differ from the views of moderators or experts. Internet forums, including Facebook groups, appear to be a useful adjunct to face-to-face help-seeking for supporting those who have been bereaved by suicide.

Divergent Gene Expression Responses to Complicated Grief and Non-complicated Grief

PubMed Central

Irwin, Michael R.; Arevalo, Jesusa M. G.; Cole, Steven W.

2014-01-01

The “widowhood effect” (i.e., morbidity/mortality in recently bereaved spouses) may be related to changes in immune function, but little is known about the impact of bereavement on gene transcription in immune cells. This study examined how Complicated Grief and Non-complicated Grief responses to bereavement differentially affect leukocyte gene expression. Genome-wide transcriptional profiling and bioinformatic analyses were completed on 63 older adults. Thirty-six of them had lost their spouse/partner on average 2 years ago, and 27 were nonbereaved, married controls. Twelve of the bereaved participants met criteria for Complicated Grief. Compared to nonbereaved controls, bereavement (both Complicated Grief and Non-complicated Grief) was associated with upregulated expression of genes involved in general immunologic activation and a selective downregulation of genes involved in B lymphocyte responses. However, Complicated Grief and Non-complicated Grief differed markedly in their expression of Type I interferon-related transcripts, with Non-complicated Grief subjects showing substantial upregulation relative to nonbereaved controls and Complicated Grief subjects showing substantial downregulation. Bereavement significantly modulates immune function gene expression. The magnitude of bereavement-related distress (i.e., Complicated Grief vs. Non-complicated Grief) is linked to differential patterns of transcription factor activation and gene expression involved in innate antiviral responses. These findings provide a molecular framework for understanding the health effects of bereavement, as well as new insights into the particular gene modules that are most sensitive to the individual's psychological response to loss. PMID:24380850

Siblings after Suicide--"The Forgotten Bereaved"

ERIC Educational Resources Information Center

Dyregrov, Kari; Dyregrov, Atle

2005-01-01

There is scarce research on "the forgotten bereaved"--the children and adolescents who lose a sibling by suicide. In this paper we explore their psychosocial situation and needs for assistance through a Norwegian nationwide study. The results show that particularly younger bereaved siblings are suffering from posttraumatic and grief…

Association Between Spousal Suicide and Mental, Physical, and Social Health Outcomes: A Longitudinal and Nationwide Register-Based Study.

PubMed

Erlangsen, Annette; Runeson, Bo; Bolton, James M; Wilcox, Holly C; Forman, Julie L; Krogh, Jesper; Shear, M Katherine; Nordentoft, Merete; Conwell, Yeates

2017-05-01

Bereavement after spousal suicide has been linked to mental disorders; however, a comprehensive assessment of the effect of spousal suicide is needed. To determine whether bereavement after spousal suicide was linked to an excessive risk of mental, physical, and social health outcomes when compared with the general population and spouses bereaved by other manners. This nationwide, register-based cohort study conducted in Denmark of 6.7 million individuals aged 18 years and older from 1980 to 2014 covered more than 136 million person-years and compared people bereaved by spousal suicide with the general population and people bereaved by other manners of death. Incidence rate ratios were calculated using Poisson regressions while adjusting for sociodemographic characteristics and the presence of mental and physical disorders. Mental disorders (any disorder, mood, posttraumatic stress disorder, anxiety, alcohol use disorders, drug use disorders, and self-harm); physical disorders (cancers, diabetes, sleep disorder, cardiovascular diseases, chronic lower respiratory tract diseases, liver cirrhosis, and spinal disc herniation); causes of mortality (all-cause, natural, unintentional, suicide, and homicide); social health outcomes; and health care use. The total study population included 3 491 939 men, 4814 of whom were bereaved by spousal suicide, and 3 514 959 women, 10 793 of whom were bereaved by spousal suicide. Spouses bereaved by a partner's suicide had higher risks of developing mental disorders within 5 years of the loss (men: incidence rate ratio, 1.8; 95% CI, 1.6-2.0; women: incidence rate ratio, 1.7; 95% CI, 1.6-1.8) than the general population. Elevated risks for developing physical disorders, such as cirrhosis and sleep disorders, were also noted as well as the use of more municipal support, sick leave benefits, and disability pension funds than the general population. Compared with spouses bereaved by other manners of death, those bereaved by suicide had higher risks for developing mental disorders (men: incidence rate ratio, 1.7; 95% CI, 1.5-1.9; women: incidence rate ratio, 2.0; 95% CI, 1.9-2.2), suicidal behaviors, mortality, and municipal support. Additionally, a higher level of mental health care use was noted. Exposure to suicide is stressful and affects the bereaved spouse on a broad range of outcomes. The excess risks of mental, physical, and social health outcomes highlight a need for more support directed toward spouses bereaved by suicide.

Association Between Spousal Suicide and Mental, Physical, and Social Health Outcomes

PubMed Central

Runeson, Bo; Bolton, James M.; Wilcox, Holly C.; Forman, Julie L; Krogh, Jesper; Shear, M. Katherine; Nordentoft, Merete; Conwell, Yeates

2017-01-01

Importance Bereavement after spousal suicide has been linked to mental disorders; however, a comprehensive assessment of the effect of spousal suicide is needed. Objective To determine whether bereavement after spousal suicide was linked to an excessive risk of mental, physical, and social health outcomes when compared with the general population and spouses bereaved by other manners. Design, Setting, and Participants This nationwide, register-based cohort study conducted in Denmark of 6.7 million individuals aged 18 years and older from 1980 to 2014 covered more than 136 million person-years and compared people bereaved by spousal suicide with the general population and people bereaved by other manners of death. Incidence rate ratios were calculated using Poisson regressions while adjusting for sociodemographic characteristics and the presence of mental and physical disorders. Main Outcomes and Measures Mental disorders (any disorder, mood, posttraumatic stress disorder, anxiety, alcohol use disorders, drug use disorders, and self-harm); physical disorders (cancers, diabetes, sleep disorder, cardiovascular diseases, chronic lower respiratory tract diseases, liver cirrhosis, and spinal disc herniation); causes of mortality (all-cause, natural, unintentional, suicide, and homicide); social health outcomes; and health care use. Results The total study population included 3 491 939 men, 4814 of whom were bereaved by spousal suicide, and 3 514 959 women, 10 793 of whom were bereaved by spousal suicide. Spouses bereaved by a partner’s suicide had higher risks of developing mental disorders within 5 years of the loss (men: incidence rate ratio, 1.8; 95% CI, 1.6-2.0; women: incidence rate ratio, 1.7; 95% CI, 1.6-1.8) than the general population. Elevated risks for developing physical disorders, such as cirrhosis and sleep disorders, were also noted as well as the use of more municipal support, sick leave benefits, and disability pension funds than the general population. Compared with spouses bereaved by other manners of death, those bereaved by suicide had higher risks for developing mental disorders (men: incidence rate ratio, 1.7; 95% CI, 1.5-1.9; women: incidence rate ratio, 2.0; 95% CI, 1.9-2.2), suicidal behaviors, mortality, and municipal support. Additionally, a higher level of mental health care use was noted. Conclusions and Relevance Exposure to suicide is stressful and affects the bereaved spouse on a broad range of outcomes. The excess risks of mental, physical, and social health outcomes highlight a need for more support directed toward spouses bereaved by suicide. PMID:28329305

Bereavement and College Students: The Role of Counseling Psychology

ERIC Educational Resources Information Center

Servaty-Seib, Heather L.; Taub, Deborah J.

2010-01-01

In this review article, the authors integrate the theoretical, empirical, and clinical literature relevant to the phenomenon of college student bereavement. They synthesize information on two theories of mourning that appear to fit well with the experience of bereaved college students with information about the developmental, cohort, and…

Early Parental Adjustment and Bereavement after Childhood Cancer Death

ERIC Educational Resources Information Center

Barrera, Maru; O'connor, Kathleen; D'Agostino, Norma Mammone; Spencer, Lynlee; Nicholas, David; Jovcevska, Vesna; Tallet, Susan; Schneiderman, Gerald

2009-01-01

This study comprehensively explored parental bereavement and adjustment at 6 months post-loss due to childhood cancer. Interviews were conducted with 18 mothers and 13 fathers. Interviews were transcribed verbatim and analyzed based on qualitative methodology. A model describing early parental bereavement and adaptation emerged with 3 domains:…

A Bereavement Support Program for Survivors of Cancer Deaths: A Description and Evaluation.

ERIC Educational Resources Information Center

Souter, Susan J.; Moore, Timothy E.

1990-01-01

Describes bereavement support program for survivors of cancer deaths developed by Riverdale Hospital in Toronto, Ontario. Presents detailed program evaluation which asked bereaved survivors who were program participants for one year to evaluate program aspects and facilitation of their grief by volunteers. Recommendations for expansion and…

The Bereaved Caregiver: A Prospective Study of Changes in Well-Being.

ERIC Educational Resources Information Center

Mullan, Joseph T.

1992-01-01

Analyzed bereavement adaptation among family caregivers to dementia patients. Bereavement group, as compared with active caregivers, dropped substantially in overload and increased in mastery and guilt. Depression showed curvilinear trend, declining from time of death, rising to preloss levels by end of year. Caregiver stressors, baseline…

Similarities and Differences in Spouses Coping with SIDS.

ERIC Educational Resources Information Center

Carroll, Ruth; Shaefer, Sarah

1994-01-01

Examined differences within 34 pairs of parents bereaved by Sudden Infant Death Syndrome (SIDS), 3-40 months after their loss. Findings revealed that bereaved parents sought support from within family most frequently and from outside resources the least. Bereaved mothers used these coping patterns significantly more often than did fathers. Found…

Happy to Talk...To a Point: Bereaved Young Men and Emotional Disclosure

ERIC Educational Resources Information Center

McNess, Andrew

2008-01-01

This study focuses upon the social experiences of bereaved young men, with particular emphasis on the social costs of bereavement-related personal disclosure. Their experiences of regulating their social behaviour were suggestive of the persistence of "traditional" notions of masculine identity (e.g. hegemonic masculinity). While this…

A Psychometric Evaluation of the Core Bereavement Items

ERIC Educational Resources Information Center

Holland, Jason M.; Nam, Ilsung; Neimeyer, Robert A.

2013-01-01

Despite being a routinely administered assessment of grieving, few studies have empirically examined the psychometric properties of the Core Bereavement Items (CBI). The present study investigated the factor structure, internal reliability, and concurrent validity of the CBI in a large, diverse sample of bereaved young adults (N = 1,366).…

Bereavement Rituals in the Muscogee Creek Tribe

ERIC Educational Resources Information Center

Walker, Andrea C.; Balk, David E.

2007-01-01

A qualitative, collective case study explores bereavement rituals in the Muscogee Creek tribe. Data from interviews with 27 participants, all adult members of the tribe, revealed consensus on participation in certain bereavement rituals. Common rituals included (a) conducting a wake service the night before burial; (b) never leaving the body alone…

77 FR 12109 - Proposed Information Collection (Bereaved Family Member Satisfaction Survey) Activity: Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-28

... (Bereaved Family Member Satisfaction Survey) Activity: Comment Request AGENCY: Veterans Health... techniques or the use of other forms of information technology. Title: Bereaved Family Member Satisfaction... members of deceased veterans on their satisfaction with the quality care provided to their loved one prior...

Bereavement experiences of mothers and fathers over time after the death of a child due to cancer.

PubMed

Alam, Rifat; Barrera, Maru; D'Agostino, Norma; Nicholas, David B; Schneiderman, Gerald

2012-01-01

The authors investigated longitudinally bereavement in mothers and fathers whose children died of cancer. Thirty-one parents were interviewed 6 and 18 months post-death. Analyses revealed parental differences and changes over time: (a) employment--fathers were more work-focused; (b) grief reactions--mothers expressed more intense grief reactions that lessened over time; (c) coping--mothers were more child-focused, fathers more task-focused; (d) relationship with bereaved siblings-mothers actively nurtured relationship with child; (e) spousal relationship--parents reported diversity in their relationship over time; and (f) relationship with extended family--mothers maintained contact with extended family more. Findings illustrate parental differences in bereavement over time that might be partly socially determined. These findings emphasize the need for tailoring bereavement support services in the family.

Parental Bereavement during Mid-to-Later Life: Pre-to-Post-Bereavement Functioning and Intrapersonal Resources for Coping

PubMed Central

Floyd, Frank J.; Seltzer, Marsha Mailick; Greenberg, Jan S.; Song, Jieun

2012-01-01

The death of a child when parents are in mid-to-late life is a traumatic event for aging parents. In order to evaluate adjustment, the impact of unanticipated versus anticipated deaths, and the effects of internal resources for coping with bereavement, we examined pre- and post-bereavement functioning, using the 1992/94 and 2004/06 waves of the Wisconsin Longitudinal Study, for parents (M age = 52 and 65 years, respectively) whose adult child died between these dates (n = 175). The results revealed a general pattern of adaptation in which most bereaved parents were functioning as well as a matched comparison group (n = 175), though more depression symptoms were present both before and after the death of the child for the mothers of children who died from long-term illnesses and the fathers of children who committed suicide, suggesting that conditions predating the death were chronic strains for these parents. Intrapersonal resources, including a sense of purpose in life and high levels of agreeableness, were associated with better functioning, particularly for bereaved parents whose children’s deaths were not anticipated. The study places parental bereavement in the context of normative aging and the framework of chronic life strain. PMID:23088199

Death, bereavement and randomised controlled trials (BRACELET): a methodological study of policy and practice in neonatal and paediatric intensive care trials.

PubMed

Snowdon, Claire; Brocklehurst, Peter; Tasker, Robert; Ward Platt, Martin; Harvey, Sheila; Elbourne, Diana

2014-07-01

Researchers have seldom included bereaved parents in studies of participants' views of randomised controlled trials (RCTs); hence our understanding of the impact of trials is based on skewed and incomplete samples. Little is known about parental experiences of the death of a child subsequent to their enrolment in a trial or of provision made for this experience by clinicians and trial teams. The Bereavement and RAndomised ControlLEd Trials (BRACELET) study was funded to consider bereavement in the context of paediatric intensive care (PIC) and neonatal intensive care (NIC) trials. The study comprised three interlinked components: a quantitative survey of RCT activity in UK paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs), UK RCT recruitment and mortality rates, and provision for bereavement during 2002-6; a qualitative interview study involving 51 bereaved parents and 59 clinicians and trial team members associated with five neonatal trials; and a methodological study to inform future research. Fifty RCTs were identified as having enrolled babies or children from 2002 to 2006. Approximately 50% of UK NICUs and PICUs (54 NICUs, six PICUs) participated in at least one of these trials. Collectively they enrolled over 3000 children. Most enrolled small numbers, the majority of participants being enrolled by a small group of academic medical units. The proportion of deaths following trial enrolment was 17% in NIC trials and 6% in PIC trials. The qualitative study showed that trial-related decisions were made in a range of circumstances, some after extremely preterm births, others after complicated term deliveries, often under time pressures and in escalating crises. Parents' interest in trials appeared to recede initially but could re-emerge over time. They often valued opportunities to engage with a trial and were interested in more contact and information than they actually received. Clinicians often saw NICU bereavement policies as meeting parental needs, and trial participation as being of relatively minor significance in bereavement. This view may result from the positioning of clinicians' encounters with parents only in the initial stages of grief when trials were not a priority. Trial teams used a range of bereavement strategies, from no further contact to a pioneering multipart follow-up package. Communication with bereaved parents was complicated by limited contact opportunities. Trial teams were obliged to work without knowing whether their communications were appreciated, were problematic, or even whether they were received by parents. The methodological component highlighted strategies for recruitment and data collection in this sensitive setting. Recruitment by unsupported postal contact generally failed and a more personal approach via clinicians was more effective, supplemented by publicity material distributed via trusted organisations. A co-ordinated response to bereavement is as much a part of the running of trials as recruitment, and needs to be considered at trial inception. BRACELET has demonstrated the value and feasibility of research with bereaved parents involved in NIC trials. In order to respond to bereavement in a fair and sensitive way, as well as to better inform the design of RCTs, it is crucial that we listen to bereaved parents and evaluate new methods for so doing. More research is therefore needed into the experiences of bereavement subsequent to trial enrolment, with study of bereavement strategies in NIC trials as they are introduced. In addition, future studies should determine whether parents and triallists in PIC trials (and trials in adults) face the same issues as in NIC trials. Careful studies are necessary to explore how feedback of trial results are received and understood by bereaved and non-bereaved parents, and how individual trial teams manage this situation. An additional research area for exploring experiences of parenting twins and higher-order births in trials arose from BRACELET. Developmental research should continue to explore means of involving a wider range of parents in future research, including via publicity and specialist websites. Finally, methodological research is needed to ensure that we have the tools to explore, with parents and other relatives, as partners in research, a range of trial-related topics, which might be challenging, as the information is complex or the focus is sensitive. Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research.

Grief, Depressive Symptoms, and Physical Health among Recently Bereaved Spouses

ERIC Educational Resources Information Center

Utz, Rebecca L.; Caserta, Michael; Lund, Dale

2012-01-01

Purpose: Widowhood is among the most distressing of all life events, resulting in both mental and physical health declines. This paper explores the dynamic relationship between physical health and psychological well-being among recently bereaved spouses. Design and Methods: Using a sample of 328 bereaved persons who participated in the "Living…

Longitudinal Effects of Parental Bereavement on Adolescent Developmental Competence

ERIC Educational Resources Information Center

Brent, David A.; Melhem, Nadine M.; Masten, Ann S.; Porta, Giovanna; Walker Payne, Monica

2012-01-01

The aim of this study is to assess the impact of sudden parental bereavement on subsequent attainment of developmental competencies. This longitudinal study reports on 126 youth bereaved by sudden parental death (suicide, accident, or natural death) and 116 demographically similar nonbereaved controls assessed at 9, 21, 33, and 62 months after…

Attitudes to Bereavement and Intellectual Disabilities in an Irish Context

ERIC Educational Resources Information Center

Dodd, Philip; McEvoy, John; Guerin, Suzanne; McGovern, Elizabeth; Smith, Elaine; Hillery, John

2005-01-01

Background: The influence of grief and bereavement on the lives of people with intellectual disabilities is currently receiving much interest. Many of the long-standing rituals associated with bereavement are still practised in Ireland, probably more than in many other Western countries. The present authors were interested in studying the…

Adapting the Transtheoretical Model of Change to the Bereavement Process

ERIC Educational Resources Information Center

Calderwood, Kimberly A.

2011-01-01

Theorists currently believe that bereaved people undergo some transformation of self rather than returning to their original state. To advance our understanding of this process, this article presents an adaptation of Prochaska and DiClemente's transtheoretical model of change as it could be applied to the journey that bereaved individuals…

Implications of Parental Suicide and Violent Death for Promotion of Resilience of Parentally-Bereaved Children

ERIC Educational Resources Information Center

Brown, Ana C.; Sandler, Irwin N.; Tein, Jenn-Yun; Liu, Xianchen; Haine, Rachel A.

2007-01-01

This article considers the implications of suicide and violent deaths (including suicide, homicide, and accidents) for the development of interventions for parentally bereaved children. Analyses of data from the Family Bereavement Program find minimal differences in children's mental health problems, grief or risk and protective factors based on…

The Essence of Peer Bereavement for American Youth of Color: A Phenomenological Exploration

ERIC Educational Resources Information Center

Wheat, Laura S.

2011-01-01

At any given point in time, significant numbers of teenagers are impacted by the death of someone their age. Peer bereavement in middle adolescence coincides with a period when adolescents are primarily concerned with peer relationships and struggling to construct a stable identity for themselves. Peer bereavement interferes with these…

Experiences of Bereaved Secondary Students in the High School Environment

ERIC Educational Resources Information Center

Myers-Autrey, Roberta Lee

2010-01-01

Bereaved high school adolescents are often affected in a myriad of ways by the death of a loved one. The traumatic experience and bereavement process add complexity to high school adolescents' development and this phenomenon is not fully understood, in particular in regards to communication and relationships in the school environment. The…

Effects of Sudden vs. Chronic Illness Death on Bereavement Outcome.

ERIC Educational Resources Information Center

Sanders, Catherine M.

1982-01-01

Interviewed bereaved persons shortly after the death of a close family member and 18 months later. Respondents were grouped according to mode of death. The short-term chronic illness group made the most favorable adjustment. Sudden death and long-term chronic illness death groups sustained higher intensities of bereavement. (Author/RC)

Positive Parenting as a Protective Resource for Parentally Bereaved Children

ERIC Educational Resources Information Center

Haine, Rachel A.; Wolchik, Sharlene A.; Sandler, Irwin N.; Millsap, Roger E.; Ayers, Tim S.

2006-01-01

Positive parenting was examined as a protective resource against the adverse effects of negative life events on parentally bereaved children's mental health problems. The sample consisted of 313 recently bereaved children ages 8 to 16 and their current caregiver. Both the compensatory (direct effect independent of negative life events) and the…

77 FR 27542 - Agency Information Collection Activities (Bereaved Family Member Satisfaction Survey) Under OMB...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-10

... Activities (Bereaved Family Member Satisfaction Survey) Under OMB Review AGENCY: Veterans Health...: Bereaved Family Member Satisfaction Survey, VA Form 10- 21081(NR). OMB Control Number: 2900-0701. Type of...) will be use to survey family members of deceased veterans on their satisfaction with the quality care...

Bereaved Adults' Evaluations of Grief Management Messages: Effects of Message Person Centeredness, Recipient Individual Differences, and Contextual Factors

ERIC Educational Resources Information Center

Rack, Jessica; Burleson, Brant; Bodie, Graham; Holmstrom, Amanda; Servaty-Seib, Heather

2008-01-01

This study identifies grief management strategies that bereaved adults evaluate as more and less helpful, assesses whether the person centeredness of these strategies explains their helpfulness, and determines whether strategy helpfulness varies as a function of demographic, personality, and situational factors. Participants (105 bereaved young…

[Patterns of coping strategies after bereavement among spouses of cancer patients].

PubMed

Asai, Mariko; Matsui, Yutaka; Uchitomi, Yosuke

2013-12-01

The purposes of this study were (1) to identify healthy and unhealthy patterns of coping strategies after bereavement among spouses of cancer patients and 2) to explore the characteristics of patients and spouses associated with these patterns of coping strategies. The participants were 821 bereaved individuals whose spouses had died at the National Cancer Center Hospital East. Three patterns of coping strategies after bereavement were found: "Distraction Focused" (healthy), "Continuing Bonds Focused" (unhealthy), and "General Coping" (almost healthy). Two strategies for improving the unhealthy coping patterns of "Continuing Bonds Focused" were (1) enhancing "Distraction" and reducing "Continuing Bonds" for achieving "Distraction Focused" (healthy) and (2) enhancing both "Distraction" and "Social Sharing/Reconstruction" for achieving "General Coping" (almost healthy). The patients' characteristics associated with the bereaved spouses' coping strategy of "Continuing Bonds Focused" were "under 65 years", "history of psychiatric consultation", "duration of last hospital admission was less than one week", and "time since cancer diagnosis to death was less than one year". These four characteristics of the deceased patients were considered to be risk factors for spouses who would utilize unhealthy coping patterns after bereavement.

Coping Flexibility and Complicated Grief: A Comparison of American and Chinese Samples

PubMed Central

Burton, Charles L.; Yan, Oscar H.; Pat-Horenczyk, Ruth; Chan, Ide S. F.; Ho, Samuel; Bonanno, George A.

2011-01-01

Background The ability to process a death, and the ability to remain optimistic and look beyond the loss, are both thought to be effective means of coping with loss and other aversive events. Recently, these seemingly contrary dimensions have been integrated into the idea of coping flexibility. Method In this study we assessed the ability of married and bereaved individuals in the US and Hong Kong to use both coping approaches as operationalized by the trauma-focused and forward-focused coping scales of a previously validated questionnaire. We also calculated a single flexibility score. Results Bereaved participants reported greater trauma-focused coping ability than did married participants. However, bereaved participants meeting criteria for complicated grief (CG) reported less forward-focused coping than both asymptomatic bereaved and married participants. The CG group also showed less overall coping flexibility than the asymptomatic bereaved and married groups. Country was not a factor. Conclusions Findings suggest that deficits in coping flexibility are indicative of pathology in bereaved individuals, and that this relationship extends across cultures. Limitations of the study and directions for future research are discussed. PMID:21898713

Emotion regulation in bereavement: searching for and finding emotional support in social network sites

NASA Astrophysics Data System (ADS)

Döveling, Katrin

2015-04-01

In an age of rising impact of online communication in social network sites (SNS), emotional interaction is neither limited nor restricted by time or space. Bereavement extends to the anonymity of cyberspace. What role does virtual interaction play in SNS in dealing with the basic human emotion of grief caused by the loss of a beloved person? The analysis laid out in this article provides answers in light of an interdisciplinary perspective on online bereavement. Relevant lines of research are scrutinized. After laying out the theoretical spectrum for the study, hypotheses based on a prior in-depth qualitative content analysis of 179 postings in three different German online bereavement platforms are proposed and scrutinized in a quantitative content analysis (2127 postings from 318 users). Emotion regulation patterns in SNS and similarities as well as differences in online bereavement of children, adolescents and adults are revealed. Large-scale quantitative findings into central motives, patterns, and restorative effects of online shared bereavement in regulating distress, fostering personal empowerment, and engendering meaning are presented. The article closes with implications for further analysis in memorialization practices.

What are the physical and psychological health effects of suicide bereavement on family members? An observational and interview mixed-methods study in Ireland

PubMed Central

Matvienko-Sikar, Karen; Larkin, Celine; Corcoran, Paul; Arensman, Ella

2018-01-01

Objectives Research focussing on the impact of suicide bereavement on family members’ physical and psychological health is scarce. The aim of this study was to examine how family members have been physically and psychologically affected following suicide bereavement. A secondary objective of the study was to describe the needs of family members bereaved by suicide. Design A mixed-methods study was conducted, using qualitative semistructured interviews and additional quantitative self-report measures of depression, anxiety and stress (DASS-21). Setting Consecutive suicide cases and next-of-kin were identified by examining coroner’s records in Cork City and County, Ireland from October 2014 to May 2016. Participants Eighteen family members bereaved by suicide took part in a qualitative interview. They were recruited from the Suicide Support and Information System: A Case-Control Study (SSIS-ACE), where family members bereaved by suicide (n=33) completed structured measures of their well-being. Results Qualitative findings indicated three superordinate themes in relation to experiences following suicide bereavement: (1) co-occurrence of grief and health reactions; (2) disparity in supports after suicide and (3) reconstructing life after deceased’s suicide. Initial feelings of guilt, blame, shame and anger often manifested in enduring physical, psychological and psychosomatic difficulties. Support needs were diverse and were often related to the availability or absence of informal support by family or friends. Quantitative results indicated that the proportion of respondents above the DASS-21 cut-offs respectively were 24% for depression, 18% for anxiety and 27% for stress. Conclusions Healthcare professionals’ awareness of the adverse physical and psychosomatic health difficulties experienced by family members bereaved by suicide is essential. Proactively facilitating support for this group could help to reduce the negative health sequelae. The effects of suicide bereavement are wide-ranging, including high levels of stress, depression, anxiety and physical health difficulties. PMID:29331974

Nurses' experiences providing bereavement follow-up: an exploratory study using feminist poststructuralism.

PubMed

MacConnell, Grace; Aston, Megan; Randel, Pat; Zwaagstra, Nick

2013-04-01

To describe the experiences of nurses who provided bereavement follow-up with families after the death of a child or a pregnancy loss and explore facilitators, barriers and challenges. Bereavement follow-up after the death of a child has been identified as an indicator of quality end of life care by families and health care professionals. Research suggests communication with bereaved families can be challenging and intimidating for nurses, particularly those who have had limited experience. In-depth information about the personal, professional and institutional experiences of nurses providing this care is lacking. Eight registered nurses with experience in providing bereavement follow-up to families were interviewed. Purposive sampling provided information rich cases. Feminist poststructuralism was the guiding theory and methodology used to uncover underlying discourses. This methodology uses the concepts of discourse analysis, subjectivity and agency to enable a critical understanding of the relationships. The nurses described complex interactions between themselves, the families, hospital practices and policy, and social norms around the discourses of death and professionalism. The importance of relationship, self-care and closure, professional boundaries, invisible nature of the practice and institutional support were prominent themes. Insights into the challenges and rewards of providing bereavement follow-up are discussed in the context of power relations, and recommendations for change are offered. Nurses in the study were strongly committed to providing ongoing care to families who had experienced the death of a child or a pregnancy loss. Relationships were important to bereavement follow-up care, and the connections with families were often emotional for the nurses. Nurses and other health professionals would benefit from increased support and education related to bereavement and communication with grieving families. Clarity related to institutional policies to support bereavement care is paramount in helping nurses and others in this work. © 2012 Blackwell Publishing Ltd.

Honoring the voices of bereaved caregivers: a Metasummary of qualitative research.

PubMed

Holtslander, Lorraine; Baxter, Sharon; Mills, Kelly; Bocking, Sarah; Dadgostari, Tina; Duggleby, Wendy; Duncan, Vicky; Hudson, Peter; Ogunkorode, Agatha; Peacock, Shelley

2017-09-06

Family caregiving in the context of advanced disease in particular, can be physically and emotionally taxing. Caregivers can subsequently face bereavement exhausted with few supports, limited resources and a significant proportion will develop negative psychological and social outcomes. Although some research has attended to the bereavement experiences of family caregivers who had cared for a person requiring palliative care, a comprehensive qualitative understanding of the impact of caregiving on bereavement has not been articulated. The purpose of this study was to conduct a qualitative metasummary to explore the experiences of bereaved family caregivers of people who received palliative care services, regardless of their underlying disease. Sandelowski and Barroso's qualitative metasummary method was utilized: 1287 articles were identified through extensive database searches (i.e. - MEDLINE, PsychINFO, and CINAHL) and reviewed to determine if they fit the criteria. Those included in the review were assessed for study quality. Findings from each study were then thematically coded and a frequency of themes was calculated. The sample consisted of 47 qualitative studies. A total of 15 themes emerged. In descending order of frequency, the 15 themes were: the individual emotions of serenity, sadness, guilt, uncertainty, trauma, escape, and anger; post-loss experiences that helped the caregiver in bereavement; post-loss experiences that hindered; practical life changes; caregiver role identity; pre-loss experiences that helped; pre-loss experiences that hindered; caregiver context; and a need for different kinds of supports. Three key findings emerged from the themes: (1) many different aspects of the caregiving experience impact the bereavement experience, (2) every bereavement experience is unique, and (3) a variety of supports must be developed and made available to caregivers to meet these unique needs. Based on the metasummary findings, changes are needed in practice and policy to ensure the health and well-being of the family caregiver is maintained by offering support both during caregiving and bereavement.

Creating philanthropic foundations to deal with grief: case studies of bereaved parents.

PubMed

Rossetto, Kelly R

2014-01-01

The current study involves the analysis of six bereaved parents' stories and argues that the development of philanthropic foundations helped these parents make meaning of their children's deaths and find purpose in the midst of their grief. Furthermore, philanthropy, as a way of making meaning and finding purpose, is a mutually beneficial process because it helps both the bereaved founders and the communities the organizations reach. Connections between these narratives and the bereavement literature help us better understand the individual/family grief process and meaning making, as well as how internal grief states intersect with communities.

The Lifekeeper Memory Quilt: evaluation of a suicide postvention program.

PubMed

Peters, Kath; Staines, Alan; Cunningham, Colleen; Ramjan, Lucie

2015-01-01

The Lifekeeper Memory Quilt Project, implemented by the Salvation Army (Suicide Prevention-Bereavement Support Services) in Australia in 2008, aimed to provide support for those bereaved by suicide and to create greater public awareness of suicide. To evaluate participants' satisfaction with this project, 82 bereaved individuals completed surveys and 30 completed an interview. Results indicated that the Quilt was helpful in assisting participants in their bereavement. The Quilt project gave participants an opportunity to reflect on the life of their loved one and provided a space for them to grieve without fear of negative social reactions.

Two perspectives on the needs of individuals bereaved by suicide.

PubMed

Gall, Terry Lynn; Henneberry, Jesse; Eyre, Melissa

2014-01-01

To qualitatively explore the needs of suicidally bereaved individuals, researchers interviewed 11 suicide bereaved individuals and 4 mental health workers. Common themes of bereaved persons included the suicide grief experience, coping, interpersonal domain, struggle with meaning, self-reflection, and moving forward. Mental health workers emphasized the nature of the helping relationship, the need to emotionally process the grief, the centrality of meaning making, importance of support groups, and the role of individual counseling. These 2 perspectives informed "best practices" for postvention (e.g., understanding the need for meaning-making while recognizing when to move on).

Guilt in bereavement: a review and conceptual framework.

PubMed

Li, Jie; Stroebe, Margaret; Chan, Cecilia L W; Chow, Amy Y M

2014-01-01

Thirty-four quantitative and 9 qualitative studies are reviewed to indicate current understanding of the nature and impact of guilt in bereavement. This overview suggests that guilt is especially prevalent among some vulnerable subgroups, and it is associated with maladaptive health outcomes. Being male, longer bereavement time, and good end-of life experience seem to be associated with less guilt feelings. However, definition ambiguity, measurement difficulties, and cultural insensitivity are evident in studies. Therefore, a multidimensional conceptualization of guilt and a structural model to guide future investigation of this phenomenon in the bereavement context is proposed.

Support Needs and Experiences of People Bereaved by Suicide: Qualitative Findings from a Cross-Sectional British Study of Bereaved Young Adults

PubMed Central

De Souza, Tanisha; Stevenson, Fiona; King, Michael; Osborn, David; Morant, Nicola

2018-01-01

People bereaved by suicide are at increased risk of suicide, but evidence is lacking that available interventions reduce suicide risk. Few large-scale studies have described the views of suicide-bereaved people regarding their needs for support. Our objective was to explore the nature of young adults’ experiences of support after bereavement by suicide and their views on valued and unhelpful aspects. We conducted a cross-sectional study of staff and students aged 18–40 at 37 United Kingdom (UK) higher educational institutions in 2010, eliciting qualitative responses to two questions probing experiences of support and unmet needs after the suicide of a close contact. We conducted thematic analysis of responses from 420 adults bereaved by suicide, of whom 75% had received support after the loss. We identified three broad descriptive areas corresponding to important aspects of support: value and experiences of the support received; views on specific support needs; and reasons for not seeking support. We found that needs for emotional support exist throughout the social networks of people who die by suicide but are often hidden. Our findings suggest a need for proactive offers of support from family, friends, and professionals after suicide, repeated regularly in case a bereaved person does not feel ready for support early on. PMID:29614053

Comparing Cognitive, Relational and Stress Mechanisms Underlying Gender Differences in Recovery from Bereavement-Related Internalizing Problems

ERIC Educational Resources Information Center

Little, Michelle; Sandler, Irwin N.; Wolchik, Sharlene A.; Tein, Jenn-Yun; Ayers, Tim S.

2009-01-01

Four putative mediators underlying gender differences in youths' recovery from bereavement-related internalizing problems were examined in a sample (N = 109; age range = 8-16 years at the initial assessment) of parentally bereaved youth: intrusive thoughts about grief, postdeath stressors, negative appraisals of postdeath stressors, and fear of…

Locus of Control and Helplessness: Gender Differences among Bereaved Parents

ERIC Educational Resources Information Center

Rubinstein, Gidi

2004-01-01

This study investigated locus of control (LC) and hopelessness (H) among 25 pairs of bereaved parents, who lost their children in the Arab--Israeli conflict, and 25 pairs of demographically matched non-bereaved parents (mean age 53). Four of the 5 hypotheses were supported by results. LC was significantly more external and H was significantly…

Recovery in Context: Bereavement, Culture, and the Transformation of the Therapeutic Self

ERIC Educational Resources Information Center

Paletti, Robin

2008-01-01

The concept of recovery is integral to the work of bereavement professionals, though there remains considerable debate as to the precise definition and applicability of the term. A number of factors have contributed to the controversy; competing bereavement models, for instance, have given rise to fundamental differences in the way that recovery…

The Role of Grief, Anxiety, and Depressive Symptoms in the Use of Bereavement Services

ERIC Educational Resources Information Center

Bergman, Elizabeth J.; Haley, William E.; Small, Brent J.

2010-01-01

This study examined the role of psychological distress in the use of bereavement services at six months post-loss by 250 bereaved spouses in the Changing Lives of Older Couples study. Approximately 52% (129) used services, commonly provided by physicians and clergy. Hierarchical logistic regression analyses indicated that Black race, higher…

Strengthening Effective Parenting Practices over the Long Term: Effects of a Preventive Intervention for Parentally Bereaved Families

ERIC Educational Resources Information Center

Hagan, Melissa J.; Tein, Jenn-Yun; Sandler, Irwin N.; Wolchik, Sharlene A.; Ayers, Tim S.; Luecken, Linda J.

2012-01-01

This study tested the effect of the Family Bereavement Program (FBP), a preventive intervention for bereaved families, on effective parenting (e.g., caregiver warmth, consistent discipline) 6 years after program completion. Families (n = 101; 69% female caregivers; 77% Caucasian, 11% Hispanic) with children between ages 8 and 16 who had…

Antecedents and Sequelae of Sudden Parental Death in Offspring and Surviving Caregivers

PubMed Central

Melhem, Nadine M.; Walker, Monica; Moritz, Grace; Brent, David A.

2008-01-01

Objectives To examine the psychiatric antecedents that put parents at risk for early death, and the psychological sequelae of bereavement in offspring and caregivers. Design A population-based study. Setting Bereaved families were recruited through the coroner’s records and by advertisement. Control families were recruited by random-digit dialing and advertisement. Participants Families with biological offspring from 7 to 25 years of age in which 1 parent died of suicide, accident, or sudden natural death were included (n=140). Controls (n=99) had 2 living parents and their biological offspring and had no death of a first-degree relative within the past 2 years. Main Outcome Measures Lifetime psychiatric history for deceased parents (probands) and new-onset psychiatric disorders, self-reported symptoms, and functional status in offspring and surviving caregivers. Results Bipolar disorder, substance abuse, and personality disorders are more common in probands who died of suicide or accident than in control parents. Bereaved offspring and their caregivers were at increased risk for depression and posttraumatic stress disorder. Bereaved offspring had a 3-fold (95% confidence interval, 1.3–7.0) increased risk of depression, even after controlling for antecedent and concomitant risk factors. Offspring bereaved by suicide showed similar outcomes compared with those bereaved by other types of death. Conclusions Bereavement conveys an increased risk of depression and posttraumatic stress disorder above and beyond other vulnerability factors. Better integration of medical and psychiatric care may prevent premature parental death, but once it occurs, physicians should be alert to the increased risk for depression and posttraumatic stress disorder in bereaved offspring and their caregivers. PMID:18458185

Sibling bereavement and continuing bonds.

PubMed

Packman, Wendy; Horsley, Heidi; Davies, Betty; Kramer, Robin

2006-11-01

Historically, from a Freudian and medical model perspective, emotional disengagement from the deceased was seen as essential to the successful adaptation of bereavement. A major shift in the bereavement literature has occurred and it is now generally accepted that despite the permanence of physical separation, the bereaved remains involved and connected to the deceased and can be emotionally sustained through continuing bonds. The majority of literature has focused on adults and on the nature of continuing bonds following the death of a spouse. In this article, the authors demonstrate how the continuing bonds concept applies to the sibling relationship. We describe the unique continued relationship formed by bereaved children and adolescents following a sibling loss, highlight the factors that influence the siblings continuing bonds expressions, and offer clinical interventions. In our view, mental health professionals can play an important role in helping parents encourage activities that may facilitate the creation and maintenance of continuing bonds in their children.

How do attachment dimensions affect bereavement adjustment? A mediation model of continuing bonds.

PubMed

Yu, Wei; He, Li; Xu, Wei; Wang, Jianping; Prigerson, Holly G

2016-04-30

The current study aims to examine mechanisms underlying the impact of attachment dimensions on bereavement adjustment. Bereaved mainland Chinese participants (N=247) completed anonymous, retrospective, self-report surveys assessing attachment dimensions, continuing bonds (CB), grief symptoms and posttraumatic growth (PTG). Results demonstrated that attachment anxiety predicted grief symptoms via externalized CB and predicted PTG via internalized CB at the same time, whereas attachment avoidance positively predicted grief symptoms via externalized CB but negatively predicted PTG directly. Findings suggested that individuals with a high level of attachment anxiety could both suffer from grief and obtain posttraumatic growth after loss, but it depended on which kind of CB they used. By contrast, attachment avoidance was associated with a heightened risk of maladaptive bereavement adjustment. Future grief therapy may encourage the bereaved to establish CB with the deceased and gradually shift from externalized CB to internalized CB. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Effect of Cause of Death on Responses to the Bereaved: Suicide Compared to Accident and Natural Causes.

ERIC Educational Resources Information Center

Allen, Breon G.; And Others

1994-01-01

Examined impact of cause of death on responses to bereaved individual. Sixty adults listened to audiotape of recently bereaved widow. There were three versions of tape, each identical except for stated cause of death: suicide, accident, or heart attack. Found that respondents were more anxious after interaction than before. Perceptions of person…

Posttraumatic Symptoms in Japanese Bereaved Family Members with Special Regard to Suicide and Homicide Cases

ERIC Educational Resources Information Center

Ogata, Kohske; Ishikawa, Takaki; Michiue, Tomomi; Nishi, Yuko; Maeda, Hitoshi

2011-01-01

The authors investigated posttraumatic stress disorder (PTSD) symptoms in Japanese bereaved family members using a questionnaire. Participants were bereaved as a result of suicide and homicide (n = 51 and 49, respectively), with natural death (n = 56) as a control; and their relationships to the deceased were parent-child (n = 79), conjugal (n =…

Social Sharing of Bereavement Experience by Chinese Bereaved Persons in Hong Kong

ERIC Educational Resources Information Center

Chow, Amy Y. M.; Chan, Cecilia L. W.; Ho, Samuel M. Y.

2007-01-01

Contrary to the belief that the Chinese do not share emotionally intense experiences, findings from a cross-sectional study of 292 respondents who lost either a spouse or a parent in the previous 2 years in Hong Kong indicated that only 10% did not share their bereavement experiences with another person. The physical health and emotional state of…

Two Models of Caregiver Strain and Bereavement Adjustment: A Comparison of Husband and Daughter Caregivers of Breast Cancer Hospice Patients

ERIC Educational Resources Information Center

Bernard, Lori L.; Guarnaccia, Charles A.

2003-01-01

Purpose: Caregiver bereavement adjustment literature suggests opposite models of impact of role strain on bereavement adjustment after care-recipient death--a Complicated Grief Model and a Relief Model. This study tests these competing models for husband and adult-daughter caregivers of breast cancer hospice patients. Design and Methods: This…

Life after Loss: Parent Bereavement and Coping Experiences after Infant Death in the Neonatal Intensive Care Unit.

PubMed

Currie, Erin R; Christian, Becky J; Hinds, Pamela S; Perna, Samuel J; Robinson, Cheryl; Day, Sara; Bakitas, Marie; Meneses, Karen

2018-05-14

The death of an infant in the neonatal intensive care unit (NICU) is a profound and unexpected loss for parents that results in a complex process of coping with bereavement. A descriptive qualitative approach was used to explore parent bereavement and coping experiences after infant death in the NICU. The Dual Process Model of Coping with Bereavement was used as a conceptual framework to help understand how parents cope with grief after infant death. Living with infant death was a process that resulted in major life changes and a process of oscillating among various coping strategies.

Resilience and vulnerability: prolonged grief in the bereaved spouses of marital partners who died of AIDS.

PubMed

Yu, Nancy Xiaonan; Chan, Cecilia L W; Zhang, Jianxin; Stewart, Sunita M

2016-01-01

Spousal bereavement is closely linked to prolonged grief, that is, significant adjustment symptoms that last for more than six months after the loss. This article focused on potential risk and protective factors that may influence bereavement outcomes. Participants in this study were surviving spouses of individuals who died of acquired immune deficiency syndrome (AIDS). These participants were themselves living with human immunodeficiency syndrome. In this cross-sectional study, 120 bereaved participants completed measures of grief, quality of dying and death of the deceased, negative conceptions of death resulting from AIDS, death attitudes, and personal resilience. The results showed that one-third (35.0%) of the bereaved participants reported grief levels above the prolonged grief cut-off scores, and can be categorized as the "prolonged grief" group. Although quality of dying and death was not associated with the intensity of grief, negative conceptions of death from AIDS, fear of death and resilience independently predicted grief symptoms in the regression models. Our findings provide insight into the grief process for the surviving spouse of AIDS victims in rural China. Since resilience is malleable, developing resilience interventions to enhance adjustment to bereavement may be a promising direction in grief counselling and therapies.

Efficacy of writing for recovery on traumatic grief symptoms of Afghani refugee bereaved adolescents: a randomized control trial.

PubMed

Kalantari, Mehrdad; Yule, William; Dyregrov, Atle; Neshatdoost, Hamidtaher; Ahmadi, S J

2012-01-01

Effective evidence-based intervention for traumatic bereavement is one of the current major research issues in the field of Post Traumatic Stress Disorder (PTSD) in children and adolescents. The "Writing for Recovery" group intervention is a new treatment approach developed by the Children and War Foundation for traumatized and bereaved children and adolescents after disasters. The purpose of this project was an empirical examination of this intervention with 12- to 18-year-old war bereaved Afghani refugees. Eighty-eight war bereaved Afghani refugees were screened using the Traumatic Grief Inventory for Children (TGIC). From those with the highest total score, 61 were randomly assigned to either an experimental (n = 29) or control group (n = 32). The experimental group received six sessions of group training on 3 consecutive days in their school. The difference of TGIC scores between the experimental group in pretest and posttest was significant (p = 0.001). Results of analysis of covariance also showed a significant effect of Writing for Recovery on the experimental group (p < 0.001). It is concluded that "Writing for Recovery" is an effective group intervention for bereaved children and adolescents after disasters.

DSM-V diagnostic criteria for bereavement-related disorders in children and adolescents: developmental considerations.

PubMed

Kaplow, Julie B; Layne, Christopher M; Pynoos, Robert S; Cohen, Judith A; Lieberman, Alicia

2012-01-01

Two bereavement-related disorders are proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V): Adjustment Disorder Related to Bereavement, to be located in the main body of the text as an official diagnostic entity; and Bereavement-Related Disorder, including a Traumatic Death Specifier, to be located in the Appendix as an invitation for further research. These diagnoses currently do not include developmentally informed criteria, despite the importance of developmental processes in the ways children and adolescents grieve. In this article, we draw upon a selective review of the empirical literature and expert clinical knowledge to recommend developmentally informed modifications and specifiers of the proposed criteria for both bereavement disorders and strategies to improve future research. This article is derived from an invited report submitted to the DSM-V Posttraumatic Stress Disorder, Trauma, and Dissociative Disorders Sub-Work Group, and suggested modifications have received preliminary approval to be incorporated into the DSM-V at the time of this writing. Adoption of these proposals will have far-reaching consequences, given that DSM-V criteria will influence both critical treatment choices for bereaved youth and the next generation of research studies.

Excluding parental grief: A critical discourse analysis of bereavement accommodation in Canadian labour standards.

PubMed

Macdonald, Mary Ellen; Kennedy, Kimberly; Moll, Sandra; Pineda, Carolina; Mitchell, Lisa M; Stephenson, Peter H; Cadell, Susan

2015-01-01

Grief following child loss is profoundly destabilizing with serious long-term repercussions for bereaved parents. Employed parents may need time away from work to deal with this loss. The purpose of this study was to reflect upon the ways labour policies and practices respond to parental bereavement. Critical discourse analysis was used to examine labour policies and practices related to employment leave for bereaved parents in Canada. Results were compared to international labour standards. Universally, employment policies provide only for the practical issues of bereavement. Commonly, leave is three days, unpaid, and meant to enable ceremonial obligations. Policies do not acknowledge the long-term suffering caused by grief or the variable intensity of different kinds of loss. Managerial, moral, normative and neoliberal values embedded in these policies efface the intensely personal experience of grief, thereby leaving employees at risk for serious health and workplace safety issues. Bereavement leave currently understands grief as a generic, time-limited state with instrumental tasks and ceremonial obligations. In contrast, research characterizes responses to child loss as intense, highly personal experiences for which healing and recovery can take years. This disconnect is especially problematic when viewed through the lens of employee wellbeing, reintegration and workplace productivity.

Effects of euthanasia on the bereaved family and friends: a cross sectional study.

PubMed

Swarte, Nikkie B; van der Lee, Marije L; van der Bom, Johanna G; van den Bout, Jan; Heintz, A Peter M

2003-07-26

To assess how euthanasia in terminally ill cancer patients affects the grief response of bereaved family and friends. Cross sectional study. Tertiary referral centre for oncology patients in Utrecht, the Netherlands. 189 bereaved family members and close friends of terminally ill cancer patients who died by euthanasia and 316 bereaved family members and close friends of comparable cancer patients who died a natural death between 1992 and 1999. Symptoms of traumatic grief assessed by the inventory of traumatic grief, current feelings of grief assessed by the Texas revised inventory of grief, and post-traumatic stress reactions assessed by the impact of event scale. The bereaved family and friends of cancer patients who died by euthanasia had less traumatic grief symptoms (adjusted difference -5.29 (95% confidence interval -8.44 to -2.15)), less current feeling of grief (adjusted difference 2.93 (0.85 to 5.01)); and less post-traumatic stress reactions (adjusted difference -2.79 (-5.33 to -0.25)) than the family and friends of patients who died of natural causes. These differences were independent of other risk factors. The bereaved family and friends of cancer patients who died by euthanasia coped better with respect to grief symptoms and post-traumatic stress reactions than the bereaved of comparable cancer patients who died a natural death. These results should not be interpreted as a plea for euthanasia, but as a plea for the same level of care and openness in all patients who are terminally ill.

The Influence of Bereavement on Body Mass Index: Results from a National Swedish Survey

PubMed Central

Oliveira, Aldair J.; Rostila, Mikael; Saarela, Jan; Lopes, Claudia S.

2014-01-01

Background Previous findings suggest that the loss of a family member is associated with health and mortality. The purpose of this study was to investigate the association between bereavement experiences and BMI, and whether there are socio-demographic differences in this association. Objective To investigate the association between bereavement experiences and BMI, and whether there are socio-demographic differences in this association. Methods We used cross-sectional data with retrospective questions from the Swedish Level of Living Survey (LNU) of 2000, including 5,142 individuals. The bereavement experiences examined in the study include the loss of a sibling, a parent or a spouse, and time since the death of a parent. BMI (kg/m2) was calculated using self-reported measurements of weight and height. The association between bereavement and BMI was evaluated through linear regressions. Results After controlling for possible confounders, most of the models detected an association between bereavement and BMI. The fully-adjusted model showed that loss of parents was associated with a 0.45 increase in BMI (SE = 0.20). The effect also seemed to be dependent on time since the loss and social class position. Conclusions The present study is the first to examine associations between different types of familial losses and BMI. We find an association between the death of a family member and BMI, but it appears to be related to time since the death, type of bereavement experience and social class. PMID:24759975

A Theoretical Model of Resource-Oriented Music Therapy with Informal Hospice Caregivers during Pre-Bereavement.

PubMed

Potvin, Noah; Bradt, Joke; Ghetti, Claire

2018-03-09

Over the past decade, caregiver pre-bereavement has received increased scholarly and clinical attention across multiple healthcare fields. Pre-bereavement represents a nascent area for music therapy to develop best practices in and an opportunity to establish clinical relevancy in the interdisciplinary team. This study was an exploratory inquiry into the role of music therapy with pre-bereaved informal hospice caregivers. This study intended to articulate (a) what pre-bereavement needs are present for informal hospice caregivers, (b) which of those needs were addressed in music, and (c) the process by which music therapy addressed those needs. A constructivist grounded theory methodology using situational analysis was used. We interviewed 14 currently bereaved informal hospice caregivers who had participated in music therapy with the care recipient. Analysis resulted in a theoretical model of resource-oriented music therapy promoting caregiver resilience. The resource, caregivers' stable caring relationships with care recipients through their pre-illness identities (i.e., spouse, parent, or child), is amplified through music therapy. Engagement with this resource mediates the risk of increased care burden and results in resilience fostering purposefulness and value in caregiving. Resource-oriented music therapy provides a unique clinical avenue for supporting caregivers through pre-bereavement, and was acknowledged by caregivers as a unique and integral hospice service. Within this model, caregivers are better positioned to develop meaning from the experience of providing care through the death of a loved one.

Suicide bereavement and postvention in major suicidology journals: lessons learned for the future of postvention.

PubMed

Andriessen, Karl

2014-01-01

Since the seminal publications of Shneidman (1969) and Cain (1972), suicide bereavement and postvention have attracted increasing research interest. To examine the topics of suicide bereavement and postvention in the core international suicidology journals, since their inception until mid-2013, in order to reveal the number of postvention articles throughout the years, their geographic distribution, and the topics of suicide bereavement and postvention that have been published. The online databases of four journals (Crisis, The Journal of Crisis Intervention and Suicide Prevention; Suicide and Life-Threatening Behavior [SLTB]; Archives of Suicide Research; and Suicidology Online) as well as the tables of content of all issues were searched. The number of articles and the countries of origin were quantified, and articles were categorized according to their content. The search identified 144 postvention articles, published during the past 40 years, almost exclusively in two journals (Crisis and SLTB). The majority of articles were (co-)authored by authors from Anglo-Saxon, Western countries. Articles were categorized in three groups: characteristics of suicide bereavement (n = 73), postvention programs (n = 66), and definition/theory and epidemiology of survivors (n = 5). Articles on suicide bereavement and postvention have been published mostly in two suicidology journals, albeit in modest numbers, and from a limited number of mostly Western countries. Our understanding of suicide bereavement and the provision of survivor support might benefit from the development of consensual definitions and from studies in other parts of the world.

Support for bereaved owners of pets.

PubMed

Clements, Paul T; Benasutti, Kathleen M; Carmone, Andy

2003-01-01

The bond that exists between people and their pets and its impact on physical and mental health. To review the current literature and explore the clinical implications of bereavement related to pets. A comprehensive review of the bereavement, veterinarian, and agricultural literature related to attitudes and response patterns to pet and animal death. The death or loss of a beloved pet can be a life-changing event.

Service and Science in Times of Crisis: Developing, Planning, and Implementing a Clinical Research Program for Children Traumatically Bereaved after 9/11

ERIC Educational Resources Information Center

Goodman, Robin F.; Brown, Elissa J.

2008-01-01

September 11, 2001 was a tragedy unparalleled in the United States, resulting in the largest number of parentally bereaved children from a single terrorist incident. The event necessitated swift and sensitive development of programs to meet the needs of bereaved children and their families, and it offered a rare opportunity to investigate the…

A Comparative Study of the Child Bereavement and Loss Responses and Needs of Schools in Hull, Yorkshire and Derry/Londonderry, Northern Ireland

ERIC Educational Resources Information Center

Tracey, Anne; Holland, John

2008-01-01

This paper reports the findings from a study of schools' responses to child bereavement in Hull, Yorkshire and Derry/Londonderry, Northern Ireland. In order to gain an insight and compare how schools in both geographical areas respond to and manage bereavement, the questionnaire "Loss in schools" was selected as an appropriate tool. It…

The Success of a Planned Bereavement Response--A Survey on Teacher Use of Bereavement Response Plans When Supporting Grieving Children in Danish Schools

ERIC Educational Resources Information Center

Lytje, Martin

2017-01-01

This article investigates the strengths and weaknesses of the Danish Bereavement response plans. These are used by teachers to support grieving students and have been implemented in 96% of all Danish schools. The study is based on an Internet survey conducted with 967 teachers. Issues investigated are: "generalisation of grief",…

The desirability of an Intensive Care Unit (ICU) clinician-led bereavement screening and support program for family members of ICU Decedents (ICU Bereave).

PubMed

Downar, James; Barua, Reeta; Sinuff, Tasnim

2014-04-01

Many bereaved family members (FMs) of intensive care unit decedents experience symptoms of complicated grief (CG) or social distress, but there is no standard screening or follow-up for these individuals. We determined the desirability and need for an intensive care unit-based bereavement screening and support program for these FMs. We surveyed bereaved FMs to measure symptoms of CG, prolonged grief disorder, and social difficulties and the desire for support; and staff physicians and nurses at 2 teaching hospitals in Toronto, Canada, to determine comfort and interest in providing routine bereavement support. We could not contact 69% of FMs largely because of inaccuracies in the patient record. Of the 64 who were contacted, 32 (50%) agreed to be surveyed a mean (SD) of 7.4 (2.2) months after the loss of their relative. Among eligible staff, 57 (61%) of 94 completed the questionnaire. Nine (28%) FMs met subthreshold criteria for CG or prolonged grief disorder, and 7 (22%) met criteria for social distress. Only 10 (31%) had received professional support for emotional symptoms, and 2 (6%) received professional assistance for their social difficulties. Fifty-eight percent supported routine screening, and 68% wanted to receive (or receive more) support. Fifty-five percent of FMs expressed a strong willingness to meet with the medical team to review events surrounding the death of the patient, which was the type of support that the health care staff were most comfortable providing. Most staff (85%) reported providing emotional support at the time of death, but few provided any support afterwards. Fifty-six (98%) of 57 would be willing to support or participate in a formal bereavement screening and support program. Respondents cited the need for training and dedicated time to carry out such a program. An ICU-based bereavement screening and support program for FMs of ICU decedents is both needed and desirable, although there are important needs and barriers. Future studies should evaluate the effectiveness for such a program at improving outcomes among bereaved FMs. Copyright © 2014 Elsevier Inc. All rights reserved.

Parental mortality rates in a western country after the death of a child: assessment of the role of the child's sex.

PubMed

Werthmann, Jessica; Smits, Luc J M; Li, Jiong

2010-02-01

Loss of a child has been associated with elevated mortality rates in parents. Studies that focus on the influence of the child's sex on parental mortality are sparse. The main objective of the present study was to reevaluate the combined impact of the parents' and child's sex within a larger sample and focus on adverse health effects as an objective measure of possible long-term effects of maladaptive grief reactions. For the time period between 1980 and 1996, all children in Denmark who died before 18 years of age were identified. Parents who had lost a child were identified as the bereaved (exposed) group. Mortality rates of parents within the same-sex parent-child dyad were compared with mortality rates of parents within the opposite-sex parent-child dyad. Separate analyses were performed for bereaved fathers and for bereaved mothers, and additional analyses were conducted to examine the sole effect of the child's sex, irrespective of parental gender. A Cox proportional hazards regression model was used to estimate the hazard ratios (HRs) with 95% CIs. The study population consisted of 21,062 parents (mean age at entry, 32 years; 11,221 mothers, 9841 fathers). Bereaved parents who had lost a child of the same sex had similar overall mortality as bereaved parents who had lost a child of the opposite sex (HR = 1.02; 95% CI, 0.85-1.22). Similar findings were observed for mortality due to natural death (HR = 0.96; 95% CI, 0.78-1.18) or mortality due to unnatural death (HR = 1.22; 95% CI, 0.84-1.77). Bereaved fathers who had lost a son had similar mortality as those bereaved by the death of a daughter (HR = 1.10; 95% CI, 0.86-1.40). Bereaved mothers who had lost a daughter had similar mortality as those bereaved by the death of a son (HR = 0.93; 95% CI, 0.70-1.22). Bereaved parents who had lost a son had mortality rates similar to those who had lost a daughter (HR = 1.09; 95% CI, 0.91-1.31). The interactions between grouping variable and sex of parents were not significant, indicating that the differential effect of losing a child based on sex of the child was not greater for fathers than for mothers. The results of this study revealed no significant effect of sex of the deceased child on mortality in these bereaved parents. The results might differ if this study was replicated in a population with a different grief culture and, more importantly, different gender schemas. Copyright 2010. Published by Elsevier Inc.

Unfinished Business in Bereavement

PubMed Central

Klingspon, Kara L.; Holland, Jason M.; Neimeyer, Robert A.; Lichtenthal, Wendy G.

2016-01-01

Unfinished business (incomplete, unexpressed or unresolved relationship issues with the deceased) is frequently discussed as a risk factor for chronic and severe grief reactions. However, few empirical studies have examined this construct. The present study aimed to address this gap in the literature by examining the presence and severity of unfinished business as well as common themes of unfinished business reported in open-ended qualitative narratives among a sample of 224 bereaved individuals. In bivariate analyses, self-reported presence of unfinished business and the severity of distress due to unfinished business were both found to be associated with poorer bereavement outcomes. However, after controlling for potential confounds, distress related to unresolved issues with the deceased emerged as a more robust correlate of these outcomes. Qualitative responses were categorized, and the type of reported unfinished business was not significantly related to the degree of unfinished business distress or other bereavement outcomes. These findings provide preliminary justification for bereavement interventions that aim to ameliorate distress related to unresolved relational issues with the deceased. PMID:26057117

Unfinished Business in Bereavement.

PubMed

Klingspon, Kara L; Holland, Jason M; Neimeyer, Robert A; Lichtenthal, Wendy G

2015-01-01

Unfinished business (incomplete, unexpressed or unresolved relationship issues with the deceased) is frequently discussed as a risk factor for chronic and severe grief reactions. However, few empirical studies have examined this construct. The present study aimed to address this gap in the literature by examining the presence and severity of unfinished business as well as common themes of unfinished business reported in open-ended qualitative narratives among a sample of 224 bereaved individuals. In bivariate analyses, self-reported presence of unfinished business and the severity of distress due to unfinished business were both found to be associated with poorer bereavement outcomes. However, after controlling for potential confounds, distress related to unresolved issues with the deceased emerged as a more robust correlate of these outcomes. Qualitative responses were categorized, and the type of reported unfinished business was not significantly related to the degree of unfinished business distress or other bereavement outcomes. These findings provide preliminary justification for bereavement interventions that aim to ameliorate distress related to unresolved relational issues with the deceased.

Professional support requirements and grief interventions for parents bereaved by an unexplained death at different time periods in the grief process.

PubMed

Rudd, Rebecca A; D'Andrea, Livia M

2013-01-01

The purpose of this qualitative phenomenological study examines the support needs and grief interventions professional and bereaved parents believed were helpful during different time periods in the grief process: the first 72 hours, first three to 14 days, and two weeks and beyond. Ten professionals from the following disciplines were interviewed: emergency communications, emergency medical technician, police, fireman, detective, social worker funeral director chaplain, peer support leader, and bereavement organization. Five parents and one grandparent bereaved by Sudden Infant Death Syndrome (SIDS) or Sudden Unexplained Death in Childhood (SUDC) were interviewed. This study identified 13 support need and grief interventions: contact support people, emotional and cognitive regulation, preliminary information on cause of death, time with deceased child, accommodate and advocate, human compassion and support, describe timeline and process, referrals and resources, affordable and easy access to services, communication and follow-up, community experience, professional mental health support, and memorialize. Recommendations are provided on ways to improve services to newly bereaved parents.

The experiences of staff who support people with intellectual disability on issues about death, dying and bereavement: A metasynthesis.

PubMed

Lord, Ailsa J; Field, Stephen; Smith, Ian C

2017-11-01

Historically, people with intellectual disabilities have tended to be excluded from knowing about death, dying and bereavement. Staff in intellectual disability services can play a valuable role in improving understanding of these issues in those they support. This qualitative metasynthesis aimed to understand the experiences of staff supporting adults with intellectual disabilities with issues of death, dying and bereavement. Thirteen papers were identified following a systematic review of six databases. Three themes were developed following a lines-of-argument synthesis: (i) talking about death is hard: negotiating the uncertainty in death, dying and bereavement; (ii) the commitment to promoting a "good death"; and (iii) the grief behind the professional mask. "A cautious silence: The taboo of death" was an overarching theme. A more open culture around issues of death, dying and bereavement in intellectual disability settings is essential and could be promoted through staff training and support. © 2017 John Wiley & Sons Ltd.

Living Disconnected: Building a Grounded Theory View of Bereavement for Adults with Intellectual Disabilities.

PubMed

Clute, Mary Ann

2017-11-01

This grounded theory study gathered descriptions the bereavement experience for adults with intellectual disabilities (IDD) through the eyes and voices of a small sample of grief counselors. The counselors described bereaved adults with IDD as individuals who faced potentially heightened effects of the broken attachment bonds, increased risk of coping obstacles, long histories of unrecognized losses, and disenfranchised grief. The participants described bereaved adults with IDD (who sought treatment) as getting pushed to the sidelines to deal with their losses in isolation and confusion. It became evident that though there are many similarities between how all people cope with loss and how people with IDD cope with loss, differences exist. Subtle variations in the experience of loss and grief appear to be driven by culture and beliefs about disability and protection for those with IDD. The participants in this dissertation study contributed foundation data for a theoretical explanation of grief for adults with IDD grounded in data from bereavement counselors.

The Meanings of Outdoor Physical Activity for Parentally Bereaved Young People in the United Kingdom: Insights from an Ethnographic Study

ERIC Educational Resources Information Center

Brewer, Joanne; Sparkes, Andrew C.

2011-01-01

The purpose of this paper is to explore the meanings of outdoor physical activity in the natural environment for parentally-bereaved young people. It draws on data generated from a two-year ethnographic study that focused on the experiences of those involved with the Rocky Centre, a childhood bereavement service in the UK. Data was collected via…

Feeling Lonely Versus Being Alone: Loneliness and Social Support Among Recently Bereaved Persons

PubMed Central

2014-01-01

Objectives. Despite increases in social support following widowhood, loneliness is among the most frequently reported challenges of bereavement. This analysis explores the dynamic relationship between social support and loneliness among recently bereaved older adults. Methods. Using longitudinal data from “Living After Loss” (n = 328), latent growth curve modeling was used to estimate changes in loneliness and social support during the first year and a half of bereavement among older adults aged 50+. Results. Both loneliness and social support declined over the first year and a half of bereavement. Greater social support was associated with lower levels of loneliness overall, but the receipt of social support did not modify one’s expression of loneliness over time. Loneliness was more highly correlated with support from friends than family. Together, social support from both friends and family accounted for 36% of the total variance in loneliness. Discussion. There is conceptual and empirical overlap between the concepts of loneliness and social support, but results suggest that loneliness following widowhood cannot be remedied by interventions aimed only at increasing social support. Social support, especially that from friends, appears to be most effective if it is readily accessible and allows the newly bereaved an opportunity to express him/herself. PMID:24056690

Bereavement Photography for Children: Program Development and Healthcare Professionals’ Response

PubMed Central

Michelson, Kelly Nicole; Blehart, Kathleen; Hochberg, Todd; James, Kristin; Frader, Joel

2013-01-01

Reports of in-hospital bereavement photography focus largely on stillborns and neonates. Empiric data regarding the implementation of bereavement photography in pediatrics beyond the neonatal period and the impact of such programs on healthcare professionals (HCPs) is lacking. We describe the implementation of a pediatric intensive care unit (PICU) bereavement photography program and use questionnaire data from HCPs to describe HCPs’ reflections on the program and to identify program barriers. From July, 2007 through April, 2010 families of 59 (36%) of the 164 patients who died in the PICU participated in our bereavement photography program. Forty questionnaires from 29 HCPs caring for 39 participating patients/families indicated that families seemed grateful for the service (n=34, 85%) and that the program helped HCPs feel better about their role (n=30, 70%). Many HCPs disagreed that the program consumed too much of his/her time (n=34, 85%) and that the photographer made his/her job difficult (n=37, 92.5%). Qualitative analysis of responses to open ended questions revealed four categories: the program’s general value; positive aspects of the program; negative aspects of the program; and suggestions for improvements. Implementing bereavement photography in the PICU is feasible though some barriers exist. HCPs may benefit from such programs. PMID:24520925

Bereavement photography for children: program development and health care professionals' response.

PubMed

Michelson, Kelly Nicole; Blehart, Kathleen; Hochberg, Todd; James, Kristin

2013-07-01

Reports of in-hospital bereavement photography focus largely on stillborns and neonates. Empiric data regarding the implementation of bereavement photography in pediatrics beyond the neonatal period and the impact of such programs on healthcare professionals (HCPs) is lacking. The authors describe the implementation of a pediatric intensive care unit (PICU) bereavement photography program and use questionnaire data from HCPs to describe HCPs' reflections on the program and to identify program barriers. From July 2007 through April 2070, families of 59 (36%) of the 164 patients who died in the PICU participated in our bereavement photography program. Forty questionnaires from 29 HCPs caring for 39 participating patients/families indicated that families seemed grateful for the service (n = 34; 85%) and that the program helped HCPs feel better about their role (n = 30; 70%). Many HCPs disagreed that the program consumed too much of his/her time (n = 34; 85%) and that the photographer made his/her job difficult (n = 37; 92.5%). Qualitative analysis of responses to open-ended questions revealed 4 categories: the program's general value; positive aspects of the program; negative aspects of the program; and suggestions for improvements. Implementing bereavement photography in the PICU is feasible though some barriers exist. HCPs may benefit from such programs.

The impact of stillbirth on bereaved parents: A qualitative study.

PubMed

Nuzum, Daniel; Meaney, Sarah; O'Donoghue, Keelin

2018-01-01

To explore the lived experiences and personal impact of stillbirth on bereaved parents. Semi-structured in-depth interviews analysed by Interpretative Phenomenological Analysis (IPA) on a purposive sample of parents of twelve babies born following fetal death at a tertiary university maternity hospital in Ireland with a birth rate of c8,500 per annum and a stillbirth rate of 4.6/1000. Stillbirth had a profound and enduring impact on bereaved parents. Four superordinate themes relating to the human impact of stillbirth emerged from the data: maintaining hope, importance of the personhood of the baby, protective care and relationships (personal and professional). Bereaved parents recalled in vivid detail their experiences of care following diagnosis of stillbirth and their subsequent care. The time between diagnosis of a life-limiting anomaly or stillbirth and delivery is highlighted as important for parents as they find meaning in their loss. The impact of stillbirth on bereaved parents is immense and how parents are cared for is recalled in precise detail as they revisit their experience. Building on existing literature, these data bring to light the depth of personal experience and impact of stillbirth for parents and provides medical professionals with valuable insights to inform their care of bereaved parents and the importance of clear and sensitive communication.

Effects of euthanasia on the bereaved family and friends: a cross sectional study

PubMed Central

Swarte, Nikkie B; van der Lee, Marije L; van der Bom, Johanna G; van den Bout, Jan; Heintz, A Peter M

2003-01-01

Objective To assess how euthanasia in terminally ill cancer patients affects the grief response of bereaved family and friends. Design Cross sectional study. Setting Tertiary referral centre for oncology patients in Utrecht, the Netherlands. Participants 189 bereaved family members and close friends of terminally ill cancer patients who died by euthanasia and 316 bereaved family members and close friends of comparable cancer patients who died a natural death between 1992 and 1999. Main outcome measures Symptoms of traumatic grief assessed by the inventory of traumatic grief, current feelings of grief assessed by the Texas revised inventory of grief, and post-traumatic stress reactions assessed by the impact of event scale. Results The bereaved family and friends of cancer patients who died by euthanasia had less traumatic grief symptoms (adjusted difference -5.29 (95% confidence interval -8.44 to -2.15)), less current feeling of grief (adjusted difference 2.93 (0.85 to 5.01)); and less post-traumatic stress reactions (adjusted difference -2.79 (-5.33 to -0.25)) than the family and friends of patients who died of natural causes. These differences were independent of other risk factors. Conclusions The bereaved family and friends of cancer patients who died by euthanasia coped better with respect to grief symptoms and post-traumatic stress reactions than the bereaved of comparable cancer patients who died a natural death. These results should not be interpreted as a plea for euthanasia, but as a plea for the same level of care and openness in all patients who are terminally ill. PMID:12881258

The incidence and course of depression in bereaved youth 21 months after the loss of a parent to suicide, accident, or sudden natural death.

PubMed

Brent, David; Melhem, Nadine; Donohoe, M Bertille; Walker, Monica

2009-07-01

This study examined effects of bereavement 21 months after a parent's death, particularly death by suicide. The participants were 176 offspring, ages 7-25, of parents who died by suicide, accident, or sudden natural death. They were assessed 9 and 21 months after the death, along with 168 nonbereaved subjects. Major depression and alcohol or substance abuse 21 months after the parent's death were more common among bereaved youth than among comparison subjects. Offspring with parental suicide or accidental death had higher rates of depression than comparison subjects; those with parental suicide had higher rates of alcohol or substance abuse. Youth with parental suicide had a higher incidence of depression than those bereaved by sudden natural death. Bereavement and a past history of depression increased depression risk in the 9 months following the death, which increased depression risk between 9 and 21 months. Losing a mother, blaming others, low self-esteem, negative coping, and complicated grief were associated with depression in the second year. Youth who lose a parent, especially through suicide, are vulnerable to depression and alcohol or substance abuse during the second year after the loss. Depression risk in the second year is mediated by the increased incidence of depression within the first 9 months. The most propitious time to prevent or attenuate depressive episodes in bereaved youth may be shortly after the parent's death. Interventions that target complicated grief and blaming of others may also improve outcomes in symptomatic youth with parental bereavement.

Bereavement overload and its effects on, and related coping mechanisms of health care providers and ward administrators at National District Hospital in Bloemfontein, Free State.

PubMed

Allie, Zaid; Le Roux, Edith; Mahlatsi, Khantse; Mofokeng, Boitumelo; Ramoo, Zara-Anne; Sibiya, Khanyisile; Joubert, Gina; Van Rooyen, Jan P; Brits, Hanneke

2018-06-18

Patient death is an event that all health care workers will face at some point. Beyond the family, the greatest emotional strain is on people who work directly with the patient and family. Bereavement overload occurs after multiple losses without time for normal grief in between. To investigate bereavement overload, its effects and related coping mechanisms of personnel working in adult medical wards. Four adult medical wards at National District Hospital, Bloemfontein. An analytical cross-sectional study design was performed with the aid of an intervieweradministered questionnaire. The target population included health care providers (13 doctors and 20 nurses), eight final-year medical students, and four administrative staff working in thefour adult medical wards at National District Hospital, during August to October 2016. Half (48.9%) of the 45 participants reported bereavement overload. None of the medical students reported bereavement overload compared to 60.0% of nurses, 75.0% of administrative staff and 53.9% of doctors. Nearly two-thirds (64.5%, n = 29) stated that they suffered from compassion fatigue. The majority of participants (62.2%) used only positive coping mechanisms. The use of negative coping mechanisms correlated directly with a longer duration in the medical field. With a 49% prevalence of bereavement overload, it is important that support systems are in place to prevent the effects of negative coping mechanisms. The desirable outcome is that health care providers, who suffer from bereavement overload, experience compassion satisfaction and become more dedicated to the patients' well-being without expense to themselves.

Bereavement dream? Successful antidepressant treatment for bereavement-related distressing dreams in patients with major depression.

PubMed

Ishida, Mayumi; Onishi, Hideki; Wada, Mei; Wada, Tomomi; Wada, Makoto; Uchitomi, Yosuke; Nomura, Shinobu

2010-03-01

The death of a person is a stressful event. Such stress affects the physical and psychological well-being of the bereaved. As an associated mental disorder, major depressive disorder (MDD) is common. Some dream of the deceased, and these dreams are called bereavement dreams. Some MDD patients also experience dreams. These two types of dreams are sometimes difficult to differentiate. The dream of the bereaved might be only a bereavement-related dream, yet it might be a symptom of MDD. Herein, we report one patient who had distressing dreams after the death of her mother. A 63-year-old woman was referred for psychiatric consultation because of generalized fatigue and insomnia. Questioning her about recent events, she said that her mother had died of colonic carcinoma 5 months previously. Two months after the death, she suddenly started dreaming of her mother, getting angry with her almost every night. Generalized fatigue, insomnia, and distressing dreams appeared simultaneously. The dream caused much distress, making her afraid to fall asleep. Her psychiatric features fulfilled the DSM-IV-TR criteria for MDD, single episode. The death of her mother was considered to be one of the causes of MDD. She was administered 25 mg/day of sertraline hydrochloride. After that, her symptoms gradually disappeared, and the frequency of distressing dreams was reduced. Five months later, physical and psychiatric symptoms of MDD were completely resolved. Subsequently, she has not suffered from any distressing dreams of her mother. This case indicates that dreams experienced after the death of a loved one should not be regarded simply as bereavement dreams. Some of the dreams may be symptoms of MDD. If the dreams are the symptoms of MDD, antidepressant treatment as well as psychotherapy may be useful. Therefore, we should avoid regarding symptoms of MDD as reactions to bereavement.

Remembered parenting style and psychological well-being in young adults whose parents had experienced early child loss.

PubMed

Pantke, Renate; Slade, Pauline

2006-03-01

Pre-, peri-, or postnatal childloss can have devastating consequences for bereaved families. This study explored the long-term sequelae of these experiences for the young adult siblings' psychological well-being and the perceived quality of parenting received during participants' first 16 years of life. A bereaved group of young adult siblings was compared to a non-bereaved group on the Parent Bonding Instrument, the Rosenberg Self-esteem Scale and the Mental Health Index-5. The loss group reported their mothers, but not their fathers, to have been more protective/controlling than non-bereaved participants. No differences between the loss group and the comparison group were found for parental care, their own mental health or self-esteem. Those participants whose siblings died during the peri/post-natal period perceived their parents as more controlling than the miscarriage group as well as the non-bereaved group. Higher protection scores were evident among those born subsequent to the loss than those who were born before. Lower levels of protection were associated with better mental health across all groups. In the non-bereaved group lower levels of protection were associated with better self-esteem, but in the bereaved group a different even opposite pattern was shown. Young adults who lost a sibling when they themselves were under 5 recall their mothers as more protective/controlling than non-bereaved groups, although they do not report less care nor differ in mental health nor self-esteem. Higher levels of parental protection/control were found where the child was born subsequent to loss and for peri/post-natal loss rather than miscarriage. While high protection was associated with poorer mental health regardless of loss this may not be necessarily disadvantageous to the child's self-esteem. Differences with regard to parent gender were found.

Prenatal exposure to bereavement and type-2 diabetes: a Danish longitudinal population based study.

PubMed

Virk, Jasveer; Li, Jiong; Vestergaard, Mogens; Obel, Carsten; Kristensen, Jette Kolding; Olsen, Jørn

2012-01-01

The etiology of type-2 diabetes is only partly known, and a possible role of prenatal stress in programming offspring for insulin resistance has been suggested by animal models. Previously, we found an association between prenatal stress and type-1 diabetes. Here we examine the association between prenatal exposure to maternal bereavement during preconception and pregnancy and development of type-2 diabetes in the off-spring. We utilized data from the Danish Civil Registration System to identify singleton births in Denmark born January 1(st) 1979 through December 31(st) 2008 (N = 1,878,246), and linked them to their parents, grandparents, and siblings. We categorized children as exposed to bereavement during prenatal life if their mothers lost an elder child, husband or parent during the period from one year before conception to the child's birth. We identified 45,302 children exposed to maternal bereavement; the remaining children were included in the unexposed cohort. The outcome of interest was diagnosis of type-2 diabetes. We estimated incidence rate ratios (IRRs) from birth using log-linear poisson regression models and used person-years as the offset variable. All models were adjusted for maternal residence, income, education, marital status, sibling order, calendar year, sex, and parents' history of diabetes at the time of pregnancy. We found children exposed to bereavement during their prenatal life were more likely to have a type-2 diabetes diagnosis later in life (aIRR: 1.31, 1.01-1.69). These findings were most pronounced when bereavement was caused by death of an elder child (aIRR: 1.51, 0.94-2.44). Results also indicated the second trimester of pregnancy to be the most sensitive period of bereavement exposure (aIRR:2.08, 1.15-3.76). Our data suggests that fetal exposure to maternal bereavement during preconception and the prenatal period may increase the risk for developing type-2 diabetes in childhood and young adulthood.

Effects of directed written disclosure on grief and distress symptoms among bereaved individuals.

PubMed

Lichtenthal, Wendy G; Cruess, Dean G

2010-07-01

Bereavement-specific written disclosure trials have generally demonstrated null effects, but these studies have not directed the focus of writing. This randomized controlled trial compared directed writing that focused on either sense-making or benefit-finding, both associated with adjustment to loss, to traditional, non-directed emotional disclosure and a control condition. Bereaved undergraduates (n = 68) completed three 20-min writing sessions over 1 week. Intervention effects were found on prolonged grief disorder, depressive, and posttraumatic stress symptoms 3 months postintervention, and the benefit-finding condition appeared particularly efficacious. Physical health improved over time in all treatment groups. Findings suggested that directing written disclosure on topics associated with adjustment to bereavement may be useful for grieving individuals.

Making Sense of Bereavement in People with Profound Intellectual and Multiple Disabilities: Carer Perspectives.

PubMed

Young, Hannah; Hogg, James; Garrard, Brenda

2017-11-01

People with intellectual disabilities are thought to have a reduced capacity for understanding death. Drawing on cognitive theory, researchers have suggested that those with profound intellectual and multiple disabilities mainly perceive loss as a mismatch between past and present experiences. However, very little research has considered how carers conceptualize bereavement in relation to this group. Semi-structured interviews obtained responses from seven carers. Transcripts were examined using interpretative phenomenological analysis. Two superordinate themes emerged: 'difficulty articulating the experience of loss' and 'making sense of bereavement through familiar patterns'. Carers conceptualize bereavement primarily in cognitive terms, but also take account of relational factors mediating loss. Implications for training and further research are outlined. © 2016 John Wiley & Sons Ltd.

The role of peer relationships in parental bereavement during childhood and adolescence.

PubMed

Dopp, Alex Richard; Cain, Albert Clifford

2012-01-01

This article reviews current knowledge concerning the relationship between peer support and adjustment outcomes and experiences for parentally bereaved children. A brief overview of the effects of parental bereavement and factors influencing immediate and long-term adjustment is provided, followed by an overview of peer-provided social support and its relationship to adjustment. Current findings on the predictive value of peer support for adjustment are then discussed, with emphasis on the reciprocal positive and negative influences that peer support and adjustment (or lack thereof) exert. Areas of weakness and neglect within this domain are noted, with a focus on methodological issues, peer-relevant consequences of bereavement in need of further research, and the need for study of particular vulnerable subgroups.

EFFECTS OF DIRECTED WRITTEN DISCLOSURE ON GRIEF AND DISTRESS SYMPTOMS AMONG BEREAVED INDIVIDUALS

PubMed Central

LICHTENTHAL, WENDY G.; CRUESS, DEAN G.

2013-01-01

Bereavement-specific written disclosure trials have generally demonstrated null effects, but these studies have not directed the focus of writing. This randomized controlled trial compared directed writing that focused on either sense-making or benefit-finding, both associated with adjustment to loss, to traditional, non-directed emotional disclosure and a control condition. Bereaved undergraduates (n = 68) completed three 20-min writing sessions over 1 week. Intervention effects were found on prolonged grief disorder, depressive, and posttraumatic stress symptoms 3 months postintervention, and the benefit-finding condition appeared particularly efficacious. Physical health improved over time in all treatment groups. Findings suggested that directing written disclosure on topics associated with adjustment to bereavement may be useful for grieving individuals. PMID:24482856

Parental control, partner dependency, and complicated grief among widowed adults in the community.

PubMed

Johnson, Jeffrey G; Zhang, Baohui; Greer, Joseph A; Prigerson, Holly G

2007-01-01

Data from the Yale Bereavement Study, a community-based longitudinal study, were used to investigate the association of 192 widowed individuals' recollections of parenting affection and control during childhood with dependency on the deceased spouse and the development of severe grief symptoms following bereavement. The hypothesis that dependency on the deceased spouse mediates the association of parental affection and control during childhood with the development of severe grief following bereavement was investigated. Findings indicated that a high level of perceived parental control during childhood was associated with elevated levels of dependency on the deceased spouse and with symptoms of complicated grief. Dependency on the deceased spouse mediated the association of perceived parental control with the development of complicated grief following bereavement.

Impact of A Neonatal-Bereavement-Support DVD on Parental Grief: A Randomized Controlled Trial

PubMed Central

Rosenbaum, Joan L.; Smith, Joan R.; Yan, Yan; Abram, Nancy; Jeffe, Donna B.

2014-01-01

This study tested the effect of a neonatal-bereavement-support DVD on parental grief after their baby’s death in our Neonatal Intensive Care Unit compared with standard bereavement care (controls). Following a neonatal death, we measured grief change from 3- to 12-month follow-up using a mixed-effects model. Intent-to-treat analysis was not significant, but only 18 parents selectively watched the DVD. Thus, we subsequently compared DVD-viewers with DVD-non-viewers and controls. DVD-viewers reported higher grief at 3-month interviews compared with DVD-non-viewers and controls. Higher grief at 3 months was negatively correlated with social support and spiritual/religious beliefs. These findings have implications for neonatal-bereavement care. PMID:25530502

Prevalence and Associated Factors of Anxiety and Depressive Symptoms Among Bereaved Family Members of Cancer Patients in Korea

PubMed Central

Jho, Hyun Jung; Choi, Jin Young; Kwak, Kiu Sang; Chang, Yoon Jung; Ahn, Eun Mi; Park, Eun Jung; Paek, Soo Jin; Kim, Kyoung Mee; Kim, Soo Hyun

2016-01-01

Abstract Bereaved family members of cancer patient are at risk of having psychological problems such as anxiety and depression. However, prevalence and associated factors of anxiety and depressive symptoms among this population have not been explored in Korea. We conducted a nation-wide cross-sectional questionnaire survey of 3522 bereaved family members of cancer patients who died at 44 hospice palliative care unit (HPCU) in Korea in 2012. The questionnaire comprised the Hospital Anxiety and Depression Scale (HADS) and Good Death Inventory (GDI). Deceased patient's age, sex, primary site of cancer, duration of stay at HPCU, awareness of terminal status, bereaved family member's age, sex, and relation to the deceased were collected from Korean Terminal Cancer Patients Information System. 1121 returned questionnaires were analyzed (response rate, 31.8%). Using a cut-off value of 8 for HADS subscale, the prevalence of anxiety and depressive symptoms was 48.0% and 57.6%, respectively. Mean scores for HADS-A and HADS-D were 7.88 ± 4.87 and 8.91 ± 4.82, respectively. Among the bereaved, older age, being a spouse to the deceased, family members of younger patient, and negative score for a few GDI items were significantly associated with an increased risk of having anxiety or depressive symptoms in the multivariate logistic analysis. In conclusion, we noted the high prevalence of anxiety and depressive symptoms among the bereaved of cancer patients and identified associated factors for these psychological morbidities. Systematic efforts are needed to improve the mental health of the bereaved family members of cancer patients. PMID:27258497

The distress and benefit to bereaved family members of participating in a post-bereavement survey.

PubMed

Miyashita, Mitsunori; Aoyama, Maho; Yoshida, Saki; Yamada, Yuji; Abe, Mutsumi; Yanagihara, Kazuhiro; Shirado, Akemi; Shutoh, Mariko; Okamoto, Yoshiaki; Hamano, Jun; Miyamoto, Aoi; Nakahata, Misato

2018-02-01

Few studies have simultaneously collected quantitative data regarding the positive and negative effects of participating in post-bereavement surveys. We conducted a cross-sectional postal questionnaire survey in October 2013. Potential participants were caregivers for family members who had died in four inpatient palliative care units, two home hospices, and a general hospital. We collected opinions regarding the distress and benefit of completing a post-bereavement survey. After collecting data, we provided feedback to participating institutions in the form of study results and de-identified open-ended comments. Of 692 potential participants, 596 were sent questionnaires; 393 returned questionnaires were valid and analyzed. Of the respondents, 62% reported being distressed by completing the questionnaire. Female participants and those who were mentally ill during the caregiving period reported more distress. However, 86% of respondents reported they found the questionnaire beneficial. Better quality of end-of-life care and respondent depression were associated with more benefit. Major benefits were: contributing to the development of end-of-life care as a family (63%); expressing gratitude to the hospital and medical staff (60%); and looking back and reflecting on the end-of-life period (40%). Feeling benefit was not correlated with feeling distressed (P = -0.02). In this large-scale study on the effects of post-bereavement surveys in Japan, many bereaved family members reported that completing the survey was beneficial. In addition to possibly having feelings of distress, post-bereavement surveys might also be beneficial to end-of-life care facilities. © The Author(s) 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

SYMPTOM AND FUNCTIONAL TRAITS OF BRIEF MAJOR DEPRESSIVE EPISODES AND DISCRIMINATION OF BEREAVEMENT.

PubMed

McCabe, Patrick J; Christopher, Paul P

2016-02-01

Despite the removal of the bereavement exclusion from DSM-5, clinicians may feel uncertain on how to proceed when caring for a patient who presents with depressive symptoms following the death of someone close. The ability to better distinguish, on a symptom and functional level, between patients who experience depression in the context of bereavement and those with nonbereavement-related depression, could help guide clinical decision making. Individual and clustered depressive symptom and impairment measures were used for modeling bereavement status within a nationally representative longitudinal cohort. Deviance, linear shrinkage factor, and bias-corrected c-statistic were used for identifying a well-calibrated and discriminating final model. Of the 450 (1.2%) respondents with a single brief major depressive episode, 162 (38.4%) reported the episode as bereavement-related. The bereaved were less likely to endorse worthlessness (P < .001), social conflict (P < .001), distress (P < .001), thoughts of suicide (P = .001), wanting to die (P = .01), self-medicating (P = .01), and being withdrawn (P = .04). In a multivariate model, the bereaved were more likely to have thoughts of their own death (P = .003), guilt coupled with weight or appetite loss (P = .013), and were less likely to report social conflict (P < .001), worthlessness coupled with difficulty making decisions (P < .001), thoughts of suicide (P = .006), distress coupled with weight or appetite gain (P = .022), and self-medicating (P = .045). Traits and trait combinations differentiate individuals who experience brief depressive episodes following the death of a loved one from other brief episodes. These differences can help guide clinical care of patients who present with depressive symptoms shortly after a loved one's death. © 2015 Wiley Periodicals, Inc.

Childhood bereavement services: a survey of UK provision.

PubMed

Rolls, L; Payne, S

2003-07-01

The purpose of the study was to identify the location, range and type of childhood bereavement service provision in the UK. A questionnaire was mailed to 127 services who were either solely dedicated to childhood bereavement or who offered a service within the range of work of a host organization and for which there was a supporting organizational structure. Responses were received from 108 services (a response rate of 85%). The findings identified that 85% of childhood bereavement services are located in the voluntary sector; 14% are dedicated childhood bereavement services, while 86% are offered as part of a host organization. Forty-four per cent of host organizations are hospices. The majority of services (73%) relied on both paid and unpaid staff, with 11% relying entirely on paid staff and 14% of services relying entirely on unpaid staff. The interventions offered ranged from individual family work (86%), individual child work (62%), groupwork with families (53%) and groupwork with children (45%). In addition, services offered prebereavement support (64%), a 'drop-in' service (17%), information and advice (95%), training (32%) and the provision of resources (88%). As well as offering a service to children and their families, 74% of childhood bereavement services provided a service to 'secondary users', such as schools (66%), the emergency services (28%) and other professionals (63%). In terms of funding, 12% of services relied solely on external sources of funding, including donations, legacies, revenue from the host organization or grants, while 12% of services relied solely on internal sources of funding, including fundraising and training. The majority of services (73%), however, gained income from a range of sources. The study identifies the diversity of provision that has implications for the evaluation of childhood bereavement services.

What are the physical and psychological health effects of suicide bereavement on family members? Protocol for an observational and interview mixed-methods study in Ireland.

PubMed

Spillane, Ailbhe; Larkin, Celine; Corcoran, Paul; Matvienko-Sikar, Karen; Arensman, Ella

2017-03-30

Research indicates that experiencing the suicide of a relative can have a significant impact on family members' emotional health. However, research incorporating the impact of suicide bereavement on family members' physical health is sparse. This paper details the protocol for a mixed-methods study of suicide-bereaved family members. The study will primarily examine the physical and mental health needs of those bereaved by suicide. A secondary objective of the study is to describe the support service needs of family members bereaved by suicide. A mixed-methods approach, using semistructured interviews and self-report questionnaires, will be used. Interviews will be conducted with a group of 15-20 relatives who experienced suicide bereavement. This protocol will follow the COREQ checklist criteria for the reporting of qualitative research interviews. Thematic analysis will be used to examine experiences and impact of bereavement on psychological and physical health. Self-report quantitative data on well-being will be analysed using descriptive statistics. Ethical approval to conduct this study has been granted from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Pseudonyms will be given to participants to protect anonymity. It will be explained to participants that participation in the study is voluntary and they have to right to withdraw at any time. The findings of this research will be disseminated to regional, national and international audiences through publication in peer-reviewed international journals and presentations at scientific conferences. This research also forms part of a PhD thesis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

What are the physical and psychological health effects of suicide bereavement on family members? Protocol for an observational and interview mixed-methods study in Ireland

PubMed Central

Larkin, Celine; Corcoran, Paul; Matvienko-Sikar, Karen; Arensman, Ella

2017-01-01

Introduction Research indicates that experiencing the suicide of a relative can have a significant impact on family members' emotional health. However, research incorporating the impact of suicide bereavement on family members' physical health is sparse. This paper details the protocol for a mixed-methods study of suicide-bereaved family members. The study will primarily examine the physical and mental health needs of those bereaved by suicide. A secondary objective of the study is to describe the support service needs of family members bereaved by suicide. Methods and analysis A mixed-methods approach, using semistructured interviews and self-report questionnaires, will be used. Interviews will be conducted with a group of 15–20 relatives who experienced suicide bereavement. This protocol will follow the COREQ checklist criteria for the reporting of qualitative research interviews. Thematic analysis will be used to examine experiences and impact of bereavement on psychological and physical health. Self-report quantitative data on well-being will be analysed using descriptive statistics. Ethics and dissemination Ethical approval to conduct this study has been granted from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Pseudonyms will be given to participants to protect anonymity. It will be explained to participants that participation in the study is voluntary and they have to right to withdraw at any time. The findings of this research will be disseminated to regional, national and international audiences through publication in peer-reviewed international journals and presentations at scientific conferences. This research also forms part of a PhD thesis. PMID:28363930

Preconception maternal bereavement and infant and childhood mortality: A Danish population-based study

PubMed Central

Class, Quetzal A.; Mortensen, Preben B.; Henriksen, Tine B.; Dalman, Christina; D’Onofrio, Brian M.; Khashan, Ali S.

2015-01-01

Objectives Preconception maternal bereavement may be associated with an increased risk for infant mortality, though these previously reported findings have not been replicated. We sought to examine if the association could be replicated and explore if risk extended into childhood. Methods Using a Danish population-based sample of offspring born 1979–2009 (N=1,865,454), we predicted neonatal (0–28 days), post-neonatal infant (29–364 days), and early childhood (1–5 years) mortality following maternal bereavement in the preconception (6–0 months before pregnancy) and prenatal (between conception and birth) periods. Maternal bereavement was defined as death of a first degree relative of the mother. Analyses were conducted using logistic and log-linear Poisson regression that were adjusted for offspring, mother, and father sociodemographic and health factors. Results We identified 6,541 (0.004%) neonates, 3,538 (0.002%) post-neonates, and 2,132 (0.001%) children between the ages of 1 to 5 years who died. After adjusting for covariates, bereavement during the preconception period was associated with an increased odds of neonatal (adjusted odds ratio [aOR] = 1.87, 95% CI: 1.53–2.30) and post-neonatal infant mortality (aOR=1.52, 95% CI: 1.15–2.02). Associations were timing-specific (6 months prior to pregnancy only) and consistent across sensitivity analyses. Bereavement during the prenatal period was not consistently associated with increased risk of offspring mortality, however this may reflect relatively low statistical power. Conclusions Results support and extend previous findings linking bereavement during the preconception period with increased odds of early offspring mortality. The period immediately prior to pregnancy may be a sensitive period with potential etiological implications and ramifications for offspring mortality. PMID:26374948

The Incidence and Course of Depression in Bereaved Youth 21 Months After the Loss of a Parent to Suicide, Accident, or Sudden Natural Death

PubMed Central

Brent, David; Melhem, Nadine; Donohoe, M. Bertille; Walker, Monica

2009-01-01

Objective This study examined effects of bereavement 21 months after a parent’s death, particularly death by suicide. Method The participants were 176 offspring, ages 7–25, of parents who died by suicide, accident, or sudden natural death. They were assessed 9 and 21 months after the death, along with 168 nonbereaved subjects. Results Major depression and alcohol or substance abuse 21 months after the parent’s death were more common among bereaved youth than among comparison subjects. Offspring with parental suicide or accidental death had higher rates of depression than comparison subjects; those with parental suicide had higher rates of alcohol or substance abuse. Youth with parental suicide had a higher incidence of depression than those bereaved by sudden natural death. Bereavement and a past history of depression increased depression risk in the 9 months following the death, which increased depression risk between 9 and 21 months. Losing a mother, blaming others, low self-esteem, negative coping, and complicated grief were associated with depression in the second year. Conclusions Youth who lose a parent, especially through suicide, are vulnerable to depression and alcohol or substance abuse during the second year after the loss. Depression risk in the second year is mediated by the increased incidence of depression within the first 9 months. The most propitious time to prevent or attenuate depressive episodes in bereaved youth may be shortly after the parent’s death. Interventions that target complicated grief and blaming of others may also improve outcomes in symptomatic youth with parental bereavement. PMID:19411367

Digital Storytelling: Families' Search for Meaning after Child Death.

PubMed

Rolbiecki, Abigail J; Washington, Karla; Bitsicas, Katina

2017-01-01

Bereaved families that collectively make meaning of their grief experiences often function better than those that do not, yet most social work bereavement interventions target individuals rather than family units. In this article, authors describe an innovative social work intervention that employs digital storytelling. This is a narrative technique that combines photography, music, and spoken word to help families bereaved by child death make meaning of their loss and envision a future without their deceased child.

The impact of bereaved parents' perceived grief similarity on relationship satisfaction.

PubMed

Buyukcan-Tetik, Asuman; Finkenauer, Catrin; Schut, Henk; Stroebe, Margaret; Stroebe, Wolfgang

2017-06-01

The present research focused on bereaved parents' perceived grief similarity, and aimed to investigate the concurrent and longitudinal effects of the perceptions that the partner has less, equal, or more grief intensity than oneself on relationship satisfaction. Participants of our longitudinal study were 229 heterosexual bereaved Dutch couples who completed questionnaires 6, 13, and 20 months after the loss of their child. Average age of participants was 40.7 (SD = 9.5). Across 3 study waves, participants' perceived grief similarity and relationship satisfaction were assessed. To control for their effects, own grief level, child's gender, expectedness of loss, parent's age, parent's gender, and time were also included in the analyses. Consistent with the hypotheses, cross-sectional results revealed that bereaved parents who perceived dissimilar levels of grief (less or more grief) had lower relationship satisfaction than bereaved parents who perceived similar levels of grief. This effect remained significant controlling for the effects of possible confounding variables and actual similarity in grief between partners. We also found that perceived grief similarity at the first study wave was related to the highest level of relationship satisfaction at the second study wave. Moreover, results showed that perceived grief similarity was associated with a higher level in partner's relationship satisfaction. Results are discussed considering the comparison and similarity in grief across bereaved partners after child loss. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Prolonged grief and post-traumatic stress among relatives of missing persons and homicidally bereaved individuals: A comparative study.

PubMed

Lenferink, Lonneke I M; van Denderen, Mariëtte Y; de Keijser, Jos; Wessel, Ineke; Boelen, Paul A

2017-02-01

Traumatic loss (e.g., homicide) is associated with elevated prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD). Several studies comparing relatives of missing persons with homicidally bereaved individuals showed inconsistent results about the difference in PGD- and PTSD-levels between the groups. These studies were conducted in the context of armed conflict, which may confound the results. The current study aims to compare PGD- and PTSD-levels between the groups outside the context of armed conflict. Relatives of long-term missing persons (n=134) and homicidally bereaved individuals (n=331) completed self-report measures of PGD and PTSD. Multilevel regression modelling was used to compare symptom scores between the groups. Homicidally bereaved individuals reported significantly higher levels of PGD (d=0.86) and PTSD (d=0.28) than relatives of missing persons, when taking relevant covariates (i.e., gender, time since loss, and kinship to the disappeared/deceased person) into account. A limitation of this study is the use of self-report measures instead of clinical interviews. Prior studies among relatives of missing persons and homicidally bereaved individuals in the context of armed conflict may not be generalizable to similar samples outside these contexts. Future research is needed to further explore differences in bereavement-related psychopathology between different groups and correlates and treatment of this psychopathology. Copyright © 2016 Elsevier B.V. All rights reserved.

Continuing bonds in bereaved Pakistani Muslims: effects of culture and religion.

PubMed

Suhail, Kausar; Jamil, Naila; Oyebode, Jan; Ajmal, Mohammad Asir

2011-01-01

This study explores the bereavement process and continuing bond in Pakistani Muslims with the focus on how culture and religion influence these processes. Ten participants were interviewed and their transcribed interviews were analyzed using a grounded theory approach. Three main domains were identified from the narratives expressed by the participants: death and the process of grieving, continuing the link with the deceased, and influencing agents. The findings indicated that Pakistani Muslims maintained their link with the deceased through cultural and religious rituals, such as performing prayers, reciting holy verses, talking and dreaming about the deceased, doing charity, visiting graves, and arranging communal gatherings. The prime purpose of many of these practices was the forgiveness of the deceased. Grief reactions seemed to be determined by the nature of death, prior relationships with the deceased, reaction of society and gender of the bereaved. Religion provided a strong basis for coping and adjustment of the bereaved, through rationalizing and accepting the death. This study has important implications for counselors and family therapists who can use religious affliations to reduce the impact of loss and complicated bereavement.

The therapeutic effectiveness of using visual art modalities with the bereaved: a systematic review.

PubMed

Weiskittle, Rachel E; Gramling, Sandra E

2018-01-01

Bereaved individuals are increasingly considered at risk for negative psychological and physiological outcomes. Visual art modalities are often incorporated into grief therapy interventions, and clinical application of art therapy techniques with the bereaved has been widely documented. Although clinicians and recipients of these interventions advocate for their helpfulness in adapting to bereavement, research investigating the efficacy of visual art modalities has produced equivocal results and has not yet been synthesized to establish empirical support across settings. Accordingly, this review critically evaluates the existent literature on the effectiveness of visual art modalities with the bereaved and offers suggestions for future avenues of research. A total of 27 studies were included in the current review. Meta-analysis was not possible because of clinical heterogeneity and insufficient comparable data on outcome measures across studies. A narrative synthesis reports that therapeutic application of visual art modalities was associated with positive changes such as continuing bonds with the deceased and meaning making. Modest and conflicting preliminary evidence was found to support treatment effectiveness in alleviating negative grief symptoms such as general distress, functional impairment, and symptoms of depression and anxiety.

The Japan HOspice and Palliative Care Evaluation Study (J-HOPE Study): views about legalization of death with dignity and euthanasia among the bereaved whose family member died at palliative care units.

PubMed

Okishiro, Nao; Miyashita, Mitsunori; Tsuneto, Satoru; Sato, Kazuki; Shima, Yasuo

2009-01-01

There has been a debate in appropriateness of legalization of death with dignity and euthanasia in Japan. To clarify views about these issues, we conducted a large nationwide study of the bereaved whose family member died at palliative care units. The percentages of 429 bereaved family members (response rate 65%) who affirmed legal authorization were 52 for death with dignity and 45 for euthanasia and who affirmed assignment at the discretion of the physician involved were 37 for death with dignity and 38 for euthanasia. In conclusion, views about legalization of death with dignity and euthanasia among the bereaved are inconsistent. No consensus is reached as to legislation of these issues.

The Shared Experience Help the Bereavement to Flow: A Family Support Group Evaluation.

PubMed

Henoch, Ingela; Berg, Christina; Benkel, Inger

2016-12-01

When a family member dies, a bereavement period is taking place for all family members. The death of a parent during childhood is a highly stressful event. This study evaluates families' experiences of family support groups when a parent has died. Families were participate in groups for children, teenagers, young adults, and parents in seven sessions. The same topic which was discussed in all groups. The support groups were evaluated qualitatively and quantitatively. The participants were satisfied with the groups and experienced that the shared experience facilitated bereavement to proceed. The results indicate that families' experiences is being more open about feelings in their own family. A support group can be one possibility to help the whole family in the bereavement. © The Author(s) 2015.

The associations between religion, bereavement and depression among Hong Kong nurses.

PubMed

Cheung, Teris; Lee, Paul H; Yip, Paul S F

2017-07-04

This paper is to examine the associations between religion, bereavement and depression among nursing professionals using a cross-sectional survey design. There is little empirical evidence in Asia suggesting that religion may either increase or lower the likelihood of nursing professionals being depressed. We analyzed the results of a Mental Health Survey soliciting data from 850 Hong Kong nurses (aged 21-59, 178 males) regarding their mental well-being and associated factors, including participants' socio-economic profile and recent life-events. Multiple linear regression analyses examined associations between religion, bereavement and depression. Religious faith is weakly associated with lower self-reported depression in bereavement. Our findings confirm those studies suggesting that religion positively affects mental health and yet healthcare providers have yet to assimilate this insight.

Effects of psychoeducation on helpful support for complicated grief: a preliminary randomized controlled single-blind study.

PubMed

Nam, I S

2016-01-01

Complicated grief is a distinct psychological response of individuals facing the loss of a loved one and can lead to many types of adverse health outcomes. Although social support may be beneficial, few studies have examined the beneficial effects of helpful support on complicated grief following bereavement. A randomized controlled trial was conducted. Bereaved participants and supporters were randomized to psychoeducation on complicated grief and helpful social support or psychoeducation on complicated grief. The primary outcome was the Inventory of Complicated Grief. The results showed that psychoeducation of supporters of bereaved individuals has significant beneficial effects. Particularly, symptoms of complicated grief were decreased in bereaved individuals with supporters that received psychoeducation. The results highlight the potential of psychoeducation to facilitate helpful social support and reduce complicated grief.

Effective Communication With Bereaved Child Survivors of Suicide

PubMed Central

Mitchell, Ann M.; Wesner, Susan; Brownson, Lynn; Dysart-Gale, Deborah; Garand, Linda; Havill, Allyson

2010-01-01

TOPIC While bereavement is considered by many to be among the most stressful life events, it becomes even more distressing when it is related to the suicide of a loved one. Further, the death of a parent is traumatic for anyone, but it may be especially intensified for young children. This points to a strong need for the recognition and treatment of psychiatric and social problems associated with childhood bereavement. PURPOSE AND SOURCES The purpose of this paper is to review the literature and present a synopsis of the psychosocial outcomes of childhood suicide survivor bereavement and outline communication issues that emerge when talking with young suicide survivors. CONCLUSIONS A case is made to develop and test interventions designed to meet the mental health needs of this important group of individuals. PMID:16913962

Essential Questions on Suicide Bereavement and Postvention

PubMed Central

Andriessen, Karl; Krysinska, Karolina

2011-01-01

During the past decades public and research interest in postvention, i.e., support for families and communities after a suicide, has increased. However, the postvention field is still facing a number of important challenges and questions. This article aims to discuss a series of essential issues on suicide bereavement and postvention, regarding the current state of the art and future developments. Who is a suicide survivor and how many suicide survivors are there? Is suicide bereavement different from other types of bereavement? What are the needs of suicide survivors and what is postvention from a clinical perspective and from a public health perspective? Can postvention be prevention? With this last question, the article concludes with a series of recommendations in order to strengthen the potential of postvention as prevention. PMID:22470275

Bereavement and Complicated Grief

PubMed Central

Ghesquiere, Angela; Glickman, Kim

2013-01-01

Bereavement is a common experience in adults age 60 and older. Loss of a loved one usually leads to acute grief characterized by yearning and longing, decreased interest in ongoing activities, and frequent thoughts of the deceased. For most, acute grief naturally evolves into a state of integrated grief, where the bereaved is able to reengage with everyday activities and find interest or pleasure. About 7% of bereaved older adults, however, will develop the mental health condition of Complicated Grief (CG). In CG, the movement from acute to integrated grief is derailed, and grief symptoms remain severe and impairing. This article reviews recent publications on the diagnosis of CG, risk factors for the condition, and evidenced-based treatments for CG. Greater attention to complicated grief detection and treatment in older adults is needed. PMID:24068457

Attitudes to suicide following the suicide of a friend or relative: a qualitative study of the views of 429 young bereaved adults in the UK.

PubMed

Pitman, Alexandra; Nesse, Hedvig; Morant, Nicola; Azorina, Valeriya; Stevenson, Fiona; King, Michael; Osborn, David

2017-12-13

People bereaved by suicide are at increased risk of suicide attempt and suicide, but explanations for these associations remain theoretical. It is possible that the experience of suicide bereavement modifies personal attitudes towards suicide, but the nature of these changes remains unexplored. There is a need to understand personal attitudes to suicide following suicide bereavement, as this may inform the development of suicide prevention interventions. Our aim was to explore the attitudes of young adults bereaved by suicide towards their own likelihood of dying by suicide. We conducted a cross-sectional study of staff and students aged 18-40 at 37 United Kingdom (UK) higher educational institutions in 2010. Ethical approval was granted by the UCL Research Ethics Committee. Qualitative responses to a question probing attitudes to own suicide were provided by 429 respondents who had experienced bereavement by the suicide of a close contact. We identified key themes in this dataset using thematic analysis. Analysis identified four main themes: suicide as a more tangible option (whether feared or not); identification with the deceased and awareness of shared vulnerabilities to suicide; personal determination to avoid suicide; and beliefs regarding safeguards against suicide. These themes reflected a broad split in participants' views regarding own likelihood of dying by suicide, influenced by the degree to which own suicide was feared and the extent to which they felt in control of determining a suicide death. Whilst the majority described an aversion to the idea of attempting suicide themselves, largely through an awareness of the impact on others, a minority described their experiences as having normalised suicide as a personal option. The views of a sample of UK-based adults bereaved by suicide suggest that exposure to the suicide of a close friend or relative can influence attitudes to suicide in ways that could influence own risk of suicide attempt. The normalising attitudes to suicide observed in a minority of respondents could contribute to the observed association between suicide bereavement and suicide attempt.

Long-term Effects of the Family Bereavement Program (FBP) on Spousally-Bereaved Parents: Grief, Mental Health, Alcohol Problems, and Coping Efficacy

PubMed Central

Sandler, Irwin; Tein, Jenn-Yun; Cham, Heining; Wolchik, Sharlene; Ayers, Tim

2016-01-01

Objective Reports on the finding from a six-year follow-up of a randomized trial of the Family Bereavement Program (FBP) on outcomes for spousally-bereaved parents. Method Spousally-bereaved parents (N=131) participated in the trial in which they were randomly assigned to receive the FBP (N = 72) or literature control (LC, N = 59). Parents were assessed at four time points, pre-test, post-test, 11-months, and six-year follow-up. Parents reported on mental health problems, grief and parenting at all four time periods. At the six-year follow-up parents reported on additional measures of persistent complex bereavement disorder, alcohol abuse problems, and coping efficacy. Results Bereaved parents in the FBP as compared to those in the LC had lower levels of symptoms of depression, general psychiatric distress, prolonged grief, alcohol problems, and higher coping efficacy at the six-year follow-up. Multiple characteristics of the parent (e.g., gender, age, baseline mental health problems) and of the spousal death (e.g., cause of death) were tested as moderators of program effects on each outcome. Latent-growth modeling found that the effects of the FBP on depression, psychiatric distress and grief occurred immediately following program participation and were maintained over six-years. Mediation analysis found that improvement in positive parenting partially mediated program effects to reduce depression and psychiatric distress, but had an indirect effect to higher levels of grief at the six years follow-up. Mediation analysis also found that improved parenting at the six year follow-up was partially mediated by program effects to reduce depression and that program effects to increase coping efficacy at the six-year follow-up was partially mediated through reduced depression and grief and improved parenting. Conclusions FBP reduced mental health problems, prolonged grief and alcohol abuse and increased coping efficacy of spousally-bereaved parents six years later. Mediation pathways for program effects differed across outcomes at the six-year follow-up. PMID:27427807

Bereavement

MedlinePlus

... as a mental, physical, social or emotional reaction. Mental reactions can include anger, guilt, anxiety, sadness and despair. Physical reactions can include sleeping problems, changes in appetite, physical problems or illness. How long bereavement lasts can depend on how ...

The Effects of the Family Bereavement Program to Reduce Suicide Ideation and/or Attempts of Parentally Bereaved Children Six and Fifteen Years Later.

PubMed

Sandler, Irwin; Tein, Jenn-Yun; Wolchik, Sharlene; Ayers, Tim S

2016-04-01

Findings concerning the long-term effects of the Family Bereavement Program (FBP) to reduce suicide ideation and/or attempts of parentally bereaved children and adolescents are presented. Parental death is a significant risk factor for suicide among offspring (Guldin et al., 2015). This study is a long-term follow-up of 244 children and adolescents who had participated in a randomized trial of the FBP, examining the intervention effects on suicide ideation and/or attempts as assessed through multiple sources. Results indicate a significant effect of the FBP to reduce suicide ideation and/or attempts at the 6- and 15-year follow-up evaluation. The findings support the potential benefits of further research on "upstream" suicide prevention. © 2016 The American Association of Suicidology.

An inner struggle for hope: insights from the diaries of bereaved family caregivers.

PubMed

Holtslander, Lorraine; Duggleby, Wendy

2008-10-01

To explore the experience of hope for bereaved palliative caregivers through participant hope diaries. A secondary analysis of hope diaries collected as part of a grounded theory study of hope and bereavement. Twelve older women from a small Canadian city completed a hope diary. Content analysis (Patton, 2002) was applied to describe and interpret the data. Hope was a feeling of peace, courage, strength, and self-confidence that enabled them to face each day and look to the future with a positive outlook. Hindrances to hope were multiple losses, loneliness, and physical health concerns, which created an inner struggle for hope. Hope was fostered through positive thoughts, connections, and taking care. Writing in the diary affected their experience of hope. The diaries provide unique insight into their experience, suggesting practical ways to foster hope in bereavement.

Oppression of the bereaved: a critical analysis of grief in Western society.

PubMed

Harris, Darcy

Bereaved individuals often experience profound social pressure to conform to societal norms that constrict the experience of grief rather than support it. This article explores grief in Western society through an analysis of the underlying structures and values that are a part of this social system, utilizing the lens of critical theory. Critical theory examines social norms and conditions in order to identify and expose oppression in various contexts. This article examines the social rules that govern the expression of grief, the role of attachment, social pain, and shame as potent forces that promote compliance with social rules, and the ways that the underlying assumptions and values in Western society shape how bereaved individuals are expected to react. Implications for clinicians who work with terminally ill or bereaved individuals are then reviewed.

An evaluative survey to assess the effectiveness of using an interactive workbook to deliver bereavement education to undergraduate student midwives.

PubMed

Hollins Martin, Caroline J; Forrest, Eleanor; Wylie, Linda; Martin, Colin R

2014-08-01

the NMSF (2009) reported that 74 Trusts (40%) in the UK lack expertise in delivering maternity based bereavement care. In response, three midwifery lecturers were issued with a small grant from NHS Scotland to devise and evaluate an interactive workbook intended to develop student midwives understanding of how to deliver high quality bereavement care. to develop a workbook called--'an interactive workbook to shape bereavement care for midwives in clinical practice'--and evaluate it for effectiveness at delivering learning objectives developed from the literature and from prior written lesson plans. an evaluative audit was carried out using a scored questionnaire--Understanding Bereavement Evaluation Tool (UBET)--to gather data before and post-workbook completion. The UBET was purposely designed to gather data about participants' perceived level of learning before and post-workbook completion. Participants were student midwives (n=179) in their second/third year of study on a three year midwifery degree programme at one of three universities. the mean pre-workbook UBET score equalled 16.04 (SD=3.81) and post-intervention 26.45 (SD=2.16). A significant main effect of observation point was observed (p<0.001), with post-intervention scores considerably higher than pre-intervention. findings demonstrate that the workbook is an effective method for teaching bereavement care to student midwives (it is available from the first author). Copyright © 2013 Elsevier Ltd. All rights reserved.

Bereaved mothers' and fathers' perceptions of a legacy intervention for parents of infants in the NICU.

PubMed

Akard, T F; Duffy, M; Hord, A; Randall, A; Sanders, A; Adelstein, K; Anani, U E; Gilmer, M J

2018-01-01

Legacy-making, actions or behaviors aimed at being remembered, may be one strategy to enhance coping and improve grief outcomes for bereaved parents and siblings. While legacy interventions have been developed and tested in pediatric and adult populations, legacy activities specific to bereaved parents in the neonatal intensive care unit remain unexplored. This study explored bereaved parents' perceptions of a digital storytelling legacy-making intervention for parents after the death of an infant. Six bereaved mothers and fathers participated in a focus group interview three to 12 months after the death of an infant in the NICU. A semi-structured interview guide with open-ended questions was used to obtain parent self-reports. Qualitative content analysis identified emerging themes. Four major themes emerged regarding participants' perceptions of a legacy intervention: (a) parents' willingness to participate in a legacy intervention, (b) parents' suggestions for a feasible intervention, (c) parents' suggestions for an acceptable intervention, and (d) parents' perceived benefits of legacy-making. Participants reported that a legacy-making intervention via digital storytelling would be feasible, acceptable, and beneficial for NICU parents. Study results support the need and desire for legacy-making services to be developed and offered in the NICU.

The therapeutic effectiveness of using visual art modalities with the bereaved: a systematic review

PubMed Central

Gramling, Sandra E

2018-01-01

Bereaved individuals are increasingly considered at risk for negative psychological and physiological outcomes. Visual art modalities are often incorporated into grief therapy interventions, and clinical application of art therapy techniques with the bereaved has been widely documented. Although clinicians and recipients of these interventions advocate for their helpfulness in adapting to bereavement, research investigating the efficacy of visual art modalities has produced equivocal results and has not yet been synthesized to establish empirical support across settings. Accordingly, this review critically evaluates the existent literature on the effectiveness of visual art modalities with the bereaved and offers suggestions for future avenues of research. A total of 27 studies were included in the current review. Meta-analysis was not possible because of clinical heterogeneity and insufficient comparable data on outcome measures across studies. A narrative synthesis reports that therapeutic application of visual art modalities was associated with positive changes such as continuing bonds with the deceased and meaning making. Modest and conflicting preliminary evidence was found to support treatment effectiveness in alleviating negative grief symptoms such as general distress, functional impairment, and symptoms of depression and anxiety. PMID:29440940

Acknowledging sexual bereavement: a path out of disenfranchised grief.

PubMed

Radosh, Alice; Simkin, Linda

2016-11-01

Despite increasing awareness of the importance of sexuality for older adults, research and popular literature rarely acknowledge what we term "sexual bereavement" - mourning the loss of sexual intimacy when predeceased. The reluctance to acknowledge sexual bereavement may create "disenfranchised grief" leaving the bereaved unsupported in coping with this aspect of mourning. This preliminary study focuses on women in the United States and sought to determine whether they anticipate missing sex if predeceased, whether they would want to talk about this loss, and identified factors associated with communicating about sexual bereavement. Findings from our survey of 104 women, 55 years and older, most of whom were heterosexual, revealed that a large majority (72%) anticipates missing sex with their partner and 67% would want to initiate a discussion about this. An even higher percentage would want friends to initiate the topic. Yet, 57% of participants report it would not occur to them to initiate a discussion with a widowed friend about the friend's loss. Disenfranchised grief can have negative emotional and physical consequences. This paper suggests a role for friends and professionals in addressing this neglected issue. Copyright © 2016 Elsevier Inc. All rights reserved.

Psychiatric disorders in patients who lost family members to cancer and asked for medical help: descriptive analysis of outpatient services for bereaved families at Japanese cancer center hospital.

PubMed

Ishida, Mayumi; Onishi, Hideki; Wada, Mei; Tada, Yukio; Ito, Hiroshi; Narabayashi, Masaru; Sasaki, Yasutsuna; Nomura, Shinobu; Uchitomi, Yosuke

2011-03-01

There have been no previous studies about consultation of the bereaved who have lost a loved one to cancer and ask for medical help. The aim of this study was to investigate their basic characteristics and their psychiatric disorders. A retrospective study using clinical and background data obtained over 30 months (from April 2007 to September 2009) was conducted at outpatient services for bereaved families at the Department of Psycho-Oncology at Saitama Medical University International Medical Center, Japan. During the period of investigation, 51 patients underwent consultation. The patients were frequently female (P < 0.0001) and the spouse of the deceased. Regarding the psychiatric diagnoses, major depression was the most common (39%), followed by adjustment disorders (28%). This study revealed basic characteristics and psychiatric disorders of the bereaved who asked for medical help. Most of the patients were women (86.3%) and 86.3% of them received a psychiatric diagnosis. This information is important for both physicians and psychologists since the bereaved who have lost a loved one to cancer often ask for medical help in clinical settings.

The case for a sociology of dying, death, and bereavement.

PubMed

Thompson, Neil; Allan, June; Carverhill, Philip A; Cox, Gerry R; Davies, Betty; Doka, Kenneth; Granek, Leeat; Harris, Darcy; Ho, Andy; Klass, Dennis; Small, Neil; Wittkowski, Joachim

2016-01-01

Dying, death, and bereavement do not occur in a social vacuum. How individuals and groups experience these phenomena will be largely influenced by the social context in which they occur. To develop an adequate understanding of dying, death, and bereavement we therefore need to incorporate a sociological perspective into our analysis. This article examines why a sociological perspective is necessary and explores various ways in which sociology can be of practical value in both intellectual and professional contexts. A case study comparing psychological and sociological perspectives is offered by way of illustration.

Water immersion in neonatal bereavement photography.

PubMed

Duffey, Heather

2014-01-01

Water immersion in neonatal bereavement photography is a new technique intended to enhance the quality of the photographs provided to families following their loss. Water immersion appears to be most helpful following a second trimester fetal demise. This technique can be used by nurses, professional photographers and others in addition to more traditional neonatal bereavement photography. It does not require special skills or equipment and can be implemented in virtually any perinatal setting. The enhanced quality of photographs produced with this method can potentially provide a source of comfort to grieving families. © 2014 AWHONN.

Parental understanding and self-blame following sudden infant death: a mixed-methods study of bereaved parents' and professionals' experiences

PubMed Central

Griffiths, Frances; Sidebotham, Peter

2016-01-01

Objectives Improvements in our understanding of the role of modifiable risk factors for sudden infant death syndrome (SIDS) mean that previous reassurance to parents that these deaths were unpreventable may no longer be appropriate. This study aimed to learn of bereaved parents' and healthcare professionals' experiences of understanding causes of death following detailed sudden unexpected death in infancy (SUDI) investigations. The research questions were: How do bereaved parents understand the cause of death and risk factors identified during detailed investigation following a sudden unexpected infant death? What is the association between bereaved parents' mental health and this understanding? What are healthcare professionals' experiences of sharing such information with families? Design This was a mixed-methods study using a Framework Approach. Setting Specialist paediatric services. Participants Bereaved parents were recruited following detailed multiagency SUDI investigations; 21/113 eligible families and 27 professionals participated giving theoretical saturation of data. Data collection We analysed case records from all agencies, interviewed professionals and invited parents to complete the Hospital Anxiety and Depression Scale (HADS) and questionnaires or in-depth interviews. Results Nearly all bereaved parents were able to understand the cause of death and several SIDS parents had a good understanding of the relevant modifiable risk factors even when these related directly to their actions. Paediatricians worried that discussing risk factors with parents would result in parental self-blame and some deliberately avoided these discussions. Over half the families did not mention blame or blamed no one. The cause of death of the infants of these families varied. 3/21 mothers expressed overwhelming feelings of self-blame and had clinically significant scores on HADS. Conclusions Bereaved parents want detailed information about their child's death. Our study suggests parents want health professionals to explain the role of risk factors in SIDS. We found no evidence that sharing this information is a direct cause of parental self-blame. PMID:27198994

The bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner: A systematic review, thematic synthesis and modelling of the literature

PubMed Central

Bristowe, Katherine; Marshall, Steve; Harding, Richard

2016-01-01

Background: Socially excluded populations have poorer access to care; however, little attention has been paid to lesbian, gay, bisexual and/or trans* people. Lesbian, gay, bisexual and/or trans* people are at increased risk of certain life-limiting illnesses and may not receive the care and support they need at the end of life and into bereavement. Aim: To identify and appraise the evidence of the bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner and develop an explanatory model of lesbian, gay, bisexual and/or trans* partner bereavement. Design: Systematic review (in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) and thematic synthesis with assessment of reporting and rigour. Quantitative or qualitative articles reporting bereavement experiences of lesbian, gay, bisexual and/or trans* partners were included, excluding articles reporting multiple losses in the context of HIV or AIDS. Data sources: PsycINFO, MEDLINE, Web of Science, Scopus, Cochrane Library. Inclusion dates: database inception – 30 April 2015. Results: A total of 23 articles reporting on 13 studies were identified. Studies described universal experiences of the pain of losing a partner; however, additional barriers and stressors were reported for lesbian, gay, bisexual and/or trans* people, including homophobia, failure to acknowledge the relationship, additional legal and financial issues and the ‘shadow’ of HIV or AIDS. A novel model was developed to explain how the experience for lesbian, gay, bisexual and/or trans* people is shaped by whether the relationship was disclosed and acknowledged in life and into bereavement and how this impacts upon needs and access to care. Conclusion: There is a need for healthcare providers to avoid hetero-normative assumptions; be mindful of additional stressors in bereavement for lesbian, gay, bisexual and/or trans* people; and consider additional sources of support to deliver individualised holistic care. PMID:26944532

Assessing the quality of bereavement care after perinatal death: development and piloting of a questionnaire to assess parents' experiences.

PubMed

Aiyelaagbe, Esther; Scott, Rebecca E; Holmes, Victoria; Lane, Emma; Heazell, Alexander E P

2017-10-01

Understanding parents' experience of care is essential to develop high-quality perinatal bereavement services. This study aimed at developing a questionnaire to identify parents' needs and record their experience of care. The patient experience questionnaire was developed by professionals and parents, and piloted in a tertiary maternity unit. Responses were received from 58 parents. Sensitivity and kindness of staff and time spent with their baby were ranked as 'very important' by 95% of parents. Care in these areas largely met their needs (90%), although 5% of respondents stated that partners could have been more involved. Between 8% and 15% of respondents did not feel that language used at the diagnosis of fetal death was sensitive, clear and unambiguous. Parents did not always receive written information about their care (5%) or post-mortem (13%). Analysis of bereaved parents' responses identified areas for improvement including greater involvement of partners and a need for timely information. Impact statement What is already known on this subject?: Good quality bereavement care after perinatal death reduces the negative emotional, psychological and social effects for parents. Description of parents' experiences is a potential means to improve the quality of perinatal bereavement care. What do the results of this study add?: Parents' needs and experiences of care after perinatal death were recorded using a patient-experience questionnaire designed by a multi-professional team and parents. Staff behaviour, particularly sensitivity and kindness was highly valued by parents. Giving both verbal and written information could be improved. Training is needed for professionals, particularly those who come into contact with bereaved parents less frequently. What are the implications of these findings for clinical practice and/or further research?: Description of parents' priorities and views can be used to identify areas for improvement in perinatal bereavement care. Parents' views should be regularly sought and used to develop local services in an iterative process.

Bereavement-related depression: Did the changes induced by DSM-V make a difference? Results from a large population-based survey of French residents.

PubMed

Clesse, Florence; Leray, Emmanuelle; Bodeau-Livinec, Florence; Husky, Mathilde; Kovess-Masfety, Viviane

2015-08-15

DSM-V has been criticized for excessively expanding criteria for bereavement-related depression. The aim of this study was to quantify a potential increase in depression prevalence due to changes in diagnostic criteria and to assess the severity, clinical profile and healthcare use of new cases. A cross-sectional telephone survey was performed in 2005-2006 in four French regions. Twelve-month prevalence of psychiatric disorders was measured by CIDI-SF. Bereavement was assessed in those who endorsed the gate question to the depression module. Persons with bereavement-related depression according to DSM-IV and DSM-V diagnosis criteria were compared. Of the 22,138 respondents, 692 were bereaved. The prevalence of depression among those bereaved was 49.9% (95% CI ¼=43.7−56.0) according to DSM-IV and 59.6% (53.1−66.1) according to DSM-V [corrected]. The overall prevalence of major depression increased from 8.6% (8.1–9.1) with DSM-IV to 8.8% (8.3−9.3) with DSM-V . Cases diagnosed using DSM-IV presented more symptoms than cases diagnosed using DSM-V but clinical features were similar except regarding criterion E׳s symptoms. Healthcare use was similar between the two groups regarding consultations and psychotropic drug prescription. Some DSM-IV and DSM-V criteria were difficult to operationalize in the survey. The observed difference in prevalence according to DSM-IV and DSM-V may be reduced when clinical judgment is taken into account. The overall prevalence of major depression is only marginally increased by the new criteria. However, diagnostic changes increase the prevalence by 10 points among those bereaved. Diagnostic changes do not appear to modify service use. Copyright © 2015 Elsevier B.V. All rights reserved.

"It's a traumatic illness, traumatic to witness." A qualitative study of the experiences of bereaved family caregivers of patients with cutaneous T-cell lymphoma.

PubMed

Orlowska, D; Selman, L E; Beynon, T; Radcliffe, E; Whittaker, S; Child, F; Harding, R

2018-02-16

Cutaneous T-cell lymphomas (CTCL) are rare cancers which can be difficult to diagnose, are incurable and adversely affect quality of life, particularly in advanced disease. Families often provide care, but little is known about their experiences or needs while caring for their relative with advanced disease or in bereavement. To explore the experiences of bereaved family caregivers of patients with CTCL. Single semi-structured qualitative interviews were conducted with bereaved family caregivers of patients with CTCL recruited via a supra-regional CTCL clinic. Transcribed interviews were analysed thematically, focusing on advanced disease, the approach of death and bereavement. Fifteen carers of eleven deceased patients participated. Experiences clustered under four themes 1 Complexity of care and medical intervention 2 Carer roles in advanced CTCL 3 Person vs. organisation-centred care in advanced CTCL 4 Knowing and not knowing: reflections on dying, death and bereavement Caregivers often had vivid recollections of the challenges of caring for their relative with advanced CTCL and some took on quasi-professional roles as a result. Advanced disease made high demands on both organisational flexibility and family resources. For many caregivers, seeing disease progression was a prolonged and profoundly traumatic experience. The extent to which they were prepared for their relative's death and supported in bereavement was highly variable. Subthemes within each theme provide more detail about caregiver experiences. Family caregivers should be considered part of the wider healthcare team, acknowledging their multiple roles and the challenges they encounter in looking after their relative with CTCL as the disease progresses. Their experiences highlight the importance of organisational flexibility and of good communication between health care providers in advanced CTCL. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Extending the construct validity of dependency among conjugally bereaved adults.

PubMed

Denckla, Christy A; Bornstein, Robert F; Mancini, Anthony D; Bonanno, George A

2015-06-01

The Relationship Profile Test is a widely used measure of dependency, detachment, and healthy dependency that has been examined in both clinical and nonclinical settings, though researchers have yet to validate this measure among conjugally bereaved adults. The present study examines the construct validity of a three-facet model of dependency-detachment by comparing relationships among self-report, semistructured interview-rated, and knowledgeable informant-rated functioning among conjugally bereaved adults. Participants (N = 112) included bereaved adults (M = 51.1 years; SD = 9.7) who had experienced the loss of a spouse 1.5 to 3 years prior to taking part in this study. Findings indicate adequate psychometric properties and theoretically expected associations with various measures of wellness and health including satisfaction with life, coping flexibility, somatic complaints, and ego resiliency. Results draw attention to adaptive correlates of dependency, suggesting potentially beneficial mental health interventions. © The Author(s) 2014.

Extending the Construct Validity of Dependency Among Conjugally Bereaved Adults

PubMed Central

Denckla, Christy A.; Bornstein, Robert F.; Mancini, Anthony D.; Bonanno, George A.

2017-01-01

The Relationship Profile Test is a widely used measure of dependency, detachment, and healthy dependency that has been examined in both clinical and nonclinical settings, though researchers have yet to validate this measure among conjugally bereaved adults. The present study examines the construct validity of a three-facet model of dependency–detachment by comparing relationships among self-report, semistructured interview–rated, and knowledgeable informant–rated functioning among conjugally bereaved adults. Participants (N = 112) included bereaved adults (M = 51.1 years; SD = 9.7) who had experienced the loss of a spouse 1.5 to 3 years prior to taking part in this study. Findings indicate adequate psychometric properties and theoretically expected associations with various measures of wellness and health including satisfaction with life, coping flexibility, somatic complaints, and ego resiliency. Results draw attention to adaptive correlates of dependency, suggesting potentially beneficial mental health interventions. PMID:25038214

Bereaved adults with intellectual disabilities: a combined randomized controlled trial and qualitative study of two community-based interventions.

PubMed

Dowling, S; Hubert, J; White, S; Hollins, S

2006-04-01

Bereaved adults with intellectual disabilities are known to experience prolonged and atypical grief which is often unrecognized. The aim of this project was to find an effective way to improve mental health and behavioural outcomes. Subjects were randomized to two different therapeutic interventions: traditional counselling by volunteer bereavement counsellors, and an integrated intervention delivered by carers which offered bereavement specific support. Qualitative and quantitative methods were used to determine their effectiveness and efficacy. The counselling intervention resulted in measurable gains both clinically and in terms of quality of life; the second intervention proved impracticable in most settings and no improvement in mental health or behaviour resulted. Despite small numbers, the quantitative findings were highly significant, were supported by the qualitative data, and were of practical relevance to primary care practitioners and specialist mental health and intellectual disability staff.

Anxiety Sensitivity in Bereaved Adults with and without Complicated Grief

PubMed Central

Robinaugh, Donald J.; McNally, Richard J.; LeBlanc, Nicole J.; Pentel, Kimberly Z.; Schwarz, Noah R.; Shah, Riva M.; Nadal-Vicens, Mireya F.; Moore, Cynthia W.; Marques, Luana; Bui, Eric; Simon, Naomi M.

2014-01-01

Complicated grief (CG) is a bereavement specific syndrome chiefly characterized by symptoms of persistent separation distress. Physiological reactivity to reminders of the loss and repeated acute pangs or waves of severe anxiety and psychological pain are prominent features of CG. Fear of this grief-related physiological arousal may contribute to CG by increasing the distress associated with grief reactions and increasing the likelihood of maladaptive coping strategies and grief-related avoidance. Here, we examined anxiety sensitivity (i.e., the fear of anxiety-related sensations; AS) in two studies of bereaved adults with and without CG. In both studies, bereaved adults with CG exhibited elevated AS relative to those without CG. In Study 2, AS was positively associated with CG symptom severity among those with CG. These findings are consistent with the possibility that AS contributes to the development or maintenance of CG symptoms. PMID:25075646

Factors influencing bereaved families' decisions about organ donation: an integrative literature review.

PubMed

Walker, Wendy; Broderick, Andrew; Sque, Magi

2013-11-01

This article reports on the process and outcomes of a systematic integrative literature review, designed to enhance understanding of the factors influencing bereaved families' decisions to agree or decline the donation of their deceased relative's organs for transplantation. Research originating from eight Western countries (N = 20 studies) provided an international perspective to the review. Thematic analysis and synthesis of textual data culminated in the development of three global themes (past, present, and future) that captured the temporal dimensions of family decision making. The review findings provide valuable insight into ways of increasing the rate of consent to organ donation through the development family-centered care interventions that reflect the needs of the bereaved. Further research to explore the pathway of donation after circulatory death and the experiences of bereaved families who decline organ donation is essential to providing a more complete understanding of the factors affecting donation decisions.

Cultural perspectives of death, grief, and bereavement.

PubMed

Clements, Paul T; Vigil, Gloria J; Manno, Martin S; Henry, Gloria C; Wilks, Jonathan; Das Sarthak; Kellywood, Rosie; Foster, Wil

2003-07-01

The cultural makeup of the United States continues to change rapidly, and as minority groups continue to grow, these groups' beliefs and customs must be taken into account when examining death, grief, and bereavement. This article discusses the beliefs, customs, and rituals of Latino, African American, Navajo, Jewish, and Hindu groups to raise awareness of the differences health care professionals may encounter among their grieving clients. Discussion of this small sample of minority groups in the United States is not intended to cover all of the degrees of acculturation within each group. Cultural groups are not homogeneous, and individual variation must always be considered in situations of death, grief, and bereavement. However, because the customs, rituals, and beliefs of the groups to which they belong affect individuals' experiences of death, grief, and bereavement, health care professionals need to be open to learning about them to better understand and help.

Risk of substance use disorders following prenatal or postnatal exposure to bereavement.

PubMed

Liang, Hong; Olsen, Jørn; Cnattingus, Sven; Vestergaard, Mogens; Obel, Carsten; Gissler, Mika; Sørensen, Merete Juul; Li, Jiong

2013-09-01

Substance use disorder (SUD) is associated with major socioeconomic consequences but its etiology is only partly known. The disease predisposition may be established early in life and prenatal stress may play a role. We aimed to examine whether prenatal maternal bereavement, as the indicator of prenatal stress, was associated with an increased risk of SUD in offspring. This population-based cohort study included all children born in Denmark (N=1686416) and Sweden (N=2563659) from 1973 to 1997. The exposure was maternal bereavement by the death of a close relative 1 year before or during pregnancy. Children were followed from 10 years of age until their death, migration, onset of substance abuse, or December 31st, 2007. The main outcome is hospitalization due to substance use disorder (SUD). A total of 100363 children (2.45%) were born to mothers who had experienced bereavement 1 year before or during pregnancy. Overall, these exposed children had a similar risk of hospitalization due to SUD (IRR=1.02, 95% CI: 0.98-1.07), compared to unexposed children. Children born to mothers who lost a spouse during pregnancy had a two-fold risk (IRR=2.19, 95% CI: 1.74-2.76) and similar elevated risks were observed in children whose mothers lost a spouse during the first 10 years after child birth. Our data do not support a programming role of prenatal stress following maternal bereavement on SUD later in life. The increased risk in relation to spousal bereavement may mostly be explained by postpartum changes in familial environment. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Increased beta power in the bereaved families of the Sewol ferry disaster: A paradoxical compensatory phenomenon? A two-channel electroencephalography study.

PubMed

Jang, Kuk-In; Shim, Miseon; Lee, Sang Min; Huh, Hyu Jung; Huh, Seung; Joo, Ji-Young; Lee, Seung-Hwan; Chae, Jeong-Ho

2017-11-01

The Sewol ferry capsizing accident on South Korea's southern coast resulted in the death of 304 people, and serious bereavement problems for their families. Electroencephalography (EEG) beta frequency is associated with psychiatric symptoms, such as insomnia. The aim of this study was to investigate the relation between frontal beta power, psychological symptoms, and insomnia in the bereaved families. Eighty-four family members of the Sewol ferry victims (32 men and 52 women) were recruited and their EEG was compared with that of 25 (13 men and 12 women) healthy controls. A two-channel EEG device was used to measure cortical activity in the frontal lobe. Symptom severity of insomnia, post-traumatic stress disorder, complicated grief, and anxiety were evaluated. The bereaved families showed a higher frontal beta power than healthy controls. Subgroup analysis showed that frontal beta power was lower in the individuals with severe insomnia than in those with normal sleep. There was a significant inverse correlation between frontal beta power and insomnia symptom in the bereaved families. This study suggests that increased beta power, reflecting the psychopathology in the bereaved families of the Sewol ferry disaster, may be a compensatory mechanism that follows complex trauma. Frontal beta power could be a potential marker indicating the severity of sleep disturbances. Our results suggest that sleep disturbance is an important symptom in family members of the Sewol ferry disaster's victims, which may be screened by EEG beta power. © 2017 The Authors. Psychiatry and Clinical Neurosciences © 2017 Japanese Society of Psychiatry and Neurology.

"It still haunts me whether we did the right thing": a qualitative analysis of free text survey data on the bereavement experiences and support needs of family caregivers.

PubMed

Harrop, Emily; Morgan, Fiona; Byrne, Anthony; Nelson, Annmarie

2016-11-08

Research suggests that there may be bereavement experiences and support needs which are specific to family caregivers providing end of life care (EoLC), although this remains an under-researched area. This paper focuses on themes relating to bereavement which were derived from an analysis of free text survey responses collected in a research priority setting exercise for palliative and EoLC. The priority setting exercise involved a public survey, designed to generate research priorities. Rather than identify research topics, many people instead described their experiences and raised more general questions relating to palliative and end of life care. To explore these experiences and perspectives a supplementary thematic analysis was conducted on the survey responses. 1403 respondents took part, including patients, current and bereaved carers, health and social care professionals, volunteers and members of the public. Several grief issues were identified, which seem specific to the experiences of family caregivers. Responses demonstrated a relationship between death experiences, feelings of guilt and bereavement outcomes for some family caregivers, as well as caregiver experiences of a "void" created by the withdrawal of professional support after death. Communication and support needs were also identified by participants. This analysis provides further evidence of some of the specific effects that caring for a loved one at the end of life can have on bereavement experiences. Finding ways of improving communication around the time of death and effective follow up approaches post death could help to address some of these issues.

Grief, Bereavement, and Coping With Loss (PDQ®)—Patient Version

Cancer.gov

Grief, bereavement (mourning), and coping with loss are common challenges following the loss of a loved one from cancer. Learn about coping and the grief process in adults and children in this expert-reviewed information summary.

The Bereaved Parent Needs Assessment: a new instrument to assess the needs of parents whose children died in the pediatric intensive care unit*.

PubMed

Meert, Kathleen L; Templin, Thomas N; Michelson, Kelly N; Morrison, Wynne E; Hackbarth, Richard; Custer, Joseph R; Schim, Stephanie M; Briller, Sherylyn H; Thurston, Celia S

2012-11-01

To evaluate the reliability and validity of the Bereaved Parent Needs Assessment, a new instrument to measure parents' needs and need fulfillment around the time of their child's death in the pediatric intensive care unit. We hypothesized that need fulfillment would be negatively related to complicated grief and positively related to quality of life during bereavement. Cross-sectional survey. Five U.S. children's hospital pediatric intensive care units. Parents (n = 121) bereaved in a pediatric intensive care unit 6 months earlier. Surveys included the 68-item Bereaved Parent Needs Assessment, the Inventory of Complicated Grief, and the abbreviated version of the World Health Organization Quality of Life questionnaire. Each Bereaved Parent Needs Assessment item described a potential need and was rated on two scales: 1) a 5-point rating of importance (1 = not at all important, 5 = very important) and 2) a 5-point rating of fulfillment (1 = not at all met, 5 = completely met). Three composite scales were computed: 1) total importance (percentage of all needs rated ≥4 for importance), 2) total fulfillment (percentage of all needs rated ≥4 for fulfillment), and 3) percent fulfillment (percentage of important needs that were fulfilled). Internal consistency reliability was assessed by Cronbach's α and Spearman-Brown-corrected split-half reliability. Generalized estimating equations were used to test predictions between composite scales and the Inventory of Complicated Grief and World Health Organization Quality of Life questionnaire. Two items had mean importance ratings <3, and 55 had mean ratings >4. Reliability of composite scores ranged from 0.92 to 0.94. Total fulfillment was negatively correlated with Inventory of Complicated Grief (r = -.29; p < .01) and positively correlated with World Health Organization Quality of Life questionnaire (r = .21; p < .05). Percent fulfillment was also significantly correlated with both outcomes. Adjusting for parent's age, education, and loss of an only child, percent fulfillment remained significantly correlated with Inventory of Complicated Grief but not with World Health Organization Quality of Life questionnaire. The Bereaved Parent Needs Assessment demonstrated reliability and validity to assess the needs of parents bereaved in the pediatric intensive care unit. Meeting parents' needs around the time of their child's death may promote adjustment to loss.

Thank you for your lovely card: ethical considerations in responding to bereaved parents invited in error to participate in childhood cancer survivorship research.

PubMed

Wakefield, Claire E; McLoone, Jordana K; Donovan, Leigh A; Cohn, Richard J

2015-02-01

Research exploring the needs of families of childhood cancer survivors is critical to improving the experiences of future families faced by this disease. However, there are numerous challenges in conducting research with this unique population, including a relatively high mortality rate. In recognition that research with cancer survivors is a relational activity, this article presents a series of cases of parents bereaved by childhood cancer who unintentionally received invitations to participate in survivorship research. We explore six ethical considerations, and compare our experiences with that described previously. Our considerations include the sharing of confidential information with external parties to confirm past patients' vital status and appropriate researcher responses to bereaved parents. The management of researchers' emotional safety when working with illness populations and the fact that study invitations can elicit grief responses in non-bereaved families are discussed. To conclude, we argue for the benefits of inviting bereaved parents whose children died after treatment completion in survivorship research. Such parents' early survivorship experiences will otherwise be systemically neglected. We argue that discussing complex cases can assist researchers to protect participants' and researchers' emotional well-being. We hope to contribute to the dearth of discussion about research operating procedures to address these issues.

Palliative care consultation, quality-of-life measurements, and bereavement for end-of-life care in patients with lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).

PubMed

Griffin, John P; Koch, Kathryn A; Nelson, Judith E; Cooley, Mary E

2007-09-01

To develop clinical practice guidelines for application of palliative care consultation, quality-of-life measurements, and appropriate bereavement activities for patients with lung cancer. To review the pertinent medical literature on palliative care consultation, quality-of-life measurements, and bereavement for patients with lung cancer, developing multidisciplinary discussions with authorities in these areas, and evolving written guidelines for end-of-life care of these patients. Palliative care consultation has developed into a new specialty with credentialing of experts in this field based on extensive experience with patients in end-of-life circumstances including those with lung cancer. Bereavement studies of the physical and emotional morbidity of family members and caregivers before, during, and after the death of a cancer patient have supported truthful communication, consideration of psychological problems, effective palliative care, understanding of the patient's spiritual and cultural background, and sufficient forewarning of impending death. Multidisciplinary investigations and experiences, with emphasis on consultation and delivery of palliative care, timely use of quality-of-life measurements for morbidities of treatment modalities and prognosis, and an understanding of the multifaceted complexities of the bereavement process, have clarified additional responsibilities of the attending physician.

Complicated grief and bereavement in young adults following close friend and sibling loss.

PubMed

Herberman Mash, Holly B; Fullerton, Carol S; Ursano, Robert J

2013-12-01

This study examined the association between types of loss (i.e., sibling or close friend) and relationship quality (i.e., depth and conflict) with complicated grief, depression, somatic symptoms, and world assumptions in bereaved young adults. Participants were 107 young adults aged 17-29 years who were either bereaved or had never experienced a loss. Among bereaved participants, 66 lost a close friend and seven lost a sibling within the past 3 years (M = 1.63 years). Nineteen percent of the young adults met criteria for complicated grief and 31% had mild to severe depression. Participants with a deceased sibling reported greater depth in the relationship as compared to those who lost a friend. They were also more likely to have complicated grief (57% versus 15%) and report significantly higher levels of grief, depression, and somatic symptoms. Those who lost a sibling reported a lower sense of meaningfulness and benevolence of the world and self-worth as compared with those who lost a close friend or had not experienced a loss. Complicated grief and depression are common among bereaved young adults. Sibling loss is particularly distressing to young adults, due in part to the high level of relationship depth, and is associated with increased psychological and physical symptoms postloss. © 2013 Wiley Periodicals, Inc.

Religion and spirituality in online suicide bereavement: an analysis of online memorials.

PubMed

Krysinska, Karolina; Andriessen, Karl; Corveleyn, Jozef

2014-01-01

Religion and spirituality can be valuable resources in coping with bereavement. There is a paucity of studies focusing specifically on their role in suicide bereavement, although there are indications that religion/spirituality can be helpful for suicide survivors. The study explores the role of religion and/or spirituality in suicide bereavement by analyzing this theme in online memorials dedicated to suicide victims. We randomly selected 250 memorials in two online cemeteries: Faces of Suicide and Gone too Soon. Interpretative and deductive thematic analysis was used to identify themes in the collected material, including the theme of religion/spirituality. References to religion/spirituality were found in 14% of memorials. These memorials were written by family members, friends, and (ex-)partners of the deceased and were dedicated mostly to young adult males. Religion/spirituality was mentioned in the context of God's will, peace wish, continuation of the spirit, afterlife, reunion, gratitude, description of the deceased, and grief reactions of suicide survivors. Some suicide survivors spontaneously mention the role of religious/spiritual beliefs in coping with their loss. Future studies could explore which subgroups of the bereaved are likely to turn to these resources, and whether they can contribute to the well-being of the suicide survivors.

The bereavement process of tissue donors' family members: responses of grief, posttraumatic stress, personal growth, and ongoing attachment.

PubMed

Hogan, Nancy; Schmidt, Lee; Coolican, Maggie

2014-09-01

Donated tissues can save lives of critically burned patients and those needing a heart valve replacement. Tissues enhance the lives of a million recipients annually through transplants of corneas, bones, tendons, and vein grafts. Unfortunately, the need for some tissues exceeds their availability. The goal of the quantitative component of this mixed methods study was to identify the grief, posttraumatic stress, personal growth, and ongoing attachment response of tissue donors' family members during a 2-year period. Simultaneous mixed methods design. The sample for this study consisted of 52 tissue donors' family members, mostly widows (83%). Data were collected for 2 years to test changes in grief, posttraumatic stress, panic behavior, personal growth, and ongoing attachment. The bereaved participants experienced significantly fewer grief reactions, less posttraumatic stress, and greater personal growth. There was no significant difference in the ongoing attachment to their deceased loved ones. The results of this study may reinforce the positive meaning that tissue donors' family members can find in tissue donation. Findings also demonstrate that the bereavement process corroborates contemporary bereavement and attachment theories. Health professionals are encouraged to seek donations with less worry that tissue donors' family members will experience adverse outcomes during bereavement.

Bereavement and behavioral changes as risk factors for cognitive decline in adults with Down syndrome.

PubMed

Fonseca, Luciana Mascarenhas; de Oliveira, Melaine Cristina; de Figueiredo Ferreira Guilhoto, Laura Maria; Cavalheiro, Esper Abrao; Bottino, Cássio Mc

2014-01-01

Cognitive decline and Alzheimer's disease often affect older adults with Down syndrome (DS) much earlier than those in the general population. There is also growing evidence of the effects of negative life events on the mental health and behavior of individuals with intellectual disability. However, to our knowledge, this is the first study investigating objective cognitive decline following bereavement in aging individuals with DS. The objective of this study was to determine whether cognitive decline correlates with bereavement following the recent loss of a caregiver or with behavioral changes in a sample of adult individuals with DS who do not meet the criteria for dementia or depression, using the longitudinal assessment of the Cambridge Cognitive Examination (CAMCOG), together with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). We evaluated 18 subjects at baseline and over a follow-up period of 14-22 months, attempting to determine whether cognitive decline correlates with bereavement following the recent loss of the main caregiver or with behavioral changes (as assessed with the Neuropsychiatric Inventory). The mean rate of change in CAMCOG was -1.83 (standard deviation 4.51). Behavioral changes had a significant direct influence on cognitive decline. When bereavement was accompanied by behavioral changes, the probability of cognitive decline was 87% (odds ratio 3.82). The occurrence of behavioral changes attributed to bereavement following the loss of the primary caregiver significantly increases the probability of cognitive decline in individuals with DS. Longitudinal comparison of the CAMCOG and use of the IQCODE appear to enrich the analysis of cognitive decline in individuals with DS. Further studies involving larger samples are needed in order to corroborate and expand upon our findings, which can have implications for the clinical management of older adults with DS.

Languages of Grief: a model for understanding the expressions of the bereaved

PubMed Central

Corless, Inge B.; Limbo, Rana; Bousso, Regina Szylit; Wrenn, Robert L.; Head, David; Lickiss, Norelle; Wass, Hannelore

2014-01-01

The aim of this work is to provide an overview of the key features of the expressions of grief. Grief is a response to loss or anticipated loss. Although universal, its oral and nonverbal expression varies across cultures and individuals. Loss is produced by an event perceived to be negative to varying degrees by the individuals involved and has the potential to trigger long-term changes in a person's cognitions and relationships. The languages used by the bereaved to express grief differ from the language used by professionals, creating dissonance between the two. Data were obtained from English language Medline and CINAHL databases, from professional and personal experiences, interviews with experts, and exploration of cemetery memorials. Blog websites and social networks provided additional materials for further refinement of the model. Content analysis of the materials and agreement by the authors as to the themes resulted in the development of the model. To bridge the gap between professional language and that used by the bereaved, a Languages of Grief model was developed consisting of four Modes of Expression, four Types of Language, plus three Contingent Factors. The Languages of Grief provides a framework for comprehending the grief of the individual, contributing to clinical understanding, and fruitful exploration by professionals in better understanding the use of languages by the bereaved. Attention to the Modes of Expression, Types of Language, and Contingent Factors provides the professional with a richer understanding of the grieving individual, a step in providing appropriate support to the bereaved. The Languages of Grief provides a framework for application to discrete occurrences with the goal of understanding grief from the perspective of the bereaved. PMID:25750773

Offspring psychopathology following preconception, prenatal, and postnatal maternal bereavement stress

PubMed Central

Class, Quetzal A.; Abel, Kathryn M.; Khashan, Ali S.; Rickert, Martin E.; Dalman, Christina; Larsson, Henrik; Hultman, Christina M.; Långström, Niklas; Lichtenstein, Paul; D’Onofrio, Brian M.

2013-01-01

Background Preconception, prenatal, and postnatal maternal stress are associated with increased offspring psychopathology, but findings are inconsistent and need replication. We estimated associations between maternal bereavement stress and offspring autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, suicide attempt, and completed suicide. Methods Using Swedish registers, we conducted the largest population-based study to date examining associations between stress exposure in 738,144 offspring born 1992–2000 for childhood outcomes and 2,155,221 offspring born 1973–1997 for adult outcomes with follow-up through 2009. Maternal stress was defined as death of a first degree relative during 6 months before conception, across pregnancy, or the first two postnatal years. Cox proportional survival analyses were used to obtain hazard ratios (HR) in unadjusted and adjusted analyses. Results Marginal increased risk of bipolar disorder and schizophrenia following preconception bereavement stress was not significant. Third trimester prenatal stress increased risk of ASD (adjusted HR=1.58, 95% CI: 1.15–2.17) and ADHD (adjusted HR=1.31, 95% CI: 1.04–1.66). First postnatal year stress increased risk for offspring suicide attempt (adjusted HR=1.13, 95% CI: 1.02–1.25) and completed suicide (adjusted HR=1.51, 95% CI: 1.08–2.11). Bereavement stress during the second postnatal year increased risk of ASD (adjusted HR=1.30, 95% CI: 1.09–1.55). Conclusions Further research is needed on associations between preconception stress and psychopathological outcomes. Prenatal bereavement stress increases risk of offspring ASD and ADHD. Postnatal bereavement stress moderately increases risk of offspring suicide attempt, completed suicide, and ASD. Smaller previous studies may have overestimated associations between early stress and psychopathological outcomes. PMID:23591021

Grief interventions for people bereaved by suicide: A systematic review.

PubMed

Linde, Katja; Treml, Julia; Steinig, Jana; Nagl, Michaela; Kersting, Anette

2017-01-01

Adaption to the loss of a loved one due to suicide can be complicated by feelings of guilt, shame, responsibility, rejection, and stigmatization. Therefore people bereaved by suicide have an increased risk for developing complicated grief which is related to negative physical and mental disorders and an increased risk for suicidal behavior. Grief interventions are needed for this vulnerable population. The aim of this systematic review was to provide an overview of the current state of evidence concerning the effectiveness of interventions that focus on grief for people bereaved by suicide. We conducted a systematic literature search using PubMed, Web of Science, and PsycINFO for articles published up until November 2016. Relevant papers were identified and methodological quality was assessed by independent raters. A narrative synthesis was conducted. Seven intervention studies met the inclusion criteria. Two interventions were based on cognitive-behavioral approaches, four consisted of bereavement groups, and one utilized writing therapy. As five of the seven interventions were effective in reducing grief intensity on at least one outcome measure, there is some evidence that they are beneficial. Bereavement groups tend to be effective in lowering the intensity of uncomplicated grief, as are writing interventions in lowering suicide-specific aspects of grief. Cognitive-behavioral programs were helpful for a subpopulation of people who had high levels of suicidal ideation. On average, methodological quality was low so the evidence for benefits is not robust. The stability of treatment effects could not be determined as follow-up assessments are rare. Generalizability is limited due to homogeneous enrollments of mainly female, white, middle-aged individuals. People bereaved by suicide are especially vulnerable to developing complicated grief. Therefore, grief therapies should be adapted to and evaluated in this population. Prevention of complicated grief may be successful in populations of high risk individuals.

Longitudinal changes and predictors of prolonged grief for bereaved family caregivers over the first 2 years after the terminally ill cancer patient's death.

PubMed

Tsai, Wei-I; Prigerson, Holly G; Li, Chung-Yi; Chou, Wen-Chi; Kuo, Su-Ching; Tang, Siew Tzuh

2016-05-01

A significant minority of bereaved caregivers experience prolonged grief. However, few longitudinal studies have examined prolonged grief, especially in an Asian context. We explored longitudinal changes and factors predicting prolonged grief in bereaved caregivers of terminally ill Taiwanese cancer patients. Observational, prospective, and longitudinal. Prolonged grief symptoms were measured with the PG-13 at 6, 13, 18, and 24 months postloss. A convenience sample of 493 caregivers (83.3% participation rate) of terminally ill cancer patients was recruited from a medical center in Taiwan. The prevalence of prolonged grief decreased significantly over time from the patient's death (7.73%, 1.80%, 2.49%, and 1.85% at 6, 13, 18, and 24 months postloss, respectively, p < 0.05 at all times in reference to 6 months postloss). Caregivers' likelihood of prolonged grief was significantly higher if they had severe preloss depressive symptoms, negatively perceived their relative's dying situation, and were poorly prepared for the patient's death. However, the likelihood of prolonged grief decreased significantly with greater perceived concurrent social support and subjective caregiving burden right before the patient's death. Prolonged grief in bereavement diminished over time and was predicted by modifiable factors before, during, and after bereavement. To facilitate bereavement adjustment and avoid prolonged grief, healthcare professionals should develop and provide at-risk caregivers with effective interventions starting when patients are still alive to improve their dying experience, to facilitate preparedness for the patient's forthcoming death, to alleviate caregivers' preloss depressive symptoms, and to enhance their perceived postloss social support. © The Author(s) 2015.

Effects of the Family Bereavement Program on Academic Outcomes, Educational Expectations and Job Aspirations 6 Years Later: The Mediating Role of Parenting and Youth Mental Health Problems

PubMed Central

Schoenfelder, Erin N.; Tein, Jenn-Yun; Wolchik, Sharlene; Sandler, Irwin N.

2014-01-01

Experiencing the death of a parent during childhood is associated with a variety of difficulties, including lower academic achievement, that have implications for functioning in childhood and adulthood. This study examines effects of the Family Bereavement Program (FBP), a preventive intervention for parentally-bereaved youth and their caregivers, on grade point averages (GPA), educational expectations and job aspirations of youths 6 years after the intervention. A total of 244 bereaved youths ages 8-16 and their caregivers were randomized to either the FBP or a comparison group that received books about bereavement. Assessments occurred at pretest, post-test, and 11-month and 6-year follow-ups. Direct program effects on educational outcomes and job aspirations 6 years later were non-significant, although the program improved educational expectations for children with fewer behavior problems at program entry, and GPA for younger children. Mediational pathways for program effects on educational outcomes were also tested. Program-induced improvements in effective parenting at 11-month follow-up were associated with higher GPAs at 6-year follow-up for youth who were younger or for whom more time had passed since the loss. Program-induced improvements in parenting and teacher-rated youth mental health problems at the 6-year follow-up mediated program effects on youths’ educational expectations for those with fewer behavior problems at program entry. The implications of these findings for understanding processes related to academic and educational outcomes following the death of a parent and for prevention efforts to help bereaved and other high-risk children succeed in school are discussed. PMID:25052624

Bereaved families are still embittered after the Sewol ferry accident in Korea: A follow-up study 18 and 30months after the disaster.

PubMed

Yun, Ji-Ae; Huh, Hyu-Jung; Han, Hye-Sung; Huh, Seung; Chae, Jeong-Ho

2018-04-01

The Sewol ferry accident that occurred in April 2014 was one of the most tragic human-made disasters in Korean history. Due to the deaths of hundreds of children, bereaved families likely feel embittered; however, there is little extant research documenting embitterment among those who experienced the disaster. Consequently, we investigated bereaved family members' embitterment and other psychiatric symptoms 18months and 30months after the disaster. Data from a cross-sectional survey were obtained 18months (Time 1) and 30months (Time 2) after the disaster. We ascertained socio-demographic variables and variables obtained from a self-reporting questionnaire (i.e., depression, anxiety, posttraumatic stress disorder, complicated grief, and embitterment) among 56 bereaved family members. Bereaved families showed substantial embitterment at Time 1 (64.3%), which increased at Time 2 (76.8%, t=1.761, p=0.084). The participants who displayed increased embitterment at Time 2 also increased in anxiety, post-traumatic stress symptoms, and complicated grief (but not depression). Furthermore, participants who displayed decreased embitterment at Time 2 also decreased in all other psychiatric symptoms. (time×group interaction in depression (F 0.644, p=0.426), anxiety (F 4.970, p=0.030), PTSD (F 10.699, p=0.002), and complicated grief (F 8.389, p=0.005)). Embitterment of bereaved families had not ceased after 18months and even increased 1year later. Additionally, as embitterment increased, many other psychiatric symptoms also increased, and vice versa. Our results suggest that embitterment is associated or can even influence other psychiatric symptoms; therefore, embitterment should be examined after disasters. Copyright © 2018 Elsevier Inc. All rights reserved.

Languages of Grief: a model for understanding the expressions of the bereaved.

PubMed

Corless, Inge B; Limbo, Rana; Bousso, Regina Szylit; Wrenn, Robert L; Head, David; Lickiss, Norelle; Wass, Hannelore

2014-01-01

The aim of this work is to provide an overview of the key features of the expressions of grief. Grief is a response to loss or anticipated loss. Although universal, its oral and nonverbal expression varies across cultures and individuals. Loss is produced by an event perceived to be negative to varying degrees by the individuals involved and has the potential to trigger long-term changes in a person's cognitions and relationships. The languages used by the bereaved to express grief differ from the language used by professionals, creating dissonance between the two. Data were obtained from English language Medline and CINAHL databases, from professional and personal experiences, interviews with experts, and exploration of cemetery memorials. Blog websites and social networks provided additional materials for further refinement of the model. Content analysis of the materials and agreement by the authors as to the themes resulted in the development of the model. To bridge the gap between professional language and that used by the bereaved, a Languages of Grief model was developed consisting of four Modes of Expression, four Types of Language, plus three Contingent Factors. The Languages of Grief provides a framework for comprehending the grief of the individual, contributing to clinical understanding, and fruitful exploration by professionals in better understanding the use of languages by the bereaved. Attention to the Modes of Expression, Types of Language, and Contingent Factors provides the professional with a richer understanding of the grieving individual, a step in providing appropriate support to the bereaved. The Languages of Grief provides a framework for application to discrete occurrences with the goal of understanding grief from the perspective of the bereaved.

General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study

PubMed Central

2014-01-01

Background General Practitioners (GPs) are well-positioned to provide grief support to patients. Most GPs view the provision of bereavement care as an important aspect of their role and the GP is the health professional that many people turn to when they need support. We aimed to explore GPs’ understandings of bereavement care and their education and professional development needs in relation to bereavement care. Methods An in-depth qualitative design was adopted using a social constructionist approach as our aims were exploratory and applied. Nineteen GPs (12 women and 7 men) living in Western Australia were interviewed; 14 were based in metropolitan Perth and 5 in rural areas. GPs were invited, via a letter, to participate in a semi-structured interview. The interviews occurred within each GP’s workplace or, for the rural GPs, via telephone, and all interviews were digitally audio-recorded and transcribed. Results Analysis was based upon constant comparison and began as soon as possible after each interview. The data revealed four tensions or opposing views concerning bereavement and bereavement care. These were (1) whether grief is a standardised versus an individual process, (2) the role of the GP in intervening versus promoting resilience, (3) the GP as a broker of services versus a service provider, and (4) the need for formal education and professional development versus ‘on-the-job’ experiential learning. Conclusions GPs have a critical role in exploring distress, including grief. However, changes need to be made to ensure GPs have up-to-date knowledge of contemporary theories and approaches. GPs urgently need education both at the undergraduate and postgraduate degree levels, and in continuing professional development. Otherwise GPs will rely on out-dated theories and constructions of grief, which may be detrimental to patient care. PMID:24670040

General Practitioners' experiences of bereavement care and their educational support needs: a qualitative study.

PubMed

O'Connor, Moira; Breen, Lauren J

2014-03-27

General Practitioners (GPs) are well-positioned to provide grief support to patients. Most GPs view the provision of bereavement care as an important aspect of their role and the GP is the health professional that many people turn to when they need support. We aimed to explore GPs' understandings of bereavement care and their education and professional development needs in relation to bereavement care. An in-depth qualitative design was adopted using a social constructionist approach as our aims were exploratory and applied. Nineteen GPs (12 women and 7 men) living in Western Australia were interviewed; 14 were based in metropolitan Perth and 5 in rural areas. GPs were invited, via a letter, to participate in a semi-structured interview. The interviews occurred within each GP's workplace or, for the rural GPs, via telephone, and all interviews were digitally audio-recorded and transcribed. Analysis was based upon constant comparison and began as soon as possible after each interview. The data revealed four tensions or opposing views concerning bereavement and bereavement care. These were (1) whether grief is a standardised versus an individual process, (2) the role of the GP in intervening versus promoting resilience, (3) the GP as a broker of services versus a service provider, and (4) the need for formal education and professional development versus 'on-the-job' experiential learning. GPs have a critical role in exploring distress, including grief. However, changes need to be made to ensure GPs have up-to-date knowledge of contemporary theories and approaches. GPs urgently need education both at the undergraduate and postgraduate degree levels, and in continuing professional development. Otherwise GPs will rely on out-dated theories and constructions of grief, which may be detrimental to patient care.

DSM-5: proposed changes to depressive disorders.

PubMed

Wakefield, Jerome C

2012-03-01

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is currently undergoing a revision that will lead to a fifth edition in 2013. Proposed changes for DSM-5 include the creation of several new categories of depressive disorder. Some nosologists have expressed concern that the proposed changes could yield many 'false-positive diagnoses' in which normal distress is mislabeled as a mental disorder. Such confusion of normal distress and mental disorder undermines the interpretability of clinical trials and etiological research, causes inefficient allocation of resources, and incurs risks of unnecessary treatment. To evaluate these concerns, I critically examine five proposed DSM-5 expansions in the scope of depressive and grief disorders: (1) a new mixed anxiety/depression category; (2) a new premenstrual dysphoric disorder category; (3) elimination of the major depression bereavement exclusion; (4) elimination of the adjustment disorder bereavement exclusion, thus allowing the diagnosis of subsyndromal depressive symptoms during bereavement as adjustment disorders; and (5) a new category of adjustment disorder related to bereavement for diagnosing pathological non-depressive grief. I examine each proposal's face validity and conceptual coherence as well as empirical support where relevant, with special attention to potential implications for false-positive diagnoses. I conclude that mixed anxiety/depression and premenstrual dysphoric disorder are needed categories, but are too broadly drawn and will yield substantial false positives; that the elimination of the bereavement exclusion is not supported by the evidence; and that the proposed elimination of the adjustment-disorder bereavement exclusion, as well as the new category of grief-related adjustment disorder, are inconsistent with recent grief research, which suggests that these proposals would massively pathologize normal grief responses.

Effectiveness of a Hospice Community Bereavement Program.

ERIC Educational Resources Information Center

Longman, Alice J.

1993-01-01

Assessed extent of unresolved grief in bereaved individuals attending two programs, their spiritual perspectives, and the relationship between them. Fifty-six individuals completed questionnaires, and 42 completed same questionnaires 3 months later. Results indicated that individuals manifested initial reactions to death, and these reactions were…

Survivor-Victim Status, Attachment, and Sudden Death Bereavement.

ERIC Educational Resources Information Center

Reed, Mark D.; Greenwald, Jason Y.

1991-01-01

Examined significance of survivor-victim relationship in understanding grief following sudden death bereavement by suicide or accident. Results showed that survivor-victim attachment was more important than survivor status (parent versus sibling/child) in explaining grief reactions. Compared to accident survivors, suicide survivors experienced…

Pilot evaluation of a group therapy program for children bereaved by suicide.

PubMed

Daigle, Marc S; Labelle, Réal J

2012-01-01

Thousands of children are bereaved each year by suicide, yet there exists very little literature specifically on the psychological care, programs, and interventions available to help them. (1) To build and validate theoretical models for the Group Therapy Program for Children Bereaved by Suicide (PCBS); (2) to test these models in a preliminary evaluation. In the first part, we built theoretical models, which were then validated by scientists and clinicians. In the second part, the sessions of the PCBS were observed and rated. The participating children were tested pre- and postprogram. Positive changes were observed in the participating children in terms of basic safety, realistic understanding and useful knowledge, inappropriate behaviors, physical and psychological symptoms, child-parent and child-child communication, capacity for social and affective reinvestment, actualization of new models of self and the world, self-esteem, awareness and use of tools, cognitive, verbal, written and drawing abilities, cognitive dissonance, ambivalence, antagonism, and isolation. The changes reported in the bereaved children show that the PCBS has some efficacy.

[Bereavement and complicated grief: towards a definition of Prolonged Grief Disorder for DSM-5].

PubMed

Lombardo, Luigi; Lai, Carlo; Luciani, Massimiliano; Morelli, Emanuela; Buttinelli, Elena; Aceto, Paola; Lai, Silvia; D'Onofrio, Marianna; Galli, Federico; Bellizzi, Fernando; Penco, Italo

2014-01-01

Mourning is a natural response to a loss and a condition which most people experience several times during their lives. Most individuals adjust adequately to the loss of a relative, neverthless, a small but noteworthy proportion of bereaved individuals experience a syndrome of prolonged psychological distress in relation to bereavement. Prolonged distress and disability in connection with bereavement has been termed Complicated Grief (CG) or Prolonged Grief Disorder (PGD). The purpose of this paper is to analyze the literature on loss and mourning making a review of the main studies published between 1993 and 2013, identified through a search conducted on Medline/PubMed, in order to describe the epidemiological and clinical aspects of "normal" grief and "complicated" grief, pointing out the path of the clinical definition of PGD and proposed diagnostic criteria for inclusion in the next edition of the Diagnostic and Statistic Manual of Mental Disorders, Fifth edition (DSM-5). The two main diagnostic systems proposed by Horowitz and Prigerson are also compared.

Gradually Disengaging: Parent-Health care Provider Relationships After a Child's Death in the Pediatric Intensive Care Unit.

PubMed

Butler, Ashleigh E; Hall, Helen; Copnell, Beverley

2018-06-01

When a child dies in the intensive care unit, many bereaved parents want relationships with their child's health care staff to continue in the form of follow-up care. However, the nature of these relationships and how they change across the parents' bereavement journey is currently unknown. This article explores early and ongoing relationships between parents and health care staff when a child dies in intensive care. Constructivist grounded theory methods were used to recruit 26 bereaved parents from four Australian pediatric intensive care units into the study. Data were collected via audio-recorded, semistructured interviews and analyzed using the constant comparative methods and theoretical memoing. Findings show that these relationships focus on Gradually disengaging, commonly moving through three phases after the child dies: Saying goodbye, Going home, and Seeking supports. These findings provide guidance to health care staff on what families need as they leave the intensive care unit and move through bereavement.

Domains of Social Support That Predict Bereavement Distress Following Homicide Loss.

PubMed

Bottomley, Jamison S; Burke, Laurie A; Neimeyer, Robert A

2017-05-01

Psychological adaptation following homicide loss can prove more challenging for grievers than other types of losses. Although social support can be beneficial in bereavement, research is mixed in terms of identifying whether it serves as a buffer to distress following traumatic loss. In particular, studies have not parsed out specific domains of social support that best predict positive bereavement outcomes. Recruiting a sample of 47 African Americans bereaved by homicide, we examined six types of social support along with the griever's perceived need for or satisfaction with each and analyzed them in relation to depression, anxiety, complicated grief, and posttraumatic stress disorder outcomes. Results of multivariate analyses revealed that the griever's level of satisfaction with physical assistance at the initial assessment best predicted lower levels of depression, anxiety, and posttraumatic stress disorder levels 6 months later, while less need for physical assistance predicted lower complicated grief at follow-up. Clinical implications and suggestions for future research are discussed.

An internet-based self-help intervention for older adults after marital bereavement, separation or divorce: study protocol for a randomized controlled trial.

PubMed

Brodbeck, Jeannette; Berger, Thomas; Znoj, Hans Joerg

2017-01-13

Marital bereavement and separation or divorce are among the most stressful critical life events in later life. These events require a dissolution of social and emotional ties, adjustments in daily routine and changes in identity and perspectives for the future. After a normative grief or distress reaction, most individuals cope well with the loss. However, some develop a prolonged grief reaction. Internet-based self-help interventions have proved beneficial for a broad range of disorders, including complicated grief. Based on the task model and the dual-process model of coping with bereavement, we developed a guided internet-based self-help intervention for individuals who experienced marital bereavement, separation or divorce at least 6 months prior to enrolment. The intervention consists of 10 text-based self-help sessions and one supportive email a week. The primary purpose of this study is the evaluation of the feasibility and efficacy of the intervention compared with a waiting control group. The secondary purpose is to compare the effects in bereaved and separated participants. Furthermore, we aim to analyze other predictors, moderators and mediators of the outcome, such as age, psychological distress and intensity of use of the intervention. The design is a randomized controlled trial with a waiting control condition of 12 weeks and a 24-weeks follow-up. At least 72 widowed or separated participants will be recruited via our study website and internet forums. Primary outcomes are reductions in grief symptoms, depression and psychological distress. Secondary outcome measures are related to loneliness, satisfaction with life, embitterment and the sessions. The trial will provide insights into the acceptance and efficacy of internet-based interventions among adults experiencing grief symptoms, psychological distress and adaptation problems in daily life after spousal bereavement, separation or divorce. Findings will add to existing knowledge by (1) evaluating an internet-based intervention specifically designed for spousal bereavement and its consequences; (2) testing whether this intervention is equally effective for individuals after separation or divorce; and (3) suggesting adaptations to improve the efficacy of the intervention, selective indication and adaptations for different needs. ClinicalTrials.gov, NCT02900534 . Registered on 1 September 2016.

Perinatal death: uncovering the needs of midwives and nurses and exploring helpful interventions in the United States, England, and Japan.

PubMed

Gardner, J M

1999-04-01

Perinatal death is a crisis for midwives and nurses as well as for bereaved parents and extended families. Surveys and interviews conducted in the United States, England, and Japan described the needs and responses of nurses and midwives as they coped with their own feelings while caring for bereaved parents. Results emphasized common needs of caregivers for increased knowledge, mentored experience, communication skills, and personal support to confidently provide sensitive care to families. Although need for education regarding cultural-specific care was revealed, participants identified helpful strategies of care for bereaved parents that could extend and improve care universally.

Bereaved adults' evaluations of grief management messages: effects of message person centeredness, recipient individual differences, and contextual factors.

PubMed

Rack, Jessica J; Burleson, Brant R; Bodie, Graham D; Holmstrom, Amanda J; Servaty-Seib, Heather

2008-01-01

This study identifies grief management strategies that bereaved adults evaluate as more and less helpful, assesses whether the person centeredness of these strategies explains their helpfulness, and determines whether strategy helpfulness varies as a function of demographic, personality, and situational factors. Participants (105 bereaved young adults) assessed the helpfulness of 16 grief management strategies; these strategies were coded for their degree of person centeredness. Strategy person centeredness was strongly correlated with helpfulness. Strategy helpfulness varied as a function of participant gender and the disruptiveness of the decedent's death, but not as a function of need for cognition or decedent closeness.

When a Baby Dies.

ERIC Educational Resources Information Center

Church, Martha Jo; And Others

Written especially for grieving mothers whose babies have died, this booklet offers an overview of stages and experiences through which bereaved parents commonly pass. Specifically, the text is intended to give comfort to bereaved parents, offer insight into the grieving process, and provide thoughts on leave-taking ceremonies. The first section…

Understanding Bereavement in a Christian University: A Qualitative Exploration

ERIC Educational Resources Information Center

Walker, Andrea C.; Gewecke, Rachelle; Cupit, Illene N.; Fox, Jeffrey T.

2014-01-01

This phenomenological study, based on ecological systems theory, examined the college student bereavement experience in a Christian university. Undergraduate students (N = 127) from a small Christian university provided answers to open-ended questions about their experiences regarding college following a death loss. Results indicate that students…

Religiosity Related to Grief Levels of Bereaved Mothers and Fathers.

ERIC Educational Resources Information Center

Bohannon, Judy Rollins

1991-01-01

Examined religiosity and bereaved mothers' (n=143) and fathers' (n=129) scores on Grief Experience Inventory. High church attendance had significant inverse relationship with death anxiety. Mothers who attended church more frequently reported significantly less loss of control, rumination, depersonalization, and optimism/despair. Church attendance…

Feasibility of a Multimedia Program for Parentally Bereaved Children

ERIC Educational Resources Information Center

Ortiz, Claudio D.; Cozza, Stephen J.; Fullerton, Carol S.; Ursano, Robert J.

2013-01-01

Background: Self-directed multimedia resources that provide psycho-educational information to selected populations have been supported in child health related areas including parenting skills in adults and literacy in children. Comparable programs for use with bereaved children and families have not been adequately developed or empirically…

Position Statement: Palliative Care for Children.

ERIC Educational Resources Information Center

Death Studies, 1993

1993-01-01

Notes that International Work Group on Death, Dying, and Bereavement recognizes wide variation of attitudes, beliefs, and behaviors pertaining to childhood death, dying, and bereavement. Statement identifies set of assumptions which can serve as guidelines, across cultures, in care of children with terminal illness and their families. (Author/NB)

Music Therapy with Bereaved Youth: Expressing Grief and Feeling Better

ERIC Educational Resources Information Center

McFerran, Katrina

2011-01-01

Music therapy is a promising intervention with bereaved youth. In comparison to other programs, it appears particularly effective for promoting the resolution of grief-related feelings; providing opportunities to express and release feelings through musical participation. Descriptions from music therapy participants are supported by research…

Music Therapy with Bereaved Teenagers: A Mixed Methods Perspective

ERIC Educational Resources Information Center

McFerran, Katrina; Roberts, Melina; O'Grady, Lucy

2010-01-01

Qualitative investigations have indicated that music therapy groups may be beneficial for bereaved teenagers. The existing relationship between young people and music serves as a platform for connectedness and emotional expression that is utilised within a therapeutic, support group format. This investigation confirms this suggestion through…

Daddy

ERIC Educational Resources Information Center

Waisanen, Ellen

2004-01-01

The autobiographical essay below was shared by Ms.Waisanen with researchers from the University of Michigan?s Child Bereavement Project when, at age16, Ms. Waisanen was interviewed in a study of the impact of parental death upon families with school-aged children. The Project, a longitudinal, community-based study of parentally bereaved children…

Taboo and the different death? Perceptions of those bereaved by suicide or other traumatic death.

PubMed

Chapple, Alison; Ziebland, Sue; Hawton, Keith

2015-05-01

Views differ on how far the subject of death has ever been taboo in Western Society. Walter (1991) criticised the way the 'taboo thesis' has been presented, arguing that it has often been 'grossly overdrawn and lacking in subtlety'. Research suggests that suicide and other traumatic death may be particularly difficult for people to talk about or even acknowledge. We interviewed 80 people bereaved due to suicide, or other traumatic death and used interpretative thematic analysis to consider whether the 'death taboo' is evident in these bereavement narratives. People referred to suicide as a different, even stigmatised, death but we also found that those bereaved through other traumatic death felt that their reactions had to be contained and relatively silent. The exception was those bereaved through terrorism or train crash, who were encouraged to grieve openly and angrily: reactions to deaths which are seen as 'private troubles' differ from reactions to deaths which are seen as 'public issues'. Using a symbolic interactionist approach we conclude that the shock and suddenness of the death is tied up both with the circumstances of the death (suicide, murder, accident, terrorism) and the attendant consequences for the social acceptance of public displays of mourning. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

The relative importance of avoidance and restoration-oriented stressors for grief and depression in bereaved parents.

PubMed

Harper, Mairi; O'Connor, Rory C; O'Carroll, Ronan E

2015-01-01

Previous research has identified a number of individual risk factors for parental bereavement including the sex of the parent, the sex of the child, avoidance-focussed coping style and time since death. These factors emerged from research where variables were tested univariately and their relative importance is currently unknown. The current research, therefore, aims to investigate which risk factors are important, multivariately, for the outcomes of grief and depression in parents following the death of their child. Psychosocial measures were completed by 106 bereaved parents four years post-loss, recruited from death records in Scotland. The cause of the child's death included long-term illness and stillbirths as well as sudden and violent deaths. In multivariate regression analyses, depression was predicted by higher avoidance-focussed coping and higher number of restoration-oriented stressors such as relationship difficulties, problems at work and financial issues. Grief was predicted by higher avoidance, restoration stressors and level of continuing bonds. The present study adds to the knowledge about the phenomenon of parental bereavement with participants recruited directly from death records rather than through support, clinical or obituary sources. Factors previously found to be associated with outcomes when tested univariately such as sudden, violent death or sex of the parent were not significant when tested multivariately. This study highlights that different vulnerability factors exist for grief and depression in bereaved parents.

Cost effectiveness of a community-based crisis intervention program for people bereaved by suicide.

PubMed

Comans, Tracy; Visser, Victoria; Scuffham, Paul

2013-01-01

Postvention services aim to ameliorate distress and reduce future incidences of suicide. The StandBy Response Service is one such service operating in Australia for those bereaved through suicide. Few previous studies have reported estimates or evaluations of the economic impact and outcomes associated with the implementation of bereavement/grief interventions. To estimate the cost-effectiveness of a postvention service from a societal perspective. A Markov model was constructed to estimate the health outcomes, quality-adjusted life years, and associated costs such as medical costs and time off work. Data were obtained from a prospective cross-sectional study comparing previous clients of the StandBy service with a control group of people bereaved by suicide who had not had contact with StandBy. Costs and outcomes were measured at 1 year after suicide bereavement and an incremental cost-effectiveness ratio was calculated. The base case found that the StandBy service dominated usual care with a cost saving from providing the StandBy service of AUS $803 and an increase in quality-adjusted life years of 0.02. Probabilistic sensitivity analysis indicates there is an 81% chance the service would be cost-effective given a range of possible scenarios. Postvention services are a cost-effective strategy and may even be cost-saving if all costs to society from suicide are taken into account.

"DSM-5" and Bereavement: The Loss of Normal Grief?

ERIC Educational Resources Information Center

Fox, Jesse; Jones, K. Dayle

2013-01-01

The mood disorder work group has proposed to eliminate the bereavement exclusion criterion from the diagnosis of major depression in the 5th edition of the American Psychiatric Association's (2012) "Diagnostic and Statistical Manual of Mental Disorders." The proposal would break tradition with the long-held distinction between…

Assumptive Worldviews and Problematic Reactions to Bereavement

ERIC Educational Resources Information Center

Currier, Joseph M.; Holland, Jason M.; Neimeyer, Robert A.

2009-01-01

Forty-two individuals who had lost an immediate family member in the prior 2 years and 42 nonbereaved matched controls completed the World Assumptions Scale (Janoff-Bulman, 1989) and the Symptom Checklist-10-Revised (Rosen et al., 2000). Results showed that bereaved individuals were significantly more distressed than nonbereaved matched controls,…

The Effectiveness of Psychotherapeutic Interventions for Bereaved Persons: A Comprehensive Quantitative Review

ERIC Educational Resources Information Center

Currier, Joseph M.; Neimeyer, Robert A.; Berman, Jeffrey S.

2008-01-01

Previous quantitative reviews of research on psychotherapeutic interventions for bereaved persons have yielded divergent findings and have not included many of the available controlled outcome studies. This meta-analysis summarizes results from 61 controlled studies to offer a more comprehensive integration of this literature. This review examined…

The Grief Grapevine: Facebook Memorial Pages and Adolescent Bereavement

ERIC Educational Resources Information Center

Frost, Mardi

2014-01-01

How adolescents use the social networking site Facebook to express grief is a growing area of research. In reviewing current literature, it is evident that many questions still remain unanswered. Additionally, this ever-evolving platform for grief, mourning and bereavement may hold many implications for educators, policy developers and school…

Solace and Immortality: Bereaved Parents' Continuing Bond with Their Children.

ERIC Educational Resources Information Center

Klass, Dennis

1993-01-01

Considers death of child and bereaved parents. Examines nature of solace, reviews literature on inner representation of the dead, examines ways parents find solace connected with interaction with inner representation, explores shared inner representation as significant element in social support, discusses solace in terms of psychosocial meaning of…

The Biochemistry of Bereavement: Possible Basis for Chemotherapy?

ERIC Educational Resources Information Center

Fredrick, Jerome F.

1982-01-01

Reviews the physiological effect of acute grief and explores the increased susceptibility to infectious disease agents in terms of the altered biochemistry of the bereaved individual. Until basic reactions of grief are defined and the altered biochemistry established, psychological methods appear to offer the best therapy. (Author/JAC)

Children and Grief: When a Parent Dies.

ERIC Educational Resources Information Center

Worden, J. William

The research findings on childhood grief are often inconsistent and differ among studies. This book presents major findings from the Child Bereavement Study and looks at the implications of these of these findings for intervention with bereaved children and their families. Following an introduction describing the methodology of the Child…

Bereavement and Coping of South Asian Families Post 9/11

ERIC Educational Resources Information Center

Inman, Arpana G.; Yeh, Christine J.; Madan-Bahel, Anvita; Nath, Shivani

2007-01-01

Eleven first-generation South Asian family members who lost a relative in the World Trade Center attacks on September 11, 2001, were interviewed about their loss and their coping strategies. Data were analyzed using consensual qualitative research (CQR) methodology. Participant responses clearly delineated bereavement reactions and coping within a…

Uncomplicated Depression, Suicide Attempt, and the DSM-5 Bereavement Exclusion Debate: An Empirical Evaluation

ERIC Educational Resources Information Center

Wakefield, Jerome C.; Schmitz, Mark F.

2014-01-01

Purpose: To evaluate the claim, made repeatedly during "Diagnostic and Statistical Manual of Mental Disorders", Fifth Edition debates over eliminating the bereavement exclusion (BE), that ''uncomplicated'' depressive reactions have elevated suicidality like other major depressive disorder (MDD), so exclusions risk…

The Religious Life during Suicide Bereavement: A Description

ERIC Educational Resources Information Center

Vandecreek, Larry; Mottram, Kenneth

2009-01-01

This exploratory study gathered narratives from 10 female suicide survivors, exploring 3 dimensions of their religious life during bereavement: (a) the function of the survivor's personal religion, (b) the function of religious support from family and friends, and (c) the function of established religious communities. Ten themes emerged from the…

Bereavement Counselling in Uganda and Northern Ireland: A Comparison

ERIC Educational Resources Information Center

Montgomery, Lorna; Owen-Pugh, Valerie

2018-01-01

Therapeutic interventions for bereavement in Northern Ireland and in the Sub-Saharan African country of Uganda are compared. Semi-structured interviews were conducted with Ugandan (n = 18) and Northern Irish (n = 20) therapists. These were thematically analysed. The findings focused on: the counselling context, the characteristics of counsellors,…

Disambiguating Dependency and Attachment Among Conjugally Bereaved Adults

PubMed Central

DENCKLA, CHRISTY A.; BORNSTEIN, ROBERT F.; MANCINI, ANTHONY D.; BONANNO, GEORGE A.

2017-01-01

This study aims to investigate the effects of dependency and attachment in adjusting to the loss of a loved one by directly comparing the relative contribution of each to bereavement outcomes among midlife adults. Comparisons among attachment and dependency are made using models that control for attachment among three groups of bereaved adults (N=102): prolonged grievers (n=25), resolved grievers (n=41), and a married comparison group (n=36). Prolonged grievers displayed higher marginal means of dysfunctional detachment dependency and lower marginal means of healthy dependency compared to resolved grievers and married adults, even when controlling for attachment style. Findings suggest that attachment and dependency predict unique domains of grief outcome. PMID:28855854

Acceptance of spousal death: the factor of time in bereaved older adults' search for meaning.

PubMed

Chan, Wallace Chi Ho; Chan, Cecilia L W

2011-02-01

Response to the death of a spouse was examined by focusing on acceptance, which was conceptualized as both a process and an outcome. Grounded theory was applied to analyze the experience of 15 bereaved Hong Kong Chinese older adults. The main theme that emerged was time. Acceptance of spousal death was found to be related to the search for meaning in 2 time-related themes: timing of spousal death and paradoxical time perception. For paradoxical time perception, 2 subthemes were identified: truncation and daily isolation in time. For bereaved older adults, time-related meaning seeking may be best fostered by self-transcendence, (e.g., participation in volunteer work and social activities).

Service of Remembrance: a comprehensive cancer center's response to bereaved family members.

PubMed

Knight, Louise; Cooper, Rhonda S; Hypki, Cinder

2012-01-01

Comprehensive cancer centers that offer an array of clinical trials and treatment options often experience significant patient mortality rates. Bereavement resources may not be routinely incorporated into the service delivery model in these specialty hospitals. In response, an interdisciplinary team at one cancer center proposed, planned, and implemented an annual Service of Remembrance. The incorporation of music, poetry, and visual arts was important in designing a program that would provide a meaningful, spiritual experience. A community artist who designed an interactive memorial art piece played a pivotal role. This article outlines the process of institutional culture change and describes future challenges in the implementation of this type of bereavement service.

Life Experience of Bereaved Parents After the 2014 Sewol Ferry Disaster in South Korea.

PubMed

Lee, Dong Hun; Khang, Minsoo; Shin, Jiyoung; Lee, Hwa Jung; Brown, Jacqueline A

2017-01-01

The aim of this study was to identify the outcomes of parental bereavement and the changes in life experience that follow the traumatic death of a teenage child. The results of the study are aimed to assist counselors and educators who work with themes of grief and loss. From 17 in-depth interviews from parents bereaved by the Sewol ferry disaster of 2014 in South Korea, three main categories were found to capture the reality for parents after the sudden and traumatic death of a teenage child: (a) personal changes, (b) changes in close relationships, and (c) changes in social life. Recommendations for future research and potential implications were discussed.

Bodies as means for continuing post-death relationships.

PubMed

Leichtentritt, Ronit D; Mahat Shamir, Michal; Barak, Adi; Yerushalmi, Ayelet

2016-05-01

Secondary analysis of data from 30 people in three interview studies shows that bereaved people use their own and the deceased's body in their continuing efforts to maintain a relationship with the departed. Following the continuing bond perspective, the study reveals three body-associated strategies for maintaining post-death relationships: (a) the presence of the deceased in the bereaved's body, (b) body-associated actions and activities, and (c) sensing and caring for the deceased's body. The conceptual dimension of embodiment is used to interpret results. Attention is also given to the bereaved's sense of disembodiment due to social rejection of these strategies for maintaining post-death relationships. Implications for health psychologists are offered. © The Author(s) 2014.

Disambiguating Dependency and Attachment Among Conjugally Bereaved Adults.

PubMed

Denckla, Christy A; Bornstein, Robert F; Mancini, Anthony D; Bonanno, George A

2015-01-01

This study aims to investigate the effects of dependency and attachment in adjusting to the loss of a loved one by directly comparing the relative contribution of each to bereavement outcomes among midlife adults. Comparisons among attachment and dependency are made using models that control for attachment among three groups of bereaved adults ( N =102): prolonged grievers ( n =25), resolved grievers ( n =41), and a married comparison group ( n =36). Prolonged grievers displayed higher marginal means of dysfunctional detachment dependency and lower marginal means of healthy dependency compared to resolved grievers and married adults, even when controlling for attachment style. Findings suggest that attachment and dependency predict unique domains of grief outcome.

Effectiveness for a Group for Parentally Bereaved Children.

ERIC Educational Resources Information Center

Huss, Susan Norris; Ritchie, Martin

1999-01-01

Investigates the effects of a support group for middle school parentally bereaved children on self-esteem, depression, and problem behavior as well as self-beliefs about abilities to cope with loss. Solomon four group design was used with data analysis by using two way analysis of variance to determine the effect of intervention. No statistically…

Navigating Bereavement with Spirituality-Based Interventions: Implications for Non-Faith-Based Counselors

ERIC Educational Resources Information Center

Dyer, Jacqueline E. Thurston; Hagedorn, W. Bryce

2013-01-01

The relationship between spirituality and bereavement has been studied in a multitude of disciplines, yet there is a significant gap in the counseling literature on this topic. The authors explore how spirituality is often avoided in secular counseling settings, discuss adverse effects of unresolved grief on clients' functioning, and propose the…

Resilience in Parentally Bereaved Children and Adolescents Seeking Preventive Services

ERIC Educational Resources Information Center

Lin, Kirk K.; Sandler, Irwin N.; Ayers, Tim S.; Wolchik, Sharlene A.; Luecken, Linda J.

2004-01-01

This study examined environmental stress, family, and child variables that differentiate resilient children and adolescents from those with mental health problems following the death of a primary caregiver. The community-based sample included 179 bereaved children ages 8 to 16 years and their surviving caregivers who completed a test battery of…

A Guide to Setting up a College Bereavement Group: Using Monologue, Soliloquy, and Dialogue

ERIC Educational Resources Information Center

Prior, Alexandra

2015-01-01

Childhood grief disrupts and reshapes a developing child's primary attachments, emotional regulation system, and identity formation. Bereft college students have to build their grief identity simultaneously with their social, academic, vocational, and sexual identities. This article describes a bereavement group to help students work on these…

Sorrow and Solace: Neglected Areas in Bereavement Research

ERIC Educational Resources Information Center

Klass, Dennis

2013-01-01

The author argues that in its focus on finding positive outcomes, bereavement research has neglected or denigrated central phenomena in intense and long-term grief: sorrow and solace. Sorrow has two elements: yearning for the dead person and grief's depression. Consolation comes into sorrow in human relationships and from inner resources. The…

Culturally Diverse Beliefs Concerning Dying, Death, and Bereavement: A School Psychologist's Intervention Challenge.

ERIC Educational Resources Information Center

Tramonte, Michael R.

School psychologists need to employ a multicultural perspective in the areas of death, dying, and bereavement. To develop multicultural sensitivity and competency requires setting aside one's personal beliefs in an attempt to adopt another's perspective. Consequently, school psychologists first need to explore their own attitudes about death and…

Personal Fear of Death and Grief in Bereaved Mothers

ERIC Educational Resources Information Center

Barr, Peter; Cacciatore, Joanne

2008-01-01

The study explored the relation of fear of death (Multidimensional Fear of Death Scale) to maternal grief (Perinatal Grief Scale-33) following miscarriage, stillbirth, neonatal death, or infant/child death. The 400 women participants were recruited from the website, e-mail lists, and parent groups of an organization that supports bereaved parents.…

Developing and Implementing a Bereavement Support Program for College Students

ERIC Educational Resources Information Center

Battle, Cynthia L.; Greer, Joseph A.; Ortiz-Hernandez, Samia; Todd, David M.

2013-01-01

The death of a loved one can be particularly difficult for college students, as significant losses are not anticipated during this time. Bereavement experiences are, however, not uncommon among college students, and campus environments can be isolating and nonconducive to recovery. To date, few interventions have been developed to meet bereaved…

What Is "No Recovery?"

ERIC Educational Resources Information Center

Kauffman, Jeffrey

2008-01-01

Thanatologists, as Balk recently commented (Balk, 2004), have been saying that there is no recovery from bereavement, or that we should not speak of bereavement as leading to a recovery. The term recovery has a high level of plasticity and can be shaped to fit diverse meanings, including contradictory meanings. We will sort our way through some of…

Adolescent Adjustment Before and After HIV-Related Parental Death.

ERIC Educational Resources Information Center

Rotheram-Borus, Mary Jane; Weiss, Robert; Alber, Susan; Lester, Patricia

2005-01-01

The impact of HIV-related parental death on 414 adolescents was examined over a period of 6 years. The adjustment of bereaved adolescents was compared over 4 time periods relative to parental death and was also compared with the adjustment of nonbereaved adolescents. Bereaved adolescents had significantly more emotional distress, negative life…

Bereavement: Applying Erikson's Theory of Psychosocial Development to College Students.

ERIC Educational Resources Information Center

Floerchinger, Debra S.

One of the developmental challenges that a college student may have to face is the death of a significant other, friend, spouse, relative, child, or parent. This article reviews the literature on the potential effects of bereavement on a college student with respect to Erik Erikson's stage six of psychosocial development (intimacy versus…

Ghosts, Meaning, and Faith: After-Death Communications in Bereavement Narratives

ERIC Educational Resources Information Center

Kwilecki, Susan

2011-01-01

After-death communications (ADCs) are reported encounters with a deceased loved one, a contemporary type of ghost experience heralded as therapeutic in coping with bereavement. Pertinent literature generally illustrates the healing power of ADCs with brief, self-contained episodes. The functions of ADCs over the course of grief need exploration.…

A Comparative Study of Family Bereavement Groups.

ERIC Educational Resources Information Center

Hopmeyer, Estelle; Werk, Annette

1994-01-01

Examined five bereavement support groups, three of which focused on widows, family survivors of suicide, and family survivors of death of family member by cancer. Members of three groups tended to report strong satisfaction with group experience. Reasons for joining group and most valuable aspects of group experience varied as function of group…

The Inner Representation of the Dead Child and the Worldviews of Bereaved Parents.

ERIC Educational Resources Information Center

Klass, Dennis

1993-01-01

Notes that trauma of child's death challenges parents' worldview. Demonstrates how the task of affirming or remolding one's worldview is consistently intertwined with parents' continued interaction with inner representation of their dead child. Data are presented from 10-year ethnographic study of self-help group of bereaved parents. (Author/NB)

Psychiatric Symptoms in Bereaved versus Nonbereaved Youth and Young Adults: A Longitudinal Epidemiological Study

ERIC Educational Resources Information Center

Kaplow, Julie B.; Saunders, Jessica; Angold, Adrian; Costello, E. Jane

2010-01-01

Objective: To examine potential differences in psychiatric symptoms between parent-bereaved youth (N = 172), youth who experienced the death of another relative (N = 815), and nonbereaved youth (N = 235), aged 11 to 21 years, above and beyond antecedent environmental and individual risk factors. Method: Sociodemographics, family composition, and…

Supporting Schools with Loss: 'Lost for Words' in Hull.

ERIC Educational Resources Information Center

Holland, John

2003-01-01

This paper reports on efforts in Hull, England, to better train teachers to manage bereaved children. Evaluation following training shows an increased level of trained staff in schools, more use of policies and procedures, and a higher level of individuals in schools having responsibility for responses to bereavement. (Contains eight references.)…

Learning about Grief from Normal Families: SIDS, Stillbirth, and Miscarriage.

ERIC Educational Resources Information Center

DeFrain, John

1991-01-01

Discusses 10 common questions, gleaned from qualitative analysis of data from nearly 850 bereaved family members who participated in 9 distinct studies, asked by people whose lives are directly affected by the death of a baby. Offers guidelines for family therapists serving families bereaved by an infant death. (Author/NB)

Measuring Meaning: Searching for and Making Sense of Spousal Loss in Late-Life

ERIC Educational Resources Information Center

Coleman, Rachel A.; Neimeyer, Robert A.

2010-01-01

Despite much recent theorizing, evidence regarding the temporal relationship of sense-making to adjustment following bereavement remains relatively sparse. This study examined the role of searching for and making sense of loss in late-life spousal bereavement, using prospective, longitudinal data from the Changing Lives of Older Couples (CLOC)…

Effects of Directed Written Disclosure on Grief and Distress Symptoms among Bereaved Individuals

ERIC Educational Resources Information Center

Lichtenthal, Wendy G.; Cruess, Dean G.

2010-01-01

Bereavement-specific written disclosure trials have generally demonstrated null effects, but these studies have not directed the focus of writing. This randomized controlled trial compared directed writing that focused on either sense-making or benefit-finding, both associated with adjustment to loss, to traditional, non-directed emotional…

When Caregiving Ends: The Course of Depressive Symptoms after Bereavement

ERIC Educational Resources Information Center

Aneshensel, Carol S.; Botticello, Amanda L.; Yamamoto-Mitani, Noriko

2004-01-01

This study describes depressive symptoms among caregivers following bereavement and connects these trajectories to earlier features of caregiving using life course and stress process theory. Data are from a six-wave longitudinal survey (five years) of spouses and adult children caring for someone with Alzheimer's Disease. The analytic subsample (N…

Finding Positive Meaning after Loss: The Mediating Role of Reflection for Bereaved Individuals

ERIC Educational Resources Information Center

Boyraz, Guler; Horne, Sharon G.; Sayger, Thomas V.

2010-01-01

This study examined the mediating effect of reflection on the relationship between search for meaning, positive affect, negative affect, and positive meaning-finding among 380 bereaved individuals. Using structural equation modeling, reflection was found to mediate the relationship between search for meaning, affect (positive and negative), and…

Continuing Bonds in Bereaved Pakistani Muslims: Effects of Culture and Religion

ERIC Educational Resources Information Center

Suhail, Kausar; Jamil, Naila; Oyebode, Jan; Ajmal, Mohammad Asir

2011-01-01

This study explores the bereavement process and continuing bond in Pakistani Muslims with the focus on how culture and religion influence these processes. Ten participants were interviewed and their transcribed interviews were analyzed using a grounded theory approach. Three main domains were identified from the narratives expressed by the…

Positive Experiences for Participants in Suicide Bereavement Groups: A Grounded Theory Model

ERIC Educational Resources Information Center

Groos, Anita D.; Shakespeare-Finch, Jane

2013-01-01

Grounded Theory was used to examine the experiences of 13 participants who had attended psycho-educational support groups for those bereaved by suicide. Results demonstrated core and central categories that fit well with group therapeutic factors developed by I. D. Yalom (1995) and emphasized the importance of universality, imparting information…

Social Reactions to the Survivor of a Suicide in the Family: A Review of the Literature.

ERIC Educational Resources Information Center

Calhoun, Lawrence G.; Allen, Breon G.

1991-01-01

Reviews literature on reactions to family members surviving another member's suicide. Investigates three factors determining reaction of others to persons bereaved by suicide: cause of death, characteristics of deceased, and characteristics of respondent. Reviews perceptions that persons bereaved by suicide have of how others view them. Notes…

Research on Bereavement: Implications for Social Policy Development.

ERIC Educational Resources Information Center

Kiely, Margaret C.

This paper describes the results of an evaluation of the Palliative Care Service, one of the first hospices in North America (Montreal), and the implications of that research for social policy development. The objectives of the research were to evaluate the reliability of predictive assessments of bereavement risk and the effectiveness of…

Loss of a companion animal: understanding and helping the bereaved.

PubMed

Durkin, Anne

2009-07-01

Pet owners may face numerous animal losses in a lifetime. Grief following pet loss is often misunderstood and devalued. Nurses are likely to encounter patients and families mourning the loss of a companion animal. This article outlines the grief process and offers practical suggestions for assisting those who are bereaved.

Comprehending Childhood Bereavement by Parental Suicide: A Critical Review of Research on Outcomes, Grief Processes, and Interventions

ERIC Educational Resources Information Center

Hung, Natalie C.; Rabin, Laura A.

2009-01-01

The experience of bereavement by parental suicide is not well understood, as evidenced by the lack of empirically supported interventions for this underserved population. This article reviews quantitative and qualitative research on the psychopathological outcomes and thematic characteristics of childhood and adolescent suicide survivorship and…

Training Faculty Members and Resident Assistants to Respond to Bereaved Students

ERIC Educational Resources Information Center

Servaty-Seib, Heather L.; Taub, Deborah J.

2008-01-01

Scholarship about campus responses to death-related events emphasizes the need for members of the campus community to be open to discussing grief-related issues. Faculty members and resident assistants (RAs) are ideally situated to observe and respond to bereaved students. Faculty--tenure-track, adjunct, and teaching assistants--have regular…

Clinical features of pathological grief reaction in elderly patients.

PubMed

Ishii, H; Tokunaga, Y; Kawatani, D; Nishizono, M

1998-12-01

The present study investigates elderly patients suffering from a pathological grief reaction to bereavement. The subjects were nine elderly inpatients with pathological grief reactions in the Department of Psychiatry in Fukuoka University Hospital between April 1991 and March 1995. Medical records of all patients were investigated retrospectively. The results were as follows: (i) all patients were female; (ii) the deceased were all husbands; (iii) most cases were sudden death; (iv) the period to onset was variable, from immediately after death to 10 years after death; (v) a delay of grief reactions was seen in many patients; (vi) the direct causes were often something other than bereavement, such as conflict with sisters, change of residence, bone fracture and daughter's malignant illness; (vii) although there was no significant difference, the ratio of those who began to live alone after bereavement was high; (viii) the number of children were insignificant; and (ix) many patients suffered the death of a parent in childhood. The paper presents observations on the results, and discusses the psychosocial factors of elderly patients with pathological grief reactions to bereavement.

Optimizing Visits to the Site of Death for Bereaved Families After Disasters and Terrorist Events.

PubMed

Kristensen, Pål; Dyregrov, Atle; Weisæth, Lars; Straume, Marianne; Dyregrov, Kari; Heir, Trond; Bugge, Renate Grønvold

2017-09-13

In recent years it has been common after disasters and terrorist events to offer bereaved families the opportunity to visit the place where their loved ones died. Many report that such visits are beneficial in processing their loss. Various factors, both cognitive (eg, counteracting disbelief) and existential or emotional (eg, achieving a sense of closeness to the deceased), are associated with the experienced benefit. Nonetheless, exacerbations of trauma and grief reactions (eg, re-enactment fantasies) are common, with some of the bereaved also reporting adverse reactions after the visit. Subsequently, proper preparations are a prerequisite before such visits take place. This article describes how to optimize collective visits to the site of death after disasters or terrorist events for bereaved families. Important questions-for example, concerning those who should be responsible for organizing a visit and those who should be invited, the timing of the visit, what can be done at the site, the need for support personnel, and other practical issues-are discussed and general guidelines are recommended. (Disaster Med Public Health Preparedness. 2017;page 1 of 5).

Forgotten grievers: an exploration of the grief experiences of bereaved grandparents.

PubMed

Gilrane-McGarry, Ursula; O Grady, Tom

2011-04-01

Current knowledge about bereavement has been derived mostly from the experiences of spouses, parents, and children. There is a paucity of studies on the grief of grandparents. The aims of this Irish national study were to identify and describe the bereavement experiences of grandparents following the death of a grandchild and to explore their needs and supports throughout this experience. A qualitative exploratory descriptive design was employed. A multi-pronged sampling strategy was adopted. Seventeen people participated in in-depth interviews. The data was subjected to thematic field analysis through NVivo. The small body of literature generally claims that grandparents experience 'double pain', meaning that they concurrently experience feelings of loss for their grandchild and pain associated with their own child's grief. However, this study found that grandparents experience 'cumulative pain'. That is, in addition to double pain, they also experience pain from other sources. There is a need for the complexity and intensity of the grief felt by bereaved grandparents to be recognized, acknowledged, and supported by health professionals and society in general.

Development and validation of the Hogan Grief Reaction Checklist.

PubMed

Hogan, N S; Greenfield, D B; Schmidt, L A

2001-01-01

The purpose of this article is to provide data on a recently developed instrument to measure the multidimensional nature of the bereavement process. In contrast to widely used grief instruments that have been developed using rational methods of instrument construction, the Hogan Grief Reaction Checklist (HGRC) was developed empirically from data collected from bereaved adults who had experienced the death of a loved one. Factor analysis of the HGRC revealed 6 factors in the normal trajectory of the grieving process: Despair, Panic Behavior, Blame and Anger, Detachment, Disorganization, and Personal Growth. Additional data are provided that support reliability and validity of the HGRC as well as its ability to discriminate variability in the grieving process as a function of cause of death and time lapsed since death. Empirical support is also provided for Personal Growth as an integral component of the bereavement process. The article concludes by considering the substantive as well as psychometric findings of this research for such issues as traumatic grief, anticipatory grief, change in the bereaved person's self-schema, and spiritual and existential growth.

Bereaved Parents’ and Siblings’ Reports of Legacies Created by Children With Cancer

PubMed Central

Foster, Terrah L.; Gilmer, Mary Jo; Davies, Betty; Barrera, Maru; Fairclough, Diane; Vannatta, Kathryn; Gerhardt, Cynthia A.

2010-01-01

This qualitative study explored bereaved parents’ and siblings’ reports of legacies created by children with advanced cancer. Participants included 40 families of children who died from cancer, with 36 mothers, 27 fathers, and 40 siblings (ages 8–18 years). Individual interviews were completed at home approximately 10.68 months (SD = 3.48) after the child’s death. Content analysis of interviews indicated that many children living with cancer did specific things to be remembered, such as making crafts for others, willing away belongings, writing letters to loved ones, and giving special gifts. Some children, particularly those who were very ill or died unexpectedly, did not intentionally do or say anything to be remembered. Legacies included bereaved individuals remembering children’s qualities, concern for family, and beliefs about afterlife. Having advanced cancer appeared to motivate children to influence others’ lives and prepare for their own deaths. Children’s advice about how to live life inspired bereaved family members. Findings contribute to the current knowledge of legacy-making in children and offer implications for practice and future research. PMID:20032298

Witness to suffering: mindfulness and compassion fatigue among traumatic bereavement volunteers and professionals.

PubMed

Thieleman, Kara; Cacciatore, Joanne

2014-01-01

This study used a survey to investigate the relationship between mindfulness and compassion fatigue and compassion satisfaction among 41 volunteers and professionals at an agency serving the traumatically bereaved. Compassion fatigue comprises two aspects: secondary traumatic stress and burnout. Because prior research suggests that compassion satisfaction may protect against compassion fatigue, the authors hypothesized that (a) mindfulness would be positively correlated with compassion satisfaction, (b) mindfulness would be inversely correlated with compassion fatigue, and (c) there would be differences between respondents with a personal history of traumatic bereavement and those with no such history. Correlation analyses supported the first two hypotheses; an independent means t test did not provide evidence for the latter hypothesis, although the number ofnontraumatically bereaved respondents was small. Overall, this sample showed surprisingly high levels of compassion satisfaction and low levels of compassion fatigue, even among respondents thought to be at higher risk of problems due to personal trauma. Implications of these findings are particularly relevant for social workers and other professionals employed in positions in which they encounter trauma and high emotional stress.

The myth of the replacement child: parents' stories and practices after perinatal death.

PubMed

Grout, L A; Romanoff, B D

2000-03-01

Parents bereaved by perinatal death adapt to their losses in different ways. When bereaved parents give birth to a child or children subsequent to a perinatal death, their constructions of the family necessarily change. The subsequent child is thought to be at risk of psychopathology (the replacement child syndrome) if parents have not sufficiently grieved their losses. This qualitative interview study examines the family stories told by bereaved parents, with particular attention to how parents represent the dead child and subsequent children in the current family structure. We categorized parents' stories as those which suggested that parents replaced the loss by an emphasis on parenting subsequent children, or maintained a connection to the dead child through storytelling and ritual behavior. The two ways in which parents maintained the connection were to preserve the space in the family that the dead child would have inhabited, or to create an on-going relationship with the dead child for themselves and their subsequent children. There seem to be multiple paths to parenting through bereavement. The place of rituals and memorial behavior is also examined.

Nurses' Experiences of End-of-life Photography in NICU Bereavement Support.

PubMed

Martel, Sara; Ives-Baine, Lori

2018-06-07

To qualitatively explore neonatal intensive care nurses' experiences with end-of-life photography as part of their bereavement support work with families. An Interpretive Phenomenological Analysis with data collected through a focus group (n = 6) and one semi-structured interview (n = 1) with neonatal nurses from a Level 3/4 NICU in a Canadian pediatric hospital. Participants' comfort with EOL photography developed over time through exposure to bereavement scenarios and positive experiences with families. Participants' experienced a feeling of pressure to balance the photography with clinical responsibilities and find the right time to introduce photography while being sensitive to family experiences. Participants experienced EOL photography as something tangible to give families and were satisfied knowing the images might play an important role in the family's healing after the NICU. All participants had come to value EOL photography as a positive and meaningful part of their work with bereaved families. Identified challenges related to balancing the practice with the unpredictable flow and demands of critical care and to developing an appreciation for and comfort with the photography as part of their healing and the families' healing. Findings contribute insight into care-provider experience that can inform best practices, training, and staff support for palliative and bereavement work in neonatal and pediatric settings. The findings suggest a need to support nurses emotionally and clinically in carrying out this photography as part of their care for families. Copyright © 2018 Elsevier Inc. All rights reserved.

Support for Relatives Bereaved by Psychiatric Patient Suicide: National Confidential Inquiry Into Suicide and Homicide Findings.

PubMed

Pitman, Alexandra L; Hunt, Isabelle M; McDonnell, Sharon J; Appleby, Louis; Kapur, Navneet

2017-04-01

International suicide prevention strategies recommend providing support to families bereaved by suicide. The study objectives were to measure the proportion of cases in which psychiatric professionals contact next of kin after a patient's suicide and to investigate whether specific, potentially stigmatizing patient characteristics influence whether the family is contacted. Annual survey data from England and Wales (2003-2012) were used to identify 11,572 suicide cases among psychiatric patients. Multivariate regression analysis was used to describe the association between specific covariates (chosen on the basis of clinical judgment and the published literature) and the probability that psychiatric staff would contact bereaved relatives of the deceased. Relatives were not contacted after the death in 33% of cases. Contrary to the hypothesis, a violent method of suicide was independently associated with greater likelihood of contact with relatives (adjusted odds ratio=1.67). Four patient factors (forensic history, unemployment, and primary diagnosis of alcohol or drug dependence or misuse) were independently associated with less likelihood of contact with relatives. Patients' race-ethnicity and recent alcohol or drug misuse were not associated with contact with relatives. Four stigmatizing patient-related factors reduced the likelihood of contacting next of kin after patient suicide, suggesting inequitable access to support after a potentially traumatic bereavement. Given the association of suicide bereavement with suicide attempt, and the possibility of relatives' shared risk factors for suicide, British psychiatric services should provide more support to relatives after patient suicide.

Parental Grief Following the Death of a Child from Cancer: The Ongoing Odyssey.

PubMed

Snaman, Jennifer M; Kaye, Erica C; Torres, Carlos; Gibson, Deborah; Baker, Justin N

2016-09-01

The death of a child is a devastating event that results in profound grief and significant psychosocial and physical morbidities in parents. The parental grief journey is a complex phenomenon necessitating the utilization of newer models of bereavement with a focus on relationships and exploration of parents' perceived meanings of the experience. To further characterize the grief journey of parents whose child died from cancer in order to better identify parents who can benefit from additional bereavement support and design strategies to improve bereavement services for these parents. We conducted focus group sessions with 11 bereaved parents. The parents were given two prompts to describe their grief journey before and after their child's death, and their responses in a narrative form were audio-recorded. The responses were coded and studied independently by semantic content analysis. Collation and analysis of the coded responses to both prompts results in the emergence of four concepts from the parental narratives: (1) description of the grief trajectory and evolution of grief over time, (2) mechanisms of parental coping throughout the grief journey, (3) factors that exacerbate parental grief, and (4) sources of parental support throughout the grief journey. The narratives highlighted that parents whose child died of cancer experience a unique and evolving form of grief and they wish to continue their bond with the deceased child. We recommend that healthcare providers and institutions incorporate support systems into a comprehensive bereavement program for families of children who die from cancer. © 2016 Wiley Periodicals, Inc.

Cautioning Health-Care Professionals.

PubMed

Stroebe, Margaret; Schut, Henk; Boerner, Kathrin

2017-03-01

Science and practice seem deeply stuck in the so-called stage theory of grief. Health-care professionals continue to "prescribe" stages. Basically, this perspective endorses the idea that bereaved people go through a set pattern of specific reactions over time following the death of a loved one. It has frequently been interpreted prescriptively, as a progression that bereaved persons must follow in order to adapt to loss. It is of paramount importance to assess stage theory, not least in view of the current status of the maladaptive "persistent complex bereavement-related disorder" as a category for further research in DSM-5. We therefore review the status and value of this approach. It has remained hugely influential among researchers as well as practitioners across recent decades, but there has also been forceful opposition. Major concerns include the absence of sound empirical evidence, conceptual clarity, or explanatory potential. It lacks practical utility for the design or allocation of treatment services, and it does not help identification of those at risk or with complications in the grieving process. Most disturbingly, the expectation that bereaved persons will, even should, go through stages of grieving can be harmful to those who do not. Following such lines of reasoning, we argue that stage theory should be discarded by all concerned (including bereaved persons themselves); at best, it should be relegated to the realms of history. There are alternative models that better represent grieving processes. We develop guidelines to enhance such a move beyond the stage approach in both theory and practice.

Cautioning Health-Care Professionals

PubMed Central

Schut, Henk; Boerner, Kathrin

2017-01-01

Science and practice seem deeply stuck in the so-called stage theory of grief. Health-care professionals continue to “prescribe” stages. Basically, this perspective endorses the idea that bereaved people go through a set pattern of specific reactions over time following the death of a loved one. It has frequently been interpreted prescriptively, as a progression that bereaved persons must follow in order to adapt to loss. It is of paramount importance to assess stage theory, not least in view of the current status of the maladaptive “persistent complex bereavement-related disorder” as a category for further research in DSM-5. We therefore review the status and value of this approach. It has remained hugely influential among researchers as well as practitioners across recent decades, but there has also been forceful opposition. Major concerns include the absence of sound empirical evidence, conceptual clarity, or explanatory potential. It lacks practical utility for the design or allocation of treatment services, and it does not help identification of those at risk or with complications in the grieving process. Most disturbingly, the expectation that bereaved persons will, even should, go through stages of grieving can be harmful to those who do not. Following such lines of reasoning, we argue that stage theory should be discarded by all concerned (including bereaved persons themselves); at best, it should be relegated to the realms of history. There are alternative models that better represent grieving processes. We develop guidelines to enhance such a move beyond the stage approach in both theory and practice. PMID:28355991

Experiences of the bereaved in connection with the suicide of young men.

PubMed

Rasmussen, Mette Lyberg; Dieserud, Gudrun

2018-02-06

On average 110 men under 35 years of age take their own lives in Norway each year. Few receive health assistance in the period prior to the suicide, and little research exists on contact with assistance agencies for persons who take their own lives, beyond studies of the number of doctor visits before the death. This study aimed to obtain knowledge of relatives' need for assistance from the health services, both to identify suicide risk and motivate them to seek help in life crises. Sixty-one in-depth interviews with the bereaved next of kin of young men (18-30 years) were analysed using interpretative phenomenological analysis. The bereaved perceived the generally accepted assumption that suicide is attributable to mental illness as an obstacle to identifying suicide risk. Most of the bereaved saw no signs of mental illness before the suicide. The suicide crisis was associated with relational factors. The bereaved who had harboured the thought that a suicide risk existed found that it was not enough to urge the suicidal person to seek health assistance. Improved knowledge of suicide and seeking health assistance were measures that were proposed. The findings challenge the current prevention model. Healthcare personnel as well as the general population should be better informed that mental illness is neither a sufficient nor a necessary factor to explain suicide, even though a higher risk of suicide is associated with some mental disorders.

The Course of Grief in Children Bereaved by Sudden Parental Death

PubMed Central

Melhem, Nadine M.; Porta, Giovanna; Shamseddeen, Wael; Payne, Monica Walker; Brent, David A.

2014-01-01

Context There have been major advances in our understanding of the phenomenology and course of grief in adults. However, little is known about the course of grief in children. Objective We report on course and impact of children’s grief reactions following parental sudden death on subsequent psychiatric and functional status. Design Longitudinal study of bereaved children and families with yearly comprehensive assessments up to three years after parental death. Setting Bereaved children and their surviving parents recruited through the coroners’ records and advertisement. Participants 182 parentally bereaved children between 7 and 18 years of age whose parent died from suicide, accident, or sudden natural deaths. Main Exposure Sudden parental death. Main Outcome Measures Grief, functional impairment, incident depression. Results There were 3 distinct trajectories of grief reactions with a group, consisting of 10.4% of the sample, with increased grief reactions that showed no change 33 months post-death. Youths with prolonged grief reactions had higher rates of previous personal history of depression. Prolonged grief made unique contribution to increased levels of functional impairment even after controlling for clinical characteristics antecedent and following the death. Conversely, prolonged grief, both in youths and the surviving caregiver, predisposed to an increased hazard of incident depression. Another group (30%) showed increased grief reactions 9 months following the death, which gradually decreased over time. Despite this, grief reactions in this group were also associated with functional impairment and increased risk of incident depression. Conclusions Grief reactions abate over time for most children bereaved by sudden parental death; however, a subset show increased or prolonged grief reactions, which in turn increases the risk for functional impairment and depression. Research on interventions designed to relieve the burden of grief in bereaved children are needed. Such efforts should also assess and address grief reactions in the surviving parent. PMID:21893658

Grief interventions for people bereaved by suicide: A systematic review

PubMed Central

Steinig, Jana; Nagl, Michaela; Kersting, Anette

2017-01-01

Background Adaption to the loss of a loved one due to suicide can be complicated by feelings of guilt, shame, responsibility, rejection, and stigmatization. Therefore people bereaved by suicide have an increased risk for developing complicated grief which is related to negative physical and mental disorders and an increased risk for suicidal behavior. Grief interventions are needed for this vulnerable population. The aim of this systematic review was to provide an overview of the current state of evidence concerning the effectiveness of interventions that focus on grief for people bereaved by suicide. Methods We conducted a systematic literature search using PubMed, Web of Science, and PsycINFO for articles published up until November 2016. Relevant papers were identified and methodological quality was assessed by independent raters. A narrative synthesis was conducted. Results Seven intervention studies met the inclusion criteria. Two interventions were based on cognitive-behavioral approaches, four consisted of bereavement groups, and one utilized writing therapy. As five of the seven interventions were effective in reducing grief intensity on at least one outcome measure, there is some evidence that they are beneficial. Bereavement groups tend to be effective in lowering the intensity of uncomplicated grief, as are writing interventions in lowering suicide-specific aspects of grief. Cognitive-behavioral programs were helpful for a subpopulation of people who had high levels of suicidal ideation. Limitation On average, methodological quality was low so the evidence for benefits is not robust. The stability of treatment effects could not be determined as follow-up assessments are rare. Generalizability is limited due to homogeneous enrollments of mainly female, white, middle-aged individuals. Conclusions People bereaved by suicide are especially vulnerable to developing complicated grief. Therefore, grief therapies should be adapted to and evaluated in this population. Prevention of complicated grief may be successful in populations of high risk individuals. PMID:28644859

Post-traumatic stress disorder and its predictors among bereaved Tibetan adolescents four years after the Yushu earthquake: a cross-sectional survey in China.

PubMed

Dongling, Liu; Hui, Chen; Ling, Ma; Wenqian, Bie; Zailiang, Liu; Changying, Chen

2017-04-01

To examine the prevalence of post-traumatic stress disorder symptoms and to explore the predictive factors of post-traumatic stress disorder symptoms among bereaved adolescents four years after the Yushu earthquake. On 14 April 2010, the 7·1-magnitude Yushu earthquake occurred in the high-altitude, hypoxia-prone regions primarily inhabited by ethnic minorities. Many adolescents lost their parents during the earthquake. This study examined post-traumatic stress disorder and its predictors among bereaved Tibetan adolescents four years after the trauma in China. This was a cross-sectional descriptive study. This study used a cross-sectional design with 830 bereaved adolescents. Participant demographic data included gender, age and grade, and the earthquake exposure variables included the deceased relatives, whether they were buried, injured or amputated (non-life-threatening) and whether they witnessed a burial, injury or death. The post-traumatic stress disorder Checklist-Civilian version was used to assess the symptoms and prevalence of post-traumatic stress disorder, and the Coping Style Scale assessed coping styles. The results indicated that the prevalence of post-traumatic stress disorder was 19·3%. Individuals who were buried, injured or amputated (non-life-threatening), who witnessed a burial, injury or death, who suffered severe property loss during the earthquake and who had negative coping skills were the most likely individuals to have post-traumatic stress disorder symptoms. The presence of post-traumatic stress disorder was very prevalent among adolescents four years after the Yushu earthquake. Effective mental health services should be developed to facilitate postdisaster recovery for bereaved adolescents at high risk for post-traumatic stress disorder. The findings in this study improve our understanding of post-traumatic stress disorder and related risk factors in bereaved adolescents in non-Western communities, providing useful information for rebuilding and relief work. © 2016 John Wiley & Sons Ltd.

Development of a Short-Form of the RCOPE for Use with Bereaved College Students.

PubMed

Lord, Benjamin D; Collison, Elizabeth A; Gramling, Sandra E; Weiskittle, Rachel; Weisskittle, Rachel

2015-08-01

Bereavement is being increasingly recognized as a key issue in college populations (Balk in Mortality 2:207-220, 1997; Balk et al. in Death Stud 34:459-468, 2010). However, there is currently a dearth of research on the impact that the loss of a loved one has on college students and the ways that college students cope during the grieving process. This lack of research, particularly among younger groups, is problematic as researchers have shown that emerging adults experience a surprisingly high number of losses and are an at-risk group for poor post-loss outcomes (Servaty-Seib and Taub 2010; Servaty-Seib and Hamilton 2006; Arnett in Am Psychol 55(5):469, 2000). Religion is a common way that individuals cope with bereavement (Frantz et al. in Pastor Psychol 44(3):151-163, 1996) and may also be commonly used by college students to manage everyday stress (Merrill et al. 2009). The RCOPE (Pargament et al. in J Clin Psychol 56(4):519-543, 2000; J Health Psychol 9:713-730, 2004) is a frequently used measure of religious coping that has recently been evaluated for use with a bereaved undergraduate population. Lord and Gramling (2014) examined the factor structure of the RCOPE and concluded that overlap between the positive and negative religious coping subscales when used with a bereaved undergraduate sample detracted from the predictive utility of the instrument. The researchers provided evidence for the use of a new 2-factor, 39-item version of the RCOPE with the bereaved college student population. The current study replicated Lord and Gramling (2014) with a large follow-up sample of bereaved undergraduates. Participants (N = 677) consisted of individuals who had lost a loved one within the past 2 years, had a mean age of 19.1, and were predominantly female (62%) underclassmen (84% freshman or sophomore status). A majority of participants (68%) were identified as Christian. Exploratory factor analyses closely mimicked the results of the previous study, and the number of items was further reduced in order to provide a briefer version of the scale for use in future research. Hierarchical regression models demonstrated discriminate, convergent, and predictive validity of the instrument.

Long-Term Effects of Bereavement and Caregiver Intervention on Dementia Caregiver Depressive Symptoms

ERIC Educational Resources Information Center

Haley, William E.; Bergman, Elizabeth J.; Roth, David L.; McVie, Theresa; Gaugler, Joseph E.; Mittelman, Mary S.

2008-01-01

Purpose: The purpose of this study was to examine the joint effects of bereavement and caregiver intervention on caregiver depressive symptoms. Design and Methods: Alzheimer's caregivers from a randomized trial of an enhanced caregiver support intervention versus usual care who had experienced the death of their spouse (n = 254) were repeatedly…

Meaning-Making through Psychological Autopsy Interviews: The Value of Participating in Qualitative Research for Those Bereaved by Suicide

ERIC Educational Resources Information Center

Dyregrov, Kari Madeleine; Dieserud, Gudrun; Hjelmeland, Heidi Marie; Straiton, Melanie; Rasmussen, Mette Lyberg; Knizek, Birthe Loa; Leenaars, Antoon Adrian

2011-01-01

Too often ethical boards delay or stop research projects with vulnerable populations, influenced by presumed rather than empirically documented vulnerability. The article investigates how participation is experienced by those bereaved by suicide. Experiences are divided into 3 groups: (a) overall positive (62%), (b) unproblematic (10%), and (c)…

Grief Experience of Bereaved Malay/Muslim Youths in Singapore: The Spiritual Dimension

ERIC Educational Resources Information Center

Hassan, Murshidah; Mehta, Kalyani

2010-01-01

This article is based on a qualitative study conducted in Singapore which examined different coping mechanisms engaged by Malay/Muslim bereaved youths following parental death. The research applied the revised Transactional Model of Stress and Coping as well as the Adolescent Coping Scale as a theoretical framework for analysing findings. Of the…

The Experiences of Staff Who Support People with Intellectual Disability on Issues about Death, Dying and Bereavement: A Metasynthesis

ERIC Educational Resources Information Center

Lord, Ailsa J.; Field, Stephen; Smith, Ian C.

2017-01-01

Background: Historically, people with intellectual disabilities have tended to be excluded from knowing about death, dying and bereavement. Staff in intellectual disability services can play a valuable role in improving understanding of these issues in those they support. This qualitative metasynthesis aimed to understand the experiences of staff…

Concept of Death and Perceptions of Bereavement in Adults with Intellectual Disabilities

ERIC Educational Resources Information Center

McEvoy, J.; MacHale, R.; Tierney, E.

2012-01-01

Background: Bereavement is potentially a time of disruption and emotional distress. For individuals with an intellectual disability (ID), a limited understanding of the concept of death may exacerbate this distress. The aim of the present study was to investigate how individuals with ID understand and explain death and make sense of life without…

Evaluation of a Bereavement Training Program for Staff in an Intellectual Disabilities Service

ERIC Educational Resources Information Center

Reynolds, Sile; Guerin, Suzanne; McEvoy, John; Dodd, Philip

2008-01-01

The impact of a staff-training program on knowledge and confidence in supporting people with intellectual disabilities (ID) at the time of bereavement was examined. Thirty-three staff members from a Dublin, Ireland-based ID support service participated in the study. Both the training (n = 17) and control (n = 16) groups completed measures of…

Bereaved Adults with Intellectual Disabilities: A Combined Randomized Controlled Trial and Qualitative Study of Two Community-Based Interventions

ERIC Educational Resources Information Center

Dowling, S.; Hubert, J.; White, S.; Hollins, S.

2006-01-01

Background: Bereaved adults with intellectual disabilities are known to experience prolonged and atypical grief which is often unrecognized. The aim of this project was to find an effective way to improve mental health and behavioural outcomes. Methods: Subjects were randomized to two different therapeutic interventions: traditional counselling by…

Outdoor Education for Bereaved Children?

ERIC Educational Resources Information Center

Renner, Hans-Georg

2011-01-01

For many outdoor education providers, bereaved children and young people at first appear to be a new target audience. A new target audience naturally raises questions of programme planning and can give the provider a pressurised need to succeed: "Do I as the organiser have to develop a whole new programme?", "May I be required to provide some form…

Commentary on the Inclusion of Persistent Complex Bereavement-Related Disorder in DSM-5

ERIC Educational Resources Information Center

Boelen, Paul A.; Prigerson, Holly G.

2012-01-01

The DSM-5 Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders Work Group has proposed criteria for Persistent Complex Bereavement-Related Disorder (PCBRD) for inclusion in the appendix of DSM-5. The authors feel that it is important that dysfunctional grief will become a formal condition in DSM-5 because that would…

Bereavement Experiences of Mothers and Fathers over Time after the Death of a Child due to Cancer

ERIC Educational Resources Information Center

Alam, Rifat; Barrera, Maru; D'Agostino, Norma; Nicholas, David B.; Schneiderman, Gerald

2012-01-01

The authors investigated longitudinally bereavement in mothers and fathers whose children died of cancer. Thirty-one parents were interviewed 6 and 18 months post-death. Analyses revealed parental differences and changes over time: (a) employment--fathers were more work-focused; (b) grief reactions--mothers expressed more intense grief reactions…

Individual and Marital Adjustment among Bereaved and Nonbereaved Parents of Children Treated for Cancer.

ERIC Educational Resources Information Center

Tucker, Cindy L.; Hansen, James C.; Zevon, Michael A.

Studies of parents of children treated for cancer have rarely included adequate samples of fathers or couples. Further, bereaved parents have been over-represented as compared to parents of cancer survivors. This study investigated the personal and interpersonal effects of having a child treated for cancer on 124 parents. Twenty-seven married…

Dreams of Deceased Children and Countertransference in the Group Psychotherapy of Bereaved Mothers: Clinical Illustration

ERIC Educational Resources Information Center

Begovac, Branka; Begovac, Ivan

2012-01-01

This article presents, in the form of a clinical illustration, a therapeutic group of bereaved mothers with special reference to their dreams about their deceased children. The article presents descriptions of the emotions of these mothers and countertransference feelings, a topic that, to our knowledge, has not been frequently studied. The group…

Sound Continuing Bonds with the Deceased: The Relevance of Music, Including Preloss Music Therapy, for Eight Bereaved Caregivers

ERIC Educational Resources Information Center

O'Callaghan, Clare C.; McDermott, Fiona; Hudson, Peter; Zalcberg, John R.

2013-01-01

This study examines music's relevance, including preloss music therapy, for 8 informal caregivers of people who died from cancer. The design was informed by constructivist grounded theory and included semistructured interviews. Bereaved caregivers were supported or occasionally challenged as their musical lives enabled a connection with the…

A Meta-Analysis of Interventions for Bereaved Children and Adolescents

ERIC Educational Resources Information Center

Rosner, Rita; Kruse, Joachim; Hagl, Maria

2010-01-01

The main objective of this review was to provide a quantitative and methodologically sound evaluation of existing treatments for bereavement and grief reactions in children and adolescents. Two meta-analyses were conducted: 1 on controlled studies and 1 on uncontrolled studies. The 2 meta-analyses were based on a total of 27 treatment studies…

Bereavement and Loss: Developing a Memory Box to Support a Young Woman with Profound Learning Disabilities

ERIC Educational Resources Information Center

Young, Hannah; Garrard, Brenda

2016-01-01

Supporting bereaved people with profound learning disabilities still remains an under-researched area. Moreover, the barriers of communication and disenfranchised grief mean that they often do not receive the support they require, leading to emotional and behavioural difficulties. This article describes research using a case study design, which…

A Delphi Study on Staff Bereavement Training in the Intellectual and Developmental Disabilities Field

ERIC Educational Resources Information Center

Gray, Jennifer A.; Truesdale, Jesslyn

2015-01-01

The Delphi technique was used to obtain expert panel consensus to prioritize content areas and delivery methods for developing staff grief and bereavement curriculum training in the intellectual and developmental disabilities (IDD) field. The Delphi technique was conducted with a panel of 18 experts from formal and informal disability caregiving,…

The Impact of Personal Loss on the Experience of Health Professions: Graduate Students in End-of-Life and Bereavement Care

ERIC Educational Resources Information Center

Supiano, Katherine P.; Vaughn-Cole, Beth

2011-01-01

This study explored the impact of prior personal experience with grief on self-reported personal and professional development of graduate students in nursing, social work, counseling, pastoral care, and genetic counseling involved as cofacilitators in bereavement support groups, and of medical students observing interdisciplinary inpatient…

Mothers Coping With Bereavement in the 2008 China Earthquake: A Dual Process Model Analysis.

PubMed

Chen, Lin; Fu, Fang; Sha, Wei; Chan, Cecilia L W; Chow, Amy Y M

2017-01-01

The purpose of this study is to explore the grief experiences of mothers after they lost their children in the 2008 China earthquake. Informed by the dual process model, this study conducted in-depth interviews to explore how six bereaved mothers coped with such grief over a 2-year period. Right after the earthquake, these mothers suffered from intensive grief. They primarily coped with loss-oriented stressors. As time passed, these mothers began to focus on restoration-oriented stressors to face changes in life. This coping trajectory was a dynamic and integral process, which bereaved mothers oscillated between loss- and restoration-oriented stressors. This study offers insight in extending the existing empirical evidence of the dual process model.

Mothers Coping With Bereavement in the 2008 China Earthquake: A Dual Process Model Analysis.

PubMed

Chen, Lin; Fu, Fang; Sha, Wei; Chan, Cecilia L W; Chow, Amy Y M

2017-01-01

The purpose of this study is to explore the grief experiences of mothers after they lost their children in the 2008 China earthquake. Informed by the Dual Process Model, this study conducted in-depth interviews to explore how six bereaved mothers coped with such grief over a 2-year period. Right after the earthquake, these mothers suffered from intensive grief. They primarily coped with loss-oriented stressors. As time passed, these mothers began to focus on restoration-oriented stressors to face changes in life. This coping trajectory was a dynamic and integral process, which bereaved mothers oscillated between loss- and restoration-oriented stressors. This study offers insight in extending the existing empirical evidence of the Dual Process Model.

Recruitment methods for intervention research in bereavement-related depression. Five years' experience.

PubMed

Schlernitzauer, M; Bierhals, A J; Geary, M D; Prigerson, H G; Stack, J A; Miller, M D; Pasternak, R E; Reynolds, C F

1998-01-01

The authors compared various strategies for recruiting elderly subjects with bereavement-related depression into a randomized clinical trial. Over 5 years, they empaneled 65 patients from a total of 441 subjects screened (14.7%). Response to media advertisements was the single most effective strategy (54% of subjects). Another effective, but labor-intensive, strategy was using letters to bereaved spouses found through newspaper obituaries (14%); another 14% were referred by friends who had seen study advertisements. Information letters to healthcare providers yielded no study participants. Pathways to study participation did not differ as a function of race or gender and did not influence study retention or remission rates. Our experience suggests that successful intake depends on a personal mode of recruitment.

"It Was the Only Thing I Could Hold Onto, But…": Receiving a Letter of Condolence After Loss of a Loved One in the ICU: A Qualitative Study of Bereaved Relatives' Experience.

PubMed

Kentish-Barnes, Nancy; Cohen-Solal, Zoé; Souppart, Virginie; Galon, Marion; Champigneulle, Benoît; Thirion, Marina; Gilbert, Marion; Lesieur, Olivier; Renault, Anne; Garrouste-Orgeas, Maïté; Argaud, Laurent; Venot, Marion; Demoule, Alexandre; Guisset, Olivier; Vinatier, Isabelle; Troché, Gilles; Massot, Julien; Jaber, Samir; Bornstain, Caroline; Gaday, Véronique; Robert, René; Rigaud, Jean-Philippe; Cinotti, Raphaël; Adda, Mélanie; Thomas, François; Azoulay, Elie

2017-12-01

Family members of patients who die in the ICU often remain with unanswered questions and suffer from lack of closure. A letter of condolence may help bereaved relatives, but little is known about their experience of receiving such a letter. The objective of the study was to understand bereaved family members' experience of receiving a letter of condolence. Qualitative study using interviews with bereaved family members who received a letter of condolence and letters written by these family members to the ICU team. This study was designed to provide insight into the results of a larger randomized, controlled, multicenter study. Twenty-two ICUs in France. Family members who lost a loved one in the ICU and who received a letter of condolence. Thematic analysis was used and was based on 52 interviews and 26 letters. Six themes emerged: 1) a feeling of support, 2) humanization of the medical system, 3) an opportunity for reflection, 4) an opportunity to describe their loved one, 5) continuity and closure, and 6) doubts and ambivalence. Possible difficulties emerged, notably the re-experience of the trauma, highlighting the absence of further support. This study describes the benefits of receiving a letter of condolence; mainly, it humanizes the medical institution (feeling of support, confirmation of the role played by the relative, supplemental information). However, this study also shows a common ambivalence about the letter of condolence's benefit. Healthcare workers must strive to adapt bereavement follow-up to each individual situation.

Breast milk donation after neonatal death in Australia: a report.

PubMed

Carroll, Katherine E; Lenne, Brydan S; McEgan, Kerri; Opie, Gillian; Amir, Lisa H; Bredemeyer, Sandra; Hartmann, Ben; Jones, Rachel; Koorts, Pieter; McConachy, Helen; Mumford, Patricia; Polverino, Jan

2014-01-01

Lactation and breast milk can hold great value and meaning for grieving mothers who have experienced a recent death of an infant. Donation to a human milk bank (HMB) as an alternative to discarding breast milk is one means of respecting the value of breast milk. There is little research, national policy discussion, or organizational representation in Australia on the subject of breast milk donation after infant death. On 29 November 2013 the Mercy Hospital for Women in Melbourne, Australia hosted Australia's first National Stakeholder Meeting (NSM) on the topic of milk donation after neonatal death. The NSM drew together representatives from Australian HMBs, neonatal intensive care units (NICUs) currently using donor human milk, and Australia's chief NICU parent support organization. The NSM was video-recorded and transcribed, and analyzed thematically by researchers. This article reports the seven dominant themes discussed by stakeholders during the NSM: the spectrum of women's lactation and donation experiences after infant death; the roles of the HMB and NICU in meeting the needs of the bereaved donor; how bereaved mothers' lactation autonomy may interface with a HMB's donation guidelines; how milk donation may be discussed with bereaved mothers; the variation between four categories of milk donation after neonatal death; the impact of limited resources and few HMBs on providing donation programs for bereaved mothers in Australia. This article provides evidence from researchers and practitioners that can assist HMB staff in refining their bank's policy on milk donation after infant death, and provides national policy makers with key considerations to support lactation, human milk banking, and bereavement services nation-wide.

Going straight to the source: A pilot study of bereaved parent-facilitated communication training for pediatric subspecialty fellows.

PubMed

Snaman, Jennifer M; Kaye, Erica C; Cunningham, Melody J; Sykes, April; Levine, Deena R; Mahoney, Daniel; Baker, Justin N

2017-01-01

Medical trainees consistently report suboptimal instruction and poor self-confidence in communication skills. Despite this deficit, few established training programs provide comprehensive, pediatric-specific communication education, particularly in the provision of "bad news." To our knowledge, no programs currently use bereaved parent educators to facilitate communication training for pediatric subspecialty trainees. The authors designed and implemented a pilot communication training seminar in which bereaved parent educators and faculty facilitators led small groups in interactive, role-play scenarios. Surveys incorporating a retrospective preprogram assessment item to account for response-shift bias were used to assess short- and long-term changes in trainee comfort with delivering "bad news." Fifteen pediatric fellowship trainees participated in the communication seminar; complete data were available for 12 participants. After accounting for response-shift bias, participants reported significant improvement in overall preparedness, breaking bad news to a patient and family, and including the adolescent or young adult patient in conversations. Additionally, participants reported a significant improvement in their ability to address a patient and family's need for information, emotional suffering at the end of life (EOL), if and when a patient should be included in the conversation, and EOL care decisions. The participant's self-perceived improvement in comfort and preparedness persisted over time. Communication training for pediatric subspecialty trainees using bereaved parent educators is feasible and effective. Both medical trainee and bereaved parent participants benefited from involvement in this pilot study. Further iterations of this training will be modified to assess objective measures of improvement in trainees' communication skills. © 2016 Wiley Periodicals, Inc.

Gender similarities in somatic depression and in DSM depression secondary symptom profiles within the context of severity and bereavement.

PubMed

Thompson, Angus H; Bland, Roger C

2018-02-01

Most population studies report higher rates of depression among women than men, and some researchers have observed gender differences in depression symptoms overall, or in sub-groupings (e.g. somatic depression). However, gender symptom differences have been inconsistent, prompting this investigation of gender differences in secondary DSM symptom profiles in the context of bereavement status, age, and depression severity. Individuals with symptoms of core depression (flat affect or anhedonia) were selected from a large survey of adults in the Alberta, Canada workforce. Analyses involved the comparison of gender profiles across the seven DSM-IV secondary depressive symptoms plus a MANOVA of sex, bereavement, and age, with secondary symptoms comprising the dependent variable. Gender profiles were very similar, irrespective of depression severity or bereavement. Secondary symptoms were marginally more common among women and more frequent among bereaved young adults, but there was no evidence for a gender-related somatic factor. First, data were gathered only for persons in the workforce and thus may not be generalizable to, for example, stay-at-home parents or those with employment issues. Second, the focus here is restricted to DSM symptoms, leaving risk factors, social roles, and brain functioning for separate investigation. Third, inferences were drawn from associations between groups of persons, rather than between individuals, requiring caution when speculating about individual attributes. Gender differences in depression represent a difference in amount, not kind, suggesting that the range of depressive experiences is similar for men and women. There was no gender difference ascribable to somatic depression. Copyright © 2017 Elsevier B.V. All rights reserved.

A Review of the Emotional, Psychiatric and Behavioural Responses to Bereavement in People with Intellectual Disabilities

ERIC Educational Resources Information Center

Dodd, P.; Dowling, S.; Hollins, S.

2005-01-01

Background:Our knowledge and understanding of grief and its consequences have grown rapidly in recent years. There is a growing understanding that bereavement and loss represent a very significant event in the lives of people with intellectual disabilities (IDs). To date, there is no systematic review of the literature on the emotional,…

Death and Dying Course Offerings in Psychology: A Survey of Nine Midwestern States

ERIC Educational Resources Information Center

Eckerd, Lizabeth M.

2009-01-01

The certainty of facing death and bereavement and the complex personal and societal issues involved argue for the importance of death education. The current study addresses a gap in knowledge by beginning to assess the extent of dying, death, and bereavement (DD&B) course offerings by U.S. psychology departments. This article reports on data…

Visiting the Site of Death: Experiences of the Bereaved after the 2004 Southeast Asian Tsunami

ERIC Educational Resources Information Center

Kristensen, Pal; Tonnessen, Arnfinn; Weisaeth, Lars; Heir, Trond

2012-01-01

The authors examined how many bereaved relatives of Norwegian tourists who perished in the 2004 Southeast Asian Tsunami had visited the site of death and the most important outcome from the visit. We conducted in-depth interviews (n = 110) and used self-report questionnaires (Impact of Event Scale--Revised, Inventory of Complicated Grief, and…

An Exploration of Clinical Psychology's Response to Parental Bereavement in Adults with Intellectual Disability

ERIC Educational Resources Information Center

Irwin, Lynn; O'Malley, Grace; Neelofur, Shazia; Guerin, Suzanne

2017-01-01

Background: The dearth of literature regarding how or when to intervene when an adult with intellectual disability is bereaved may impede clinical practice; this study therefore aimed to explore the current clinical psychology response, so as to enhance understanding of the role of the profession in supporting grief within this population. Method:…

Along the Cancer Continuum: Integrating Therapeutic Support and Bereavement Groups for Children and Teens of Terminally Ill Cancer Patients

ERIC Educational Resources Information Center

Werner-Lin, Allison; Biank, Nancee M.

2009-01-01

Family life is altered irrevocably when a young parent is diagnosed with or dies from cancer. This article tracks the genesis and transformation of a comprehensive psychoeducational support and bereavement program for children, adolescents, and parents affected by cancer. From the inception of the program, families with parents in active treatment…

Psychological and Religious Coping Strategies of Mothers Bereaved by the Sudden Death of a Child

ERIC Educational Resources Information Center

Anderson, Miriam J.; Marwit, Samuel J.; Vandenberg, Brian; Chibnall, John T.

2005-01-01

The authors examined the associations of 3 types of psychological coping (task-based, emotion-based, avoidance), 2 types of religious coping (positive, negative), and their interactions with grief of 57 mothers bereaved by the sudden death of a child. Results indicated that mothers who use emotion-based coping report significantly higher levels of…

Perspectives on Aging: Death, Dying, Bereavement. Papers Presented at a Symposium (Provo, Utah, April 12, 1985).

ERIC Educational Resources Information Center

Gray, Howard R., Ed.; Averett, Claire H., Ed.

This volume contains papers presented at a symposium on death, dying, and bereavement. Papers were presented on: (1) "A Psychologist in Hospice Care" (Clifford Morgan and Barbara McCann); (2) "Assessment of the Kubler-Ross Stages in Counseling" (G. Michael Averett and Claire H. Averett); (3) "Making the Road Less Lonely: Role of Volunteers in…

Parental Bereavement and the Loss of a Child with Intellectual Disabilities: A Review of the Literature

ERIC Educational Resources Information Center

Reilly, Deirdre E.; Hastings, Richard P.; Vaughan, Frances L.; Huws, Jaci C.

2008-01-01

Inequalities in health care and other risk factors mean that children with intellectual disabilities are more likely to predecease their parents. Research on the effects on family members when a child with intellectual disability dies is sparse. In the present review, the authors describe 5 studies of bereavement in intellectual disability and…

Empowering People at Work in the Face of Death and Bereavement

ERIC Educational Resources Information Center

Charles-Edwards, David

2009-01-01

How people respond at work may have a critical part to play in how bereaved or terminally ill colleagues manage their grief and their lives. Although counselors, human resources, occupational health staff, and others may have an important back-up role to play, pivotal support needs to come from line managers, colleagues, and, where they exist,…

Interventions for Young Bereaved Children: A Systematic Review and Implications for School Mental Health Providers

ERIC Educational Resources Information Center

Chen, Cliff Yung-Chi; Panebianco, Andrea

2018-01-01

Background: Many young children experience the death of a family member and they may be at risk for developing psychological and behavioral problems, but not much is known about how to help young children cope with such a stressful and painful experience. Objective: The purposes of this study are to identify the interventions for bereaved young…

Paradoxes of maternal mourning.

PubMed

Brice, C W

1991-02-01

It has been customary to conceptualize mourning as a phasic or stage phenomenon (Lindemann 1944; Parkes 1972; Bowlby 1980; Knapp 1986). Such a conceptualization has proved to be of tremendous didactic value, especially in terms of succinctly organizing and communicating the major affects, behaviors, and reactions of mourning. It is, however, my belief, based upon clinical experience with many forms of bereavement, that the phenomenon of mourning is not comprised of clearly delineated stages and phases. I have come to conceptualize the phenomenon of mourning the death of a loved person as involving the bereaved's struggle with a series of more or less unresolvable paradoxes rather than as a progression through stages that possess relatively distinct and predictable beginning and ending points. The specific paradoxes encountered by a bereaved person differ, of course, in accordance with the relationship that was lost (mother, father, spouse, child, or sibling), the developmental stage of the bereaved (childhood, adolescence, adulthood, or maturity), the type of death (sudden or prolonged), and the cause of death (illness, murder, suicide, or accident). In this paper, I will address those paradoxes that seem specific to maternal mourning - that is, to mothers who are mourning the death of a child.

Prevalence and Correlates of Suicidal Ideation in a Treatment-Seeking Sample of Violent Loss Survivors.

PubMed

Williams, Joah L; Eddinger, Jasmine R; Rynearson, Edward K; Rheingold, Alyssa A

2018-05-31

Family members grieving the traumatic death of a loved one, as in cases of homicide, suicide, and fatal accidents, are at risk for a number of trauma and bereavement-related mental health problems, including posttraumatic stress disorder (PTSD), depression, prolonged grief disorder, and suicidal ideation (SI). The purpose of this study was to examine the prevalence and correlates of SI among a sample of 130 treatment-seeking traumatically bereaved family members. Adults seeking treatment at two clinics on the US West Coast were assessed for SI, clinical outcomes, and death-related characteristics. Overall, 42% of traumatically bereaved family members endorsed some form of active or passive SI on the Beck Depression Inventory suicide item. The type of loss experienced (i.e., homicide, suicide, fatal accident) was not associated with SI. Although individuals with SI reported more severe symptoms across all clinical outcomes, avoidance (OR = 2.22) and depression (OR = 1.16) were uniquely associated with SI even after adjusting for PTSD-related intrusions and hyperarousal. Results should be interpreted in light of limitations associated with cross-sectional data and a single-item outcome of SI. Routine screening for SI should be standard practice for providers working with traumatically bereaved families.

When does the responsibility of our care end: bereavement.

PubMed

Penson, Richard T; Green, Kara M; Chabner, Bruce A; Lynch, Thomas J

2002-01-01

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital, founded the Kenneth B. Schwartz Center. The Schwartz Center is a non-profit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient, support to caregivers, and sustenance to the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Two vignettes are presented of a caregiver's response to the death of a patient, contrasting the extremes of involved compassion for the family and fractured relationships. Grief for loss is an inevitable part of life and a common part of cancer care. Support of the bereaved may be one of the hardest tasks for cancer care professionals, who are confronted with the limits of modern medicine. There is a responsibility to provide grieving families with support and care; care that goes beyond the death. A compassionate response helps both those who suffer and those who care. Complicated and uncomplicated bereavement, grief reactions, resources for bereavement counseling, and the role of condolence letters are reviewed.

The prevalence of childhood traumatic grief--a comparison of violent/sudden and expected loss.

PubMed

McClatchy, Irene Searles; Vonk, M Elizabeth; Palardy, Gregory

2009-01-01

The purpose of this study was to examine the prevalence of childhood traumatic grief (CTG) and posttraumatic stress disorder (PTSD) symptoms in parentally bereaved children and compare scores between those who had lost a parent to a sudden/violent death and those who had lost a parent to an expected death. A sample of 158 parentally bereaved children ages 7-16 completed the Extended Grief Inventory (EGI); 127 of those also completed the UCLA PTSD Index. A large number of children were experiencing CTG symptoms at moderate and severe levels. There was no significant difference in EGI or UCLA PTSD Index scores between the two types of losses. Findings are discussed in relation to trauma theory, research on parentally bereaved children and implications for practice.

Sound continuing bonds with the deceased: the relevance of music, including preloss music therapy, for eight bereaved caregivers.

PubMed

O'Callaghan, Clare C; McDermott, Fiona; Hudson, Peter; Zalcberg, John R

2013-02-01

This study examines music's relevance, including preloss music therapy, for 8 informal caregivers of people who died from cancer. The design was informed by constructivist grounded theory and included semistructured interviews. Bereaved caregivers were supported or occasionally challenged as their musical lives enabled a connection with the deceased. Music was often still used to improve mood and sometimes used to confront grief. Specific music, however, was sometimes avoided to minimize sadness. Continuing bonds theory's focus on connecting with the deceased through memory and imagery engagement may expand to encompass musical memories, reworking the meaning of familiar music, and discovering new music related to the deceased. Preloss music involvement, including music therapy, between dying patients and families can help in bereavement.

Human grief: a model for prediction and intervention.

PubMed

Bugen, L A

1977-04-01

The prevalent approach to understanding of and clinical intervention in the process of mourning employs a model based on stages of bereavement. This paper suggests a theoretical conception that is not tied to a fixed order of emotional states. Two dimensions--closeness of relationship and mourner's perception of preventability of the death--are identified as prime predictors of the intensity and duration of bereavement.

Acceptance of Spousal Death: The Factor of Time in Bereaved Older Adults' Search for Meaning

ERIC Educational Resources Information Center

Chan, Wallace Chi Ho; Chan, Cecilia L. W.

2011-01-01

Response to the death of a spouse was examined by focusing on acceptance, which was conceptualized as both a process and an outcome. Grounded theory was applied to analyze the experience of 15 bereaved Hong Kong Chinese older adults. The main theme that emerged was time. Acceptance of spousal death was found to be related to the search for meaning…

Long-Term Effects of Child Death on Parents' Health-Related Quality of Life: A Dyadic Analysis

ERIC Educational Resources Information Center

Song, Jieun; Floyd, Frank J.; Seltzer, Marsha Mailick; Greenberg, Jan S.; Hong, Jinkuk

2010-01-01

This study examines the long-term effects of child death on bereaved parents' health-related quality of life (HRQoL). Using data from the Wisconsin Longitudinal Study, we compared 233 bereaved couples and 229 comparison couples (mean age = 65.11 years) and examined the life course effects of child death on parents' HRQoL. Variations in bereavement…

Network and Mutual Support for Parents Bereaved Following the Violent Deaths of Their 12- to 28-Year Old Children: A Longitudinal, Prospective Analysis.

ERIC Educational Resources Information Center

Murphy, Shirley A.; Lohan, Janet; Dimond, Margaret; Fan, Juanjuan

1998-01-01

Examines types and frequency of posttreatment contacts among bereaved parents who participated in an experimental support program. Compares those who reported high versus low social support and high versus low numbers of network confidants on selected outcome and coping variables. Number of network confidants did not significantly affect the…

Breaking Cycles of Violence. A Work Group of the International Work Group on Death, Dying and Bereavement (IWG)

ERIC Educational Resources Information Center

Death Studies, 2005

2005-01-01

Violence begets violence and it is important to understand how cycles of violence are perpetuated if we are to find solutions to the global problems they present. A multi-disciplinary group of The International Work Group on Death, Dying and Bereavement has developed a model of the cyclical events that perpetuate violence at all levels including…

Can Individuals Who Are Specialists in Death, Dying, and Bereavement Contribute to the Prevention and/or Mitigation of Armed Conflicts and Cycles of Violence?

ERIC Educational Resources Information Center

Death Studies, 2011

2011-01-01

Specialists in death, dying, and bereavement and their consequences for individuals, families, and communities have experience and research findings that are relevant to an understanding of the reactions of individuals faced by deadly violence. At such times, powerful emotions and ingrained patterns of thought and behavior can given rise to…

Meeting the Needs of Our Clients Creatively: The Impact of Art and Culture on Caregiving. Death, Value and Meaning Series.

ERIC Educational Resources Information Center

Morgan, John D., Ed.

This book integrates traditional understandings of care of the dying and bereaved with the use of arts and other forms of cultural creativity in therapy and funeralization. Authors provide insights into the practical aspects of caring for the dying and bereaved as well as new understandings of creativity. Chapters include: (1) "The Knowledge…

Complicated grief associated with Hurricane Katrina

PubMed Central

Shear, M. Katherine; McLaughlin, Katie A.; Ghesquiere, Angela; Gruber, Michael J.; Sampson, Nancy A.; Kessler, Ronald C.

2011-01-01

Background Although losses are important consequences of disasters, few epidemiological studies of disasters have assessed complicated grief (CG) and none assessed CG associated with losses other than death of loved one. Methods Data come from the baseline survey of the Hurricane Katrina Community Advisory Group (CAG), a representative sample of 3,088 residents of the areas directly affected by Hurricane Katrina. A brief screen for CG was included containing four items consistent with the proposed DSM 5 criteria for a diagnosis of bereavement-related adjustment disorder. Results 58.5% of respondents reported a significant hurricane-related loss: Most-severe losses were 29.0% tangible, 9.5% interpersonal, 8.1% intangible, 4.2% work-financial, and 3.7% death of loved one. 26.1% of respondents with significant loss had possible CG and 7.0% moderate-severe CG. Death of loved one was associated with the highest conditional probability of moderate-severe CG (18.5%, compared to 1.1–10.5% conditional probabilities for other losses) but accounted for only 16.5% of moderate-severe CG due to its comparatively low prevalence. Most moderate-severe CG was due to tangible (52.9%) or interpersonal (24.0%) losses. Significant predictors of CG were mostly unique to either bereavement (racial-ethnic minority status, social support) or other losses (pre-hurricane history of psychopathology, social competence.). Conclusions Non-bereavement losses accounted for the vast majority of hurricane-related possible CG despite risk of CG being much higher in response to bereavement than to other losses. This result argues for expansion of research on CG beyond bereavement and alerts clinicians to the need to address post-disaster grief associated with a wide range of losses. PMID:21796740

OA12 When grief and work collide.

PubMed

Rosenberg, Kathryn

2015-04-01

There is a significant price to pay for organisations that fail to take seriously the challenges involved in supporting grieving employees in the workplace, including loss of productivity, sickness absence, and low morale. The purpose of this study was to look at how social service organisations implement their bereavement policies and support bereaved staff. The study aimed to raise awareness of current issues and practices in the implementation of bereavement policies and the management and support of grieving employees on their return to work. A generic qualitative method was used and recruitment of six participants from social service organisations within New Zealand was undertaken. Non-probability purposive sampling was used. Data collection was via email interviews. While New Zealand employees are legally entitled to three days paid bereavement leave, how flexible and supportive employers were willing to be beyond that varied. Participants felt out of their depth in dealing with grieving employees and lack of training around grief and loss meant a heavy reliance on external sources of support. The study also exposed a possible lack of understanding in relation to cultural mourning rituals. This study uncovered several areas of concern relating to organisational attitudes towards grieving employees and their ability to adequately support bereaved staff on their return to work. It poses the question for future research as to whether organisations can afford not to care and serves as a springboard for examining the detrimental consequences of neglecting the realities of loss. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

When hope and grief intersect: rates and risks of prolonged grief disorder among bereaved individuals and relatives of disappeared persons in Colombia.

PubMed

Heeke, Carina; Stammel, Nadine; Knaevelsrud, Christine

2015-03-01

Forced disappearance is a frequent phenomenon in violent conflicts and regimes, yet little is known about unresolved grief processes as a possible outcome of the disappearance of a loved one. This study investigates prolonged grief disorder (PGD) and its risk factors in a sample of persons who lost a significant other to disappearance as compared with a sample of bereaved individuals, both groups having experienced displacement due to the armed conflict in Colombia. In a cross-sectional study conducted in four Colombian provinces, 73 persons who lost a significant other to disappearance and 222 bereaved individuals completed measures of PGD (PG-13), depression (HSCL-25), and PTSD (PCL-C) via face-to-face interviews. Trauma- and loss-related variables, including the extent to which significant others of disappeared persons hoped that their loved one was still alive, were assessed. Results indicated that 23% of participants who lost a significant other to disappearance met criteria for PGD as compared to 31.5% in bereaved participants. No differences were found between the two groups in terms of symptom severity of PGD, depression, posttraumatic stress disorder, or traumatic exposure. Regression analysis indicated that, among relatives and friends of disappeared persons, the extent of hope predicted PGD above and beyond depression severity whereas among bereaved persons, PGD was predicted by time since the loss, the number of traumatic events and symptom severity of PTSD and depression. The instruments were not validated for use in Colombia; generalizability of findings is limited. Forced disappearance is related to prolonged grief reactions, particularly when those left behind maintain hope that the disappeared person is still alive. Copyright © 2014 Elsevier B.V. All rights reserved.

Initial Validation of a Comprehensive Assessment Instrument for Bereavement-Related Grief Symptoms and Risk of Complications: The Indicator of Bereavement Adaptation—Cruse Scotland (IBACS)

PubMed Central

Schut, Henk; Stroebe, Margaret S.; Wilson, Stewart; Birrell, John

2016-01-01

Objective This study assessed the validity of the Indicator of Bereavement Adaptation Cruse Scotland (IBACS). Designed for use in clinical and non-clinical settings, the IBACS measures severity of grief symptoms and risk of developing complications. Method N = 196 (44 male, 152 female) help-seeking, bereaved Scottish adults participated at two timepoints: T1 (baseline) and T2 (after 18 months). Four validated assessment instruments were administered: CORE-R, ICG-R, IES-R, SCL-90-R. Discriminative ability was assessed using ROC curve analysis. Concurrent validity was tested through correlation analysis at T1. Predictive validity was assessed using correlation analyses and ROC curve analysis. Optimal IBACS cutoff values were obtained by calculating a maximal Youden index J in ROC curve analysis. Clinical implications were compared across instruments. Results ROC curve analysis results (AUC = .84, p < .01, 95% CI between .77 and .90) indicated the IBACS is a good diagnostic instrument for assessing complicated grief. Positive correlations (p < .01, 2-tailed) with all four instruments at T1 demonstrated the IBACS' concurrent validity, strongest with complicated grief measures (r = .82). Predictive validity was shown to be fair in T2 ROC curve analysis results (n = 67, AUC = .78, 95% CI between .65 and .92; p < .01). Predictive validity was also supported by stable positive correlations between IBACS and other instruments at T2. Clinical indications were found not to differ across instruments. Conclusions The IBACS offers effective grief symptom and risk assessment for use by non-clinicians. Indications are sufficient to support intake assessment for a stepped model of bereavement intervention. PMID:27741246

Past personal history of dysphoria, social support, and psychological distress following conjugal bereavement.

PubMed

Hays, J C; Kasl, S; Jacobs, S

1994-07-01

This study describe the course and risk factors of psychological distress following bereavement, controlling for factors often omitted from studies of grief: psychiatric history, social support, and coping choices of the bereaved. Spouses of patients hospitalized for serious illness or elective surgery were systematically screened and followed longitudinally through the recovery or death of the hospitalized patient. Of 440 respondents, 154 were bereaved within 2 months. Spouses were interviewed in their homes by trained interviewers at intake and 2, 6, 13, and 25 months postintake. Dependent variables were measured with the CES-D (depressive symptoms) and the PERI (general anxiety and hopelessness/helplessness) scales. Independent variables were measured with the SADS-L (past personal history of dysphoria) and the Lazarus' Ways of Coping scale as well as sociodemographic measures. Lifetime prevalence of a brief period of dysphoric mood among spouses before the patient's illness was 22%; past personal history of dysphoric mood was related to female sex, smaller networks, and more depression and anxiety during the hospitalization of their spouses. Newly widowed persons with a past history of dysphoria perceived their networks to be relatively nonsupportive, but devoted similar amounts of coping effort to seeking social support and reported similar amounts of social interaction compared with persons with no history of dysphoria. Persons with a past history of dysphoria reported elevated levels of depressive symptoms, general anxiety, and hopelessness/helplessness through 25 months postbereavement, yet their recovery trajectory was similar to those without a past history of dysphoria. It was concluded that a past history of subsyndromal symptomatology in conjunction with a stressful life event such as bereavement increases one's vulnerability to excess psychological distress.

The influence of multiple birth and bereavement on maternal and family outcomes 2 and 7years after very preterm birth.

PubMed

Treyvaud, Karli; Aldana, Andrea C; Scratch, Shannon E; Ure, Alexandra M; Pace, Carmen C; Doyle, Lex W; Anderson, Peter J

2016-09-01

Psychological distress has been reported by mothers of infants born very preterm (VPT) and by mothers of multiples (twins and triplets). This study examined the influence of i) multiple birth and ii) bereavement associated with a multifetal pregnancy, on mental health, parenting stress and family functioning for mothers of children born VPT across early childhood. Participants were 162 mothers of 194 infants (129 singletons, 65 multiples) born at <30weeks' gestation or with a birth weight<1250g who completed questionnaires when their children were two and seven years corrected age. Fifteen mothers (9%) experienced bereavement associated with a multifetal pregnancy. Maternal mental health was assessed using the General Health Questionnaire at two years and Hospital Anxiety and Depression Scale at seven years. Parenting stress and family functioning were assessed using the Parenting Stress Index and Family Assessment Device. Maternal mental health, stress and family functioning were similar in mothers of VPT singletons and multiples. However compared with mothers who had not experienced bereavement, mothers who had were 3.6 times [95% confidence interval (95% CI) 1.05, 12.5] more likely to report elevated anxiety symptoms and 3.6 times [95% CI 1.05, 12.3] more likely to report elevated depressive symptoms when their VPT child was seven years old. The results of this study highlight the need for monitoring and offering ongoing support to bereaved mothers with surviving VPT children. However, within the context of VPT birth, multiple birth does not increase the risk for maternal psychological distress in early childhood. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Long-term psychosocial outcomes among bereaved siblings of children with cancer

PubMed Central

Rosenberg, Abby R.; Postier, Andrea; Osenga, Kaci; Kreicbergs, Ulrika; Neville, Bridget; Dussel, Veronica; Wolfe, Joanne

2014-01-01

Context The death of a child from cancer affects the entire family. Little is known about the long-term psychosocial outcomes of bereaved siblings. Objectives To describe: (1) the prevalence of risky health-behaviors, psychological distress, and social support among bereaved siblings; (2) potentially modifiable factors associated with poor outcomes. Methods Bereaved siblings were eligible for this dual-center, cross-sectional, survey-based study if they were ≥16 years-old and their parents had enrolled in one of three prior studies about caring for children with cancer at end of life. Linear regression models identified associations between personal perspectives before, during, and after the family's cancer experience and outcomes (health-behaviors, psychological distress, and social support). Results Fifty-eight siblings completed surveys (62% response rate). They were approximately 12 years bereaved, with a mean age of 26 years at the time of the survey (SD=7.8). Anxiety, depression, and illicit substance use increased during the year following their brother/sister's death, but then returned to baseline. Siblings who reported dissatisfaction with communication, poor preparation for death, missed opportunities to say “goodbye,” and/or a perceived negative impact of the cancer experience on relationships tended to have higher distress and lower social support scores (p<0.001-0.031). Almost all siblings reported their loss still affected them; half stated the experience impacted current educational and career goals. Conclusion How siblings experience the death of a child with cancer may impact their long-term psychosocial well-being. Sibling-directed communication and concurrent supportive care during the cancer experience and the year following sibling death may mitigate poor long-term outcomes. PMID:24880001

Long-term psychosocial outcomes among bereaved siblings of children with cancer.

PubMed

Rosenberg, Abby R; Postier, Andrea; Osenga, Kaci; Kreicbergs, Ulrika; Neville, Bridget; Dussel, Veronica; Wolfe, Joanne

2015-01-01

The death of a child from cancer affects the entire family. Little is known about the long-term psychosocial outcomes of bereaved siblings. To describe 1) the prevalence of risky health behaviors, psychological distress, and social support among bereaved siblings and 2) potentially modifiable factors associated with poor outcomes. Bereaved siblings were eligible for this dual-center, cross-sectional, survey-based study if they were 16 years or older and their parents had enrolled in one of three prior studies about caring for children with cancer at the end of life. Linear regression models identified associations between personal perspectives before, during, and after the family's cancer experience and outcomes (health behaviors, psychological distress, and social support). Fifty-eight siblings completed surveys (62% response rate). They were approximately 12 years bereaved, with a mean age of 26 years at the time of the survey (SD 7.8). Anxiety, depression, and illicit substance use increased during the year after their brother/sister's death but then returned to baseline. Siblings who reported dissatisfaction with communication, poor preparation for death, missed opportunities to say goodbye, and/or a perceived negative impact of the cancer experience on relationships tended to have higher distress and lower social support scores (P < 0.001-0.031). Almost all siblings reported that their loss still affected them; half stated that the experience impacted current educational and career goals. How siblings experience the death of a child with cancer may impact their long-term psychosocial well-being. Sibling-directed communication and concurrent supportive care during the cancer experience and the year after the sibling death may mitigate poor long-term outcomes. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Timing of Survey Administration After Hospice Patient Death: Stability of Bereaved Respondents

PubMed Central

DiBiasio, Eleanor L.; Clark, Melissa A.; Gozalo, Pedro L.; Spence, Carol; Casarett, David J.; Teno, Joan M.

2017-01-01

Context The Centers for Medicare & Medicaid Services have elected to include a bereaved family member survey in public reporting of hospice quality data as mandated in the Affordable Care Act. However, it is not known what timepoint after death offers the most reliable responses. Objectives To examine the stability of bereaved family members’ survey responses when administered three, six and nine months after hospice patient death. Methods Bereaved family members from six geographically diverse hospices were interviewed three, six, and nine months after patient death. All respondents completed a core survey. Those whose family member died at home, in a free-standing inpatient unit, or in a nursing home also completed a site-specific module. Stability was based on top-box scoring of each item with kappa statistics, and multivariable regression models were used to assess directionality and predictors of change. To analyze the effects of grief, we assessed response stability among respondents at least one standard deviation from the mean change in grief between three and six months. Results We had 1532 surveys (536 three-month surveys, 529 six-month surveys, and 467 nine-month surveys) returned by 643 respondents (average age 61.7 years, 17.4% Black, 50.5% a child respondent) about hospice decedents (55.3% female, average age 78.6 years, 57.0% non-cancer, 40.0% at home.) The average kappa for core items between three and nine months was 0.54 (range: 0.42-0.74), 0.58 (0.41-0.69) for home-specific items, and 0.54 (0.39-0.63) for nursing home. Even among individuals demonstrating large grief changes, core items demonstrated moderate to high stability over time. Conclusion Bereaved family member responses are stable between three and nine months after the death of the patient. PMID:25647420

Grief resolution: facilitating self-transcendence in the bereaved.

PubMed

Joffrion, L P; Douglas, D

1994-03-01

1. The clinical nurse specialist (CNS) can help individuals to resolve grief that stems from personal loss and death, and encourage activities that will assist highly motivated individuals to achieve self-transcendence. 2. Self-transcendence is the ability to extend one's self beyond personal concerns and reach out to others without losing one's sense of self. The process of self-transcendence results in broader perspectives, purposes, and activities in one's life. Self-transcendent acts of giving to and/or sharing with others leads to a sense of connectedness with others, one's surroundings, and God. 3. Ultimately, the CNS encourages the bereaved person to participate in a grief resolution support group. By sharing openly and actively participating in the group process, the bereaved person learns coping skills that facilitate grief resolution and encourage the development of self-transcendency.

Feasibility of group intervention for bereaved siblings after pediatric cancer death.

PubMed

Greenwald, Naomi; Barrera, Maru; Neville, Alexandra; Hancock, Kelly

2017-01-01

This study evaluated the feasibility (acceptability, recruitment, retention rates, treatment fidelity, and outcome measures) of implementing a manualized group intervention for bereaved siblings after pediatric cancer death. A convenience sample of 10 siblings participated. The intervention consisted of eight 2-hour sessions that focused on strategies for coping with grief, relationships, and emotional growth. Positive outcomes were obtained with respect to acceptability, recruitment, retention rates, and treatment fidelity. Preliminary outcomes were mixed. Parent pre- and post-intervention outcomes suggested improvements in siblings' overall emotional and social quality of life. Siblings' self-reports reflected no improvements. These data support the feasibility of conducting this intervention and suggest beneficial outcomes based on parental reports. Further research is recommended to evaluate the group intervention efficacy with a large sample using a randomized controlled trial to address the needs of bereaved siblings.

Good grief: bereavement literature for young adults and A Monster Calls.

PubMed

Day, Giskin

2012-12-01

Recent years have seen a proliferation of critically acclaimed novels for young adults dealing with bereavement. This is part of a 'bereavement turn'--a contemporary cultural movement to examine publicly our attitudes to death and grieving. This paper examines the narrative strategies in Patrick Ness's award-winning novel A Monster Calls to look at the ways in which the psychic burden of the impending loss of a parent through cancer is managed. The book draws on conventions of children's literature to create a sense of familiarity that helps to balance the emotional stress of the story. The Kübler-Ross stages of grief serve as a heuristic that helps the story deliver catharsis in spite of its inevitably traumatic subject matter. A Monster Calls is an important addition to the canon of fictional pathography.

Psychotherapy of Bereavement After Homicide

PubMed Central

RYNEARSON, TED

1994-01-01

The author presents guidelines for the assessment and initial treatment of bereavement after a homicide. Early interventions include nonverbal techniques applied in individual and group therapy. Because patients are over-whelmed and reactive, initial treatment strategy is supportive and focuses on reestablishing resiliency rather than on preexisting vulnerabilities (ambivalence, guilt, repression, denial). Adjustment to homicidal dying is lifelong, and therapist and patient should acknowledge that change may be limited. PMID:22700202

What helps and what hinders the process of surviving the suicide of somebody close?

PubMed

Grad, Onja T; Clark, Sheila; Dyregrov, Kari; Andriessen, Karl

2004-01-01

This paper presents similar findings about the lack of support and understanding for people bereaved through suicide from four different countries and reports on each country's unique response to this challenge. This paper reports on presentations made at the conference workshop of the International Association for Suicide Prevention meeting in Chennai in 2001, and on participants' suggestions of how best to help the bereaved.

The Impact of Staff Training on the Knowledge of Support Staff in Relation to Bereavement and People with an Intellectual Disability

ERIC Educational Resources Information Center

Watters, Laura; McKenzie, Karen; Wright, Rachel

2012-01-01

This study aimed to investigate whether a 1-day training course improved support staff knowledge about bereavement and grief in people with a learning disability. A questionnaire based, mixed design was used. Forty-eight participants were randomly assigned to one of two equal groups. A staggered design allowed for group 2 to act both as a control…

Do we need to change our understanding of anticipatory grief in caregivers? A systematic review of caregiver studies during end-of-life caregiving and bereavement.

PubMed

Nielsen, Mette Kjaergaard; Neergaard, Mette Asbjoern; Jensen, Anders Bonde; Bro, Flemming; Guldin, Mai-Britt

2016-03-01

Caregivers of terminally ill patients may experience anticipatory grief or low levels of preparedness for the patient's impending death. Both concepts are related to a forewarning of the impending loss. Anticipatory grief has been suggested to be grief work before the loss, which would improve bereavement outcome, but recent studies indicate a negative impact. Hence, this review systematically investigates key issues relating to anticipatory grief and preparedness for the death; definitions, measurement tools, and potential effects on caregiver outcome. We used a systematic approach (PRISMA statement). Databases were searched for publications during 1990-2015. Studies on adult caregivers of terminally ill adult patients were included if anticipatory grief or preparedness was assessed by a measurement tool. Anticipatory grief was captured in the definition "pre-loss grief." High levels of grief and low levels of preparedness during caregiving were associated with poor bereavement outcome such as complicated grief. The assumptions that grief work before the loss would alleviate bereavement outcome was not confirmed. Thus, the concept of anticipatory grief is questioned. High preparedness was associated with improved caregiver outcome. Additional support should be given to caregivers with pre-loss grief and low preparedness. Copyright © 2016 Elsevier Ltd. All rights reserved.

Are participants in face-to-face and internet support groups the same? Comparison of demographics and depression levels among women bereaved by stillbirth.

PubMed

Gold, Katherine J; Normandin, Margaret M; Boggs, Martha E

2016-12-01

Support groups can help individuals cope with difficult health situations but have been understudied for women with perinatal bereavement. An early study suggested those using internet support groups had high rates of positive depression screens, raising the question whether these users were more symptomatic than those in similar face-to-face support groups. We therefore conducted two convenience sample surveys of women bereaved by perinatal loss, one looking at use of online support groups and the other in-person support groups. The surveys identified demographics, use of peer support, potential confounders, and current depression symptoms using the Edinburgh Postnatal Depression Scale (EPDS). Four hundred sixteen women from 18 internet groups and 60 women from 13 in-person groups met inclusion criteria. Participants in both groups were predominantly Caucasian, highly educated, and had private insurance. Severe depression symptoms were similar in the two groups despite the different modalities. Women in both face-to-face or internet groups for pregnancy and perinatal loss demonstrated similar scores on depression screens. Women of color, poor, and less-educated women were starkly underrepresented in both types of groups, raising questions about knowledge of support options, barriers to use, preferences for bereavement support, and optimization of groups for a broader population.

Assessment and associated features of prolonged grief disorder among Chinese bereaved individuals.

PubMed

Li, Jie; Prigerson, Holly G

2016-04-01

Most research on the assessment and characteristics of prolonged grief disorder (PGD) has been conducted in Western bereaved samples. Limited information about PGD in Chinese samples exists. This study aims to validate the Chinese version of the Inventory of Complicated grief (ICG), examine the distinctiveness of PGD symptoms from symptoms of bereavement-related depression and anxiety, and explore the prevalence of PGD in a Chinese sample. Responses from 1358 bereaved Chinese adults were collected through an on-line survey. They completed the Chinese version of ICG and a questionnaire measuring depression and anxiety symptoms. The findings indicate that Chinese ICG has sound validity and high internal consistency. The ICG cut-off score for PGD "caseness"in this large Chinese sample was 48. The distinctiveness of PGD symptoms from those of depression and anxiety was supported by the results of the confirmatory factor analysis and the fact that PGD occurred in isolation in the studied sample. The prevalence of PGD was13.9%. ICG is a valid instrument for use in the Chinese context. Several key characteristics of PGD in Chinese, either different from or comparable to findings in Western samples, may stimulate further research and clinical interest in the concept by providing empirical evidence from an large and influential Eastern country. Copyright © 2015 Elsevier Inc. All rights reserved.

Associations between stress and quality of life: differences between owners keeping a living dog or losing a dog by euthanasia.

PubMed

Tzivian, Lilian; Friger, Michael; Kushnir, Talma

2015-01-01

The loss of a pet may be stressful to the owner. The main objectives of this study were to compare the levels of stress and to explore the correlates of QOL of healthy adults who currently own or who have just lost their dog. The study sample contained 110 current, and 103 bereaved dog owners, all females, who lost their dogs due to euthanasia. QOL was assessed with the WHOQOL-BREF questionnaire and divided into four major domains-Physical, Psychological, Relationship, and Environmental. Demographic variables, stress, health behaviors, and social support from family, friends, and significant other were included in multivariate analysis. Stress levels were significantly higher in bereaved owners. QOL in three of the four domains (Physical, Psychological, and Relationship) of current owners were significantly better than among bereaved owners. Stress was significantly associated with these three domains of QOL. Quality of life was found to be positively associated with social support. Age was related directly only to current owners' QOL. The results suggest that a loss of a dog is associated with stress for the bereaved owner and reduced physical, psychological, and relationship QOL. Lack of social support in the case of death of a companion animal has a strong effect on owners' grief reactions.

Internal connections and conversations: the internalized other interview in bereavement work.

PubMed

Moules, Nancy J

Much of the work of grief lies in the ways the bereaved learn to maintain connection to the deceased in their lives, while living alongside the physical absence of them. The theory of an Internalized Other Interview is that we carry within ourselves impressions, memories, beliefs, assessments, doctrines, and codes of those who have shaped our lives through relationship. This internalized community of commentators is active in our lives on a day-to-day basis, but when someone dies, their active voice in the dialogue is shifted to a perceived inactivity. However, I argue that, despite the physical absence of the other, the voice continues to resonate and interact in our formation of our worlds. How our loved ones live on inside us influences who we are in the world and in our bereavement. As a result of our research and clinical work, I have come to believe that the active interviewing of the deceased person as internalized in the bereaved can have powerful and healing effects. In this article, I share the results of the research related to this intervention, describe the history located in Internalized Other Interviewing, and offer a transcription of an Internalized Other Interview with a young man and his family who recently lost both his brother and father.

Same-sex partner bereavement in older women: an interpretative phenomenological analysis.

PubMed

Ingham, Charlotte F A; Eccles, Fiona J R; Armitage, Jocelyn R; Murray, Craig D

2017-09-01

Due to the lack of existing literature, the current research explored experiences of same-sex partner bereavement in women over the age of 60. Semi-structured interviews were conducted with eight women. Transcripts were analysed using interpretative phenomenological analysis. Three themes were identified which elaborated the experiences of older women who had lost a same-sex partner: (1) being left alone encapsulated feelings of isolation and exclusion; (2) navigating visibility centred on how homophobia led to a lack of recognition of the women's grief; and (3) finding new places to be authentic related women's need for new relationships in which they could be themselves. The findings indicate that existing models of partner bereavement may provide useful frameworks when seeking to understand the experiences of older women who have lost their same-sex partners. The findings indicate that in addition to the experiences of partner bereavement noted in research with heterosexual widows, older women who lose same-sex partners may face particular challenges, which can impact upon psychological well-being and adjustment to loss. These challenges appear to result from past and current homophobic and heterosexist attitudes within the UK culture. A range of interventions at individual, group, health service, and societal levels may be beneficial in improving the psychological well-being of older women who lose a same-sex partner.

Getting straight about grief.

PubMed

Shear, M Katherine

2012-06-01

Acute grief is emotionally intense, cognitively preoccupying, and disruptive, but grief is not an illness; major depression and anxiety disorders are. Grief and mourning have a purpose. They provide an intense, focused opportunity to reregulate emotion and to engage in a learning process that is aimed at reconfiguring life without the deceased—both the internal life of the mind, and ongoing life in the world. A bereaved person needs to figure out how to find meaning, purpose, joy, and satisfaction in life without someone who has previously been central to these feelings. This reconfiguration is a very natural process that tends to occur in fits and starts as bereaved people move forward and deal with everyday life. Nevertheless, a knowledgeable, empathic and supportive clinician can foster good adjustment. Successful mourning is, however, not a given. For some people, the mourning process is derailed and acute grief is inordinately painful and prolonged. For others, the stress of bereavement triggers the onset or worsening of symptoms of MDD, an anxiety disorder or another psychiatric or medical condition, suicidality or negative health behaviors. Clinicians need to be alert to all of these problematic responses to loss. In the wake of bereavement, we need to both facilitate effective mourning and diagnose and treat co-occurring conditions.

Imagining What Could Have Happened: Types and Vividness of Counterfactual Thoughts and the Relationship With Post-traumatic Stress Reactions.

PubMed

Blix, Ines; Kanten, Alf Børre; Birkeland, Marianne Skogbrott; Thoresen, Siri

2018-01-01

A growing body of research suggests that counterfactual thinking after traumatic events is associated with post-traumatic stress reactions. In this study we explored frequency of upward and downward counterfactuals in trauma-exposed individuals, and how trauma-related counterfactuals were represented in terms of vividness. We examined the relationships between vividness and frequency of counterfactual thoughts and post-traumatic stress reactions in two groups who had experienced different types of traumatic exposure, namely survivors and bereaved from the fire on the ferry Scandinavian Star in 1990. Even after 26 years, both survivors and bereaved reported that they currently entertained thoughts about what could have happened during the fire on Scandinavian Star. Survivors reported more downward counterfactuals than the bereaved, whereas the bereaved reported more upward counterfactuals than the survivors did. Vividness of counterfactual thoughts, as well as reported frequency of upward and downward counterfactuals, were associated with post-traumatic stress reactions. Our results suggest that both upward and downward counterfactuals can be harmful, and that vivid counterfactuals about a traumatic event might play a similar role in post-traumatic stress as trauma memories. Therefore, traumatized individuals who entertain counterfactual thoughts may benefit from interventions that target these thoughts specifically.

African Americans in bereavement: grief as a function of ethnicity.

PubMed

Laurie, Anna; Neimeyer, Robert A

2008-01-01

Few empirical studies have explored the grieving process among different ethnic groups within the United States, and very little is known about how African Americans and Caucasians may differ in their experience of loss. The purpose of this study was to examine the African-American experience of grief, with particular emphasis on issues of identity change, interpersonal dimensions of the loss, and continuing attachments with the deceased. Participants were 1,581 bereaved college students (940 Caucasians and 641 African Americans) attending classes at a large southern university. Each participant completed the Inventory of Complicated Grief-Revised, the Continuing Bonds Scale, and questions regarding the circumstances surrounding his or her loss. Results revealed that African Americans experienced more frequent bereavement by homicide, maintenance of a stronger continuing bond with the deceased, greater grief for the loss of extended kin beyond the immediate family, and a sense of support in their grief, despite their tendency to talk less with others about the loss or seek professional support for it. Overall, African Americans reported higher levels of complicated grief symptoms than Caucasians, especially when they spent less time speaking to others about their loss experience. Implications of these findings for bereavement support services for African Americans were briefly noted.

Perceived timeliness of referral to hospice palliative care among bereaved family members in Korea.

PubMed

Jho, Hyun Jung; Chang, Yoon Jung; Song, Hye Young; Choi, Jin Young; Kim, Yeol; Park, Eun Jung; Paek, Soo Jin; Choi, Hee Jae

2015-09-01

We aimed to explore the perceived timeliness of referral to hospice palliative care unit (HPCU) among bereaved family members in Korea and factors associated therewith. Cross-sectional questionnaire survey was performed for bereaved family members of patients who utilized 40 designated HPCUs across Korea. The questionnaire assessed whether admission to the HPCU was "too late" or "appropriate" and the Good Death Inventory (GDI). A total of 383 questionnaires were analyzed. Of participants, 25.8 % replied that admission to HPCU was too late. Patients with hepatobiliary cancer, poor performance status, abnormal consciousness level, and unawareness of terminal status were significantly related with the too late perception. Family members with younger age and being a child of the patient were more frequently noted in the too late group. Ten out of 18 GDI scores were significantly lower in the too late group. Multiple logistic regression analysis revealed patients' unawareness of terminal status, shorter stay in the HPCU, younger age of bereaved family, and lower scores for two GDI items (staying in a favored place, living without concerning death or disease) were significantly associated with the too late group. To promote timely HPCU utilization and better quality of end of life care, patients need to be informed of the terminal status and their preference should be respected.

[Relationship between grief support and burnout syndrome in professionals and technicians of pediatric health].

PubMed

Vega V, Paula; González R, Rina; Bustos M, José; Rojo S, Leticia; López E, María Eugenia; Rosas P, Amaia; Hasbún I, Carmen Gloria

2017-01-01

Detect the presence of Burnout and bereavement support of health professionals in oncology and pediatric intensive care units in Chilean public hospitals. Transversal design of descriptive correlational type. Auto-evaluation using the Maslach Burnout Inventory and Grief Support Health Care Scale instruments in 210 professionals and technicians. For the analysis of a means comparison, the t-student test was used and for the comparison between the variables, the correlations of Pearson and Spearman were used, considering a level of significance of 5%. 4% of the participants presented with Burnout and 71% were at risk of suffering it. 52% had a high level of perception of bereavement support, especially in women and oncology personnel. When correlating support in bereavement and Burnout, the data suggests that both the recognition of the bond, as well as the loss after death of a patient, helps decrease the depersonalization of the professional and improves their personal fulfillment. Professionals in areas of high pediatric complexity are at high risk of Burnout, due to greater emotional exhaustion and low personal accomplishment. However, a greater perception of recognition and support in their bereavement is a factor that can reduce that risk. Therefore, continuous intervention programs are required within these units, with concrete strategies for accompaniment, teamwork and mourning rituals.

A Comparative Examination of Schools' Responses to Bereavement and the Associated Needs of the School Community in Galway, West of Ireland and Derry, Northern Ireland

ERIC Educational Resources Information Center

McGovern, Marguerita; Tracey, Anne

2010-01-01

The aim and objective of this study is to examine and compare how schools in Galway, Republic of Ireland and Derry in the North of Ireland (cities located within two independent jurisdictions in Ireland) manage and respond to bereavement. To carry out a survey of schools, the "Loss in Schools" questionnaire is considered the most…

Grief and Bereavement Issues and the Loss of a Companion Animal: People Living with a Companion Animal, Owners of Livestock, and Animal Support Workers

ERIC Educational Resources Information Center

Chur-Hansen, Anna

2010-01-01

Companion animals play various roles in people's lives and these roles can impact on loss, grief, bereavement and mourning when the animal has been lost, whether that is through death, when missing, or when relinquished. This paper considers not only companion animal owners, but also those who own farm animals and those who work in animal service…

The Perceived Experience of Children Bereaved by Parental Suicide.

PubMed

Schreiber, Jennifer K; Sands, Diana C; Jordan, John R

2017-06-01

Children whose parent died by suicide are a vulnerable and underserved population. This phenomenon will be described, as well as implications for practice and research. "Double Whammy," a conceptualization of the overall experience of this marginalized group, emerged through two in-depth interviews from a phenomenological qualitative study with professionals who facilitate support groups for children bereaved by parental suicide. It was corroborated with current literature and practice experiences of the authors and their colleagues. Stigma was the largest contributor to the "Double Whammy," and the following themes emerged as well: feeling isolated, feeling abandoned, and feeling responsible. The self-volition of suicide challenges how bereaved children make meaning and internalize feelings about the deceased parent, one's self, and others. Developmentally appropriate education about suicide grief, depression, and normalizing the grief process is pivotal in helping children to effectively cope and manage their feelings.

Bereavement after the suicide of a significant other

PubMed Central

Pompili, Maurizio; Shrivastava, Amresh; Serafini, Gianluca; Innamorati, Marco; Milelli, Mariantonietta; Erbuto, Denise; Ricci, Federica; Lamis, Dorian A.; Scocco, Paolo; Amore, Mario; Lester, David; Girardi, Paolo

2013-01-01

Context: It is estimated that approximately one in four people know someone who has taken their own life and that one suicide death leaves six or more suicide survivors. Aims: The aim of this paper was to review the literature regarding the association between suicide and bereavement, focusing also on the supportive and therapeutic resources available for survivors. Materials and Methods: Careful MedLine and PsycINFO searches for the period 1980-2013. Results: The review of the literature indicates that emotional turmoil in suicide survivors may last a long time and, in some cases, may end with their own suicide. Conclusion: Future research should evaluate the efficacy of professional treatments and of support groups targeting suicide survivors. Practice Implications: It is crucial to understand the bereavement process after the suicide of a significant other in order to provide proper care, reduce stigma, and improve the outcomes of related psychiatric conditions. PMID:24082246

[Parental death in childhood: the state of theoretical knowledge and clinical challenges in the future].

PubMed

Mentec, Margaux; Flahault, Cécile

2015-03-01

Although children's psychological adaptation to parental cancer is a wide field for psycho-oncological research, few empirical studies target children bereavement specifically following parental cancer. In this paper, our purpose is to make a state of art about literature concerning parental death. Literature dealing with grief concerns psychopathological consequences of parental loss and most recently post-traumatic growth. Although references about support programs have emerged, few of these programs have been scientifically evaluated. This review underlines that more studies are needed with prospective quantitative and qualitative studies, in order to describe more precisely children bereavement process and long term effects of bereavement. Psychological support for other family members and evaluation of support programs seem to be critical to improve children adaptation to parental death. Copyright © 2015 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Factors affecting recruitment and participation of bereaved parents and siblings in grief research.

PubMed

Akard, Terrah Foster; Gilmer, Mary Jo; Miller, Katy; Steele, Amii Corbisiero; Hancock, Kelly; Barrera, Maru; Compas, Bruce; Davies, Betty; Dietrich, Mary S; Fairclough, Diane L; Hogan, Nancy S; Vannatta, Kathryn; Gerhardt, Cynthia A

2014-04-01

This study examined participation factors in a study of families ( N  = 84) within 1 year of a child's cancer-related death. Specific aims were to examine associations between: (a) recruitment variables (number of phone calls made to eligible families, number of calls answered by eligible families) and participation rates (study agreement and refusal) and (b) characteristics of deceased children (gender, age, length of illness, time since death) and participation rates. Characteristics of deceased children did not differ between participating and non-participating families. Researchers made significantly fewer calls to participating versus refusing families. Participating families most often agreed during the first successful call connection, and more calls did not mean more recruitment success. Thus, it is reasonable to limit the number of calls made to bereaved families. Despite recruitment challenges, many bereaved parents and siblings are willing and interested to participate in grief research.

Chinese cultural dimensions of death, dying, and bereavement: focus group findings.

PubMed

Yick, Alice G; Gupta, Rashmi

2002-01-01

The purpose of this qualitative study is to describe Chinese immigrants and Chinese Americans' attitudes and practices about death, dying, and bereavement. To this end, three focus groups were conducted with social work graduate students, pastors and religious leaders, and service providers working in the Chinese American community in New York City. The United States is becoming increasingly multicultural, and Chinese Americans are the most rapidly growing Asian American group. Findings from this study revealed that many Chinese attitudes and practices about death and dying are rooted in Asian cultural values such as filial piety, centrality of the family, and emphasis of hierarchy. In addition, strains of Confucianism, Buddhism, Taoism, and local folklore are embedded in these death attitudes and practices. Based on themes extrapolated from the focus groups, recommendations are delineated for service providers in order to implement culturally-sensitive bereavement practices.

The Bereavement Guilt Scale.

PubMed

Li, Jie; Stroebe, Magaret; Chan, Cecilia L W; Chow, Amy Y M

2017-06-01

The rationale, development, and validation of the Bereavement Guilt Scale (BGS) are described in this article. The BGS was based on a theoretically developed, multidimensional conceptualization of guilt. Part 1 describes the generation of the item pool, derived from in-depth interviews, and review of the scientific literature. Part 2 details statistical analyses for further item selection (Sample 1, N = 273). Part 3 covers the psychometric properties of the emergent-BGS (Sample 2, N = 600, and Sample 3, N = 479). Confirmatory factor analysis indicated that a five-factor model fit the data best. Correlations of BGS scores with depression, anxiety, self-esteem, self-forgiveness, and mode of death were consistent with theoretical predictions, supporting the construct validity of the measure. The internal consistency and test-retest reliability were also supported. Thus, initial testing or examination suggests that the BGS is a valid tool to assess multiple components of bereavement guilt. Further psychometric testing across cultures is recommended.

Bereaved parents' experiences of music therapy with their terminally ill child.

PubMed

Lindenfelser, Kathryn J; Grocke, Denise; McFerran, Katrina

2008-01-01

The purpose of this study was to investigate bereaved parents' experiences of music therapy with their terminally ill child. In-depth interviews were conducted with 7 bereaved parents who were recruited through a community-based palliative care program. The parent participants' experiences varied as their children who received music therapy ranged in ages from 5 months to 12 years old. The interview transcripts were analyzed using phenomenological strategies. Five global themes emerged from the analysis. These included (a) music therapy was valued as a means of altering the child's and family's perception of their situation in the midst of adversity, (b) music therapy was a significant component of remembrance, (c) music therapy was a multifaceted experience for the child and family, (d) music therapy enhanced communication and expression, and (e) parents shared perceptions of and recommendations for improving music therapy services. These emergent themes yield knowledge into the relevance of music therapy within pediatric palliative care.

Recommendations for palliative and bereavement care in the NICU: a family-centered integrative approach.

PubMed

Kenner, C; Press, J; Ryan, D

2015-12-01

Technological advances have increased our ability to detect a life-threatening, life-limiting or lethal problem early in pregnancy, leaving parents months to anticipate a death or a prematurely born infant. Babies can also be born with unanticipated problems that could lead to death. In either scenario, perinatal palliative care should be offered as a strategy for family support. Since the preponderance of professional training focuses on saving lives, many health professionals are uncomfortable with palliative care. This article's purpose is to define best practices for the provision of family-centered perinatal and neonatal palliative care and provision of support to bereaved families experiencing anticipated and unanticipated life-limiting conditions or death of their infant. An overview of core concepts and values is presented, followed by intervention strategies to promote an integrated family-centered approach to palliative and bereavement care. The concluding section presents evidence-based recommendations.

Facial expressions of emotion and the course of conjugal bereavement.

PubMed

Bonanno, G A; Keltner, D

1997-02-01

The common assumption that emotional expression mediates the course of bereavement is tested. Competing hypotheses about the direction of mediation were formulated from the grief work and social-functional accounts of emotional expression. Facial expressions of emotion in conjugally bereaved adults were coded at 6 months post-loss as they described their relationship with the deceased; grief and perceived health were measured at 6, 14, and 25 months. Facial expressions of negative emotion, in particular anger, predicted increased grief at 14 months and poorer perceived health through 25 months. Facial expressions of positive emotion predicted decreased grief through 25 months and a positive but nonsignificant relation to perceived health. Predictive relations between negative and positive emotional expression persisted when initial levels of self-reported emotion, grief, and health were statistically controlled, demonstrating the mediating role of facial expressions of emotion in adjustment to conjugal loss. Theoretical and clinical implications are discussed.

Attachment, loss, and complicated grief.

PubMed

Shear, Katherine; Shair, Harry

2005-11-01

Bereavement is a highly disruptive experience that is usually followed by a painful but time-limited period of acute grief. An unfortunate minority of individuals experience prolonged and impairing complicated grief, an identifiable syndrome that differs from usual grief, major depression, and other DSM IV diagnostic entities. Underlying processes guiding symptoms are not well understood for either usual or complicated grief. We propose a provisional model of bereavement, guided by Myron Hofer's question "What exactly is lost when a loved one dies?" We integrate insights about biobehavioral regulation from Hofer's animal studies of infant separation, research on adult human attachment, and new ideas from bereavement research. In this model, death of an attachment figure produces a state of traumatic loss and symptoms of acute grief. These symptoms usually resolve following revision of the internalized representation of the deceased to incorporate the reality of the death. Failure to accomplish this integration results in the syndrome of complicated grief. Copyright 2005 Wiley Periodicals, Inc.

Factors Related to Parent Attendance at a Follow-Up Meeting With an Intensivist After a Child's Death in the Pediatric Intensive Care Unit.

PubMed

Suttle, Markita L; Gerhardt, Cynthia A; Fults, Marci Z

2017-01-01

Parents who experience the death of a child are at high risk for psychopathology. Because a large percentage of pediatric deaths occur in the pediatric intensive care unit each year, a follow-up meeting between bereaved parents and intensivists could provide essential emotional support, although some parents may not attend. The aim of this study was to explore demographic and medical factors that may distinguish between bereaved parents who attend a follow-up meeting with their child's pediatric intensivist and those who do not. Our analysis revealed that parents of children who died of trauma were less likely to attend a follow-up meeting with an intensivist. It is possible that symptoms of posttraumatic stress play a role in these findings. Enhanced efforts to identify other interventions for this specific subset of bereaved parents may be necessary.

Associations between Stress and Quality of Life: Differences between Owners Keeping a Living Dog or Losing a Dog by Euthanasia

PubMed Central

Tzivian, Lilian

2015-01-01

Objectives The loss of a pet may be stressful to the owner. The main objectives of this study were to compare the levels of stress and to explore the correlates of QOL of healthy adults who currently own or who have just lost their dog. Methods The study sample contained 110 current, and 103 bereaved dog owners, all females, who lost their dogs due to euthanasia. QOL was assessed with the WHOQOL-BREF questionnaire and divided into four major domains–Physical, Psychological, Relationship, and Environmental. Demographic variables, stress, health behaviors, and social support from family, friends, and significant other were included in multivariate analysis. Results Stress levels were significantly higher in bereaved owners. QOL in three of the four domains (Physical, Psychological, and Relationship) of current owners were significantly better than among bereaved owners. Stress was significantly associated with these three domains of QOL. Quality of life was found to be positively associated with social support. Age was related directly only to current owners’ QOL. Conclusions The results suggest that a loss of a dog is associated with stress for the bereaved owner and reduced physical, psychological, and relationship QOL. Lack of social support in the case of death of a companion animal has a strong effect on owners’ grief reactions. PMID:25826295

Anxiety is contagious-symptoms of anxiety in the terminally ill child affect long-term psychological well-being in bereaved parents.

PubMed

Jalmsell, Li; Kreicbergs, Ulrika; Onelöv, Erik; Steineck, Gunnar; Henter, Jan-Inge

2010-05-01

We studied the relation between unrelieved symptoms in terminally ill children and the psychological well-being in the bereaved parents 4-9 years after their loss. We contacted parents in Sweden who had lost a child to a malignancy 1992-1997. The parents were asked to assess symptoms affecting their child's well-being during his or her last month of life, and their own current psychological well-being. Altogether 449/561 (80%) eligible parents supplied information on 19 specific symptoms that may occur in children with a malignancy and how each of these symptoms had affected their child's well-being during his or her last month of life (not applicable, none, low, moderate, or severe). These results were linked to questions concerning the parents' self-assessed mental health. Parents of children who were affected by disturbed sleep also had increased risk to develop these symptoms; RR 2.0 [1.4-2.9] for depression, 1.8 [1.3-2.5] for anxiety, 1.5 [1.2-1.8] for decreased psychological well-being, and 1.5 [1.3-1.9] for decreased quality of life. Bereaved parents whose children were affected by anxiety or disturbed sleep due to anxiety or pain had an increased risk of long-term psychological morbidity. Reducing psychological complications in seriously ill children may also improve the psychological well-being in bereaved parents.

Stigma and psychological distress in suicide survivors.

PubMed

Scocco, Paolo; Preti, Antonio; Totaro, Stefano; Ferrari, Alessandro; Toffol, Elena

2017-03-01

Suicide bereavement is frequently related to clinically significant psychological distress and affected by stigma. This study was designed to evaluate the relationship between psychological distress by psychopathological domains and stigma, in a sample of individuals bereaved by suicide (suicide survivors). The data were collected between January 2012 and December 2014 and included information on sociodemographic variables (gender, age, marital status and education level) and responses to the Stigma of Suicide Survivor scale (STOSSS) and the Brief Symptom Inventory (BSI). One hundred and fifty-five suicide survivors completed the evaluation and were included in the study. Levels of psychological distress in suicide survivors, as measured by BSI, were positively related to levels of perceived stigma toward suicide survivors, as measured by STOSSS. The association was not affected by age and gender, or by marital status, education level, days from suicide or a personal history of suicide attempt. Participants with higher scores on almost all subscales of the BSI, particularly the interpersonal sensitivity and paranoid ideation subscales, reported the highest levels of perceived stigma toward suicide survivors. Levels of distress in subjects bereaved by the suicide of a relative or friend were positively associated with levels of perceived stigma toward suicide survivors. Specific interventions dedicated to the bereavement of suicide survivors might help to alleviate not only psychological distress but also stigma towards loss by suicide. Copyright © 2017 Elsevier Inc. All rights reserved.

Emotional and physiological reactivity in Complicated Grief.

PubMed

LeBlanc, Nicole J; Unger, Leslie D; McNally, Richard J

2016-04-01

Grief is a psychobiological response to the loss of a loved one. Some grief theorists suggest that this predictable response may arise from withdrawal of psychobiological regulation previously provided by the deceased (e.g. assistance with emotion regulation). Accordingly, recovery from loss may require bereaved individuals to re-establish self-regulatory control to avoid developing Complicated Grief (CG). This model implies that adults with CG may exhibit aberrant emotional responding to environmental stimuli. The present study was designed to test this hypothesis. We recruited a sample of 23 bereaved adults with CG and 26 healthy bereaved adults to complete an emotional reactivity paradigm. Participants watched a series of emotional film clips and provided measures of their self-reported emotional response. We also assessed their heart rate, respiratory sinus arrhythmia (RSA), and skin conductance level in response to these clips. Though emotional and physiological differences between the groups were rare, the CG group exhibited attenuated RSA reactivity to some emotional film clips, suggesting blunted parasympathetic nervous system reactivity in those with the disorder. Limitations include the modest sample size and unequal group sizes. Individuals with CG do not exhibit pervasive differences in emotional and physiological reactivity compared to healthy bereaved individuals. However, we did observe evidence of blunted parasympathetic nervous system reactivity in individuals with CG, which may mediate emotional inflexibility among those who develop the disorder. Copyright © 2016 Elsevier B.V. All rights reserved.

Parenting paradox: parenting after infant loss.

PubMed

Warland, Jane; O'Leary, Joann; McCutcheon, Helen; Williamson, Victoria

2011-10-01

to gain an in-depth understanding of the parenting experiences of bereaved parents in the years following an infant death. an exploratory qualitative study. semi-structured interview in the participants' homes. Data were collected over a five-month period in 2008 and analysed using thematic analysis. a purposive sample of 13 bereaved parents (10 mothers and three fathers) was used. Parents who had accessed the support services offered by two bereavement support agencies were recruited. Participants were asked to describe their experiences of raising their subsequent child. Interviews were conducted when the next born child was at least three years of age. the parents described a 'paradoxical' parenting style where they were trying to parent using two diametrically opposed unsustainable options. For example, they described trying to hold their subsequent child emotionally close but aloof at the same time. the results from this study indicate that the impact of a loss of an infant has far-reaching consequences on subsequent parenting. Support and early intervention at the time of the stillbirth and subsequent pregnancy are likely to be useful. However, further research is required to determine the extent to which early intervention can alter the tendency towards bereaved parents adopting a paradoxical parenting style. The impact of this style on mental health and the emotional health and well-being of the next born child/ren after perinatal loss should also be further examined. Copyright © 2010 Elsevier Ltd. All rights reserved.

Symptoms of prolonged grief and posttraumatic stress following loss: A latent class analysis.

PubMed

Maccallum, Fiona; Bryant, Richard A

2018-04-01

Individuals vary in how they respond to bereavement. Those who experience poor bereavement outcomes often report symptoms from more than one diagnostic category. This study sought to identify groups of individuals who share similar patterns of prolonged grief disorder and posttraumatic stress disorder symptoms to determine whether these profiles are differentially related to negative appraisals thought to contribute to prolonged grief disorder and posttraumatic stress disorder symptomatology. Participants were 185 bereaved adults. Latent class analysis was used to identify subgroups of individuals who showed similar patterns of co-occurrence of prolonged grief disorder and posttraumatic stress disorder symptoms. Multinomial regression was used to examine the extent to which appraisal domains and sociodemographic and loss factors predicted class membership. Latent class analysis revealed three classes of participants: a low symptom group, a high prolonged grief disorder symptom group, and a high prolonged grief disorder and posttraumatic stress disorder symptom group. Membership of the prolonged grief disorder group and prolonged grief disorder and posttraumatic stress disorder group was predicted by higher mean negative self-related appraisals. Demographic and loss-related factors did not predict group membership. These findings have implications for understanding co-occurrence of prolonged grief disorder and posttraumatic stress disorder symptoms following bereavement. Findings are consistent with theoretical models highlighting the importance of negative self-related beliefs in prolonged grief disorder.

WA50 We can't do it alone: hospices and schools working together to educate and support children around death, dying and bereavement.

PubMed

Paul, Sally; Quinn, Helen

2015-04-01

Educating and supporting children around death, dying and bereavement, in schools, frequently relies on the individual interest and expertise of staff (Rowling 2003). Moves to develop such work of ten results in one off projects led by external agencies. Support and education is therefore ad hoc and unequitable. A research study was undertaken between a hospice and school to develop practice in this area from a health promotion perspective. This presentation discusses the design and implementation of two practice innovations arising from this process. The innovations aimed to introduce and educate children on issues related to loss and change, whilst simultaneously ensure that school staff have the skills and confidence to support individual experiences within the school setting. This was from a harm education and early intervention standpoint. Collaborative inquiry, within an action research methodology, was used to advance the innovations. This involved school and hospice staff working together to design and facilitate the activities. A programme of activities for children aged 5 to 11 (the resilience project) was designed and integrated throughout the curriculum. This is currently being piloted. A bereavement training programme was designed and facilitated to all school staff. Evaluations reported an increase in confidence around supporting bereavement issues. The process highlighted that combing the skills and expertise of hospice and school staff was essential in developing sustainable activities, appropriate to the setting. The role of the hospice in engaging with communities to collaboratively develop education and support around death, dying and bereavement was emphasised. Rowling, L. Grief in school communities: effective support strategies. Buckingham and Philadelphia: Open University Press, 2003. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Viewing the body after bereavement due to a traumatic death: qualitative study in the UK

PubMed Central

Ziebland, S

2010-01-01

Objective Whether bereaved relatives should be encouraged to view the body after a traumatic death is uncertain. This analysis of narrative interviews interprets people’s accounts of why and how they decided whether to view the body and their emotional reactions to this, immediately and at a later stage. Design In depth interviews with qualitative analysis. Participants A maximum variation sample of 80 people bereaved because of suicide or other traumatic death. Setting Most people were interviewed in their homes. Results For those who had the option, decisions about seeing the body varied. Some wanted someone else to identify the body, because they feared how it might look or preferred to remember their relative as they had been in life. Those who had wanted to see the body gave various reasons beyond the need to check identity. Some felt they ought to see the body. Others felt that the body had not lost its social identity, so wanted to make sure the loved one was “being cared for” or to say goodbye. Some people wanted to touch the body, in privacy, but the coroner sometimes allowed this only after the postmortem examination, which made relatives feel that the body had become police property. Seeing the body brought home the reality of death; it could be shocking or distressing, but, in this sample, few who did so said they regretted it. Conclusions Even after a traumatic death, relatives should have the opportunity to view the body, and time to decide which family member, if any, should identify remains. Officials should prepare relatives for what they might see, and explain any legal reasons why the body cannot be touched. Guidelines for professional practice must be sensitive to the needs and preferences of people bereaved by traumatic death. The way that relatives refer to the body can be a strong indication for professionals about whether the person who died retains a social identity for the bereaved. PMID:20435644

Severe maternal stress exposure due to bereavement before, during and after pregnancy and risk of overweight and obesity in young adult men: a Danish National Cohort Study.

PubMed

Hohwü, Lena; Li, Jiong; Olsen, Jørn; Sørensen, Thorkild I A; Obel, Carsten

2014-01-01

Perinatal stress may programme overweight and obesity. We examined whether maternal pre- and post-natal bereavement was associated with overweight and obesity in young men. A cohort study was conducted including 119,908 men born from 1976 to 1993 and examined for military service between 2006 and 2011. Among them, 4,813 conscripts were born to mothers bereaved by death of a close relative from 12 months preconception to birth of the child (exposed group). Median body mass index (BMI) and prevalence of overweight and obesity were estimated. Odds ratio of overweight (BMI≥25 kg/m2) and obesity (BMI≥30 kg/m2) were estimated by logistic regression analysis adjusted for maternal educational level. Median BMI was similar in the exposed and the unexposed group but the prevalence of overweight (33.3% versus 30.4%, p = 0.02) and obesity (9.8% versus 8.5%, p = 0.06) was higher in the exposed group. Conscripts exposed 6 to 0 months before conception and during pregnancy had a higher risk of overweight (odds ratio 1.15, 95% confidence interval (CI): 1.03; 1.27 and odds ratio 1.13, 95% CI: 1.03; 1.25, respectively). Conscripts born to mothers who experienced death of the child's biological father before child birth had a two-fold risk of obesity (odds ratio 2.00, 95% CI: 0.93; 4.31). There was no elevated risk in those who experienced maternal bereavement postnatally. Maternal bereavement during the prenatal period was associated with increased risk of overweight or obesity in a group of young male conscripts, and this may possibly be reflected to severe stress exposure early in life. However, not all associations were clear, and further studies are warranted.

[The Application of Grief Theories to Bereaved Family Members].

PubMed

Wu, Lee-Jen Suen; Chou, Chuan-Chiang; Lin, Yen-Chun

2017-12-01

Loss is an inevitable experience for humans for which grief is a natural response. Nurses must have an adequate understanding of grief and bereavement in order to be more sensitive to these painful emotions and to provide appropriate care to families who have lost someone they love deeply. This article introduces four important grief theories: Freud's grief theory, Bowlby's attachment theory, Stroebe and Schuts' dual process model, and Neiyemer's meaning reconstruction model. Freud's grief theory holds that the process of grief adaptation involves a bereaved family adopting alternative ways to connect with the death of a loved one and to restore their self-ego. Attachment theory holds that individuals who undergo grieving that is caused by separation from significant others and that triggers the process of grief adaptation will fail to adapt if they resist change. The dual process model holds that bereaved families undergo grief adaptation not only as a way to face their loss but also to restore normality in their lives. Finally, the meaning reconstruction model holds that the grief-adaptation strength of bereaved families comes from their meaning reconstruction in response to encountered events. It is hoped that these theories offer nurses different perspectives on the grieving process and provide a practical framework for grief assessment and interventions. Additionally, specific interventions that are based on these four grief theories are recommended. Furthermore, theories of grief may help nurses gain insight into their own practice-related reactions and healing processes, which is an important part of caring for the grieving. Although the grieving process is time consuming, nurses who better understand grief will be better able to help family members prepare in advance for the death of a loved one and, in doing so, help facilitate their healing, with a view to the future and to finally returning to normal daily life.

In-utero exposure to bereavement and offspring IQ: a Danish national cohort study.

PubMed

Virk, Jasveer; Obel, Carsten; Li, Jiong; Olsen, Jørn

2014-01-01

Intelligence is a life-long trait that has strong influences on lifestyle, adult morbidity and life expectancy. Hence, lower cognitive abilities are therefore of public health interest. Our primary aim was to examine if prenatal bereavement measured as exposure to death of a close family member is associated with the intelligence quotient (IQ) scores at 18-years of age of adult Danish males completing a military cognitive screening examination. We extracted records for the Danish military screening test and found kinship links with biological parents, siblings, and maternal grandparents using the Danish Civil Registration System (N = 167,900). The prenatal exposure period was defined as 12 months before conception until birth of the child. We categorized children as exposed in utero to severe stress (bereavement) during prenatal life if their mothers lost an elder child, husband, parent or sibling during the prenatal period; the remaining children were included in the unexposed cohort. Mean score estimates were adjusted for maternal and paternal age at birth, residence, income, maternal education, gestational age at birth and birth weight. When exposure was due to death of a father the offsprings' mean IQ scores were lower among men completing the military recruitment exam compared to their unexposed counterparts, adjusted difference of 6.5 standard IQ points (p-value = 0.01). We did not observe a clinically significant association between exposure to prenatal maternal bereavement caused by death of a sibling, maternal uncle/aunt or maternal grandparent even after stratifying deaths only due to traumatic events. We found maternal bereavement to be adversely associated with IQ in male offspring, which could be related to prenatal stress exposure though more likely is due to changes in family conditions after death of the father. This finding supports other literature on maternal adversity during fetal life and cognitive development in the offspring.

Randomized Controlled Trial of Family Therapy in Advanced Cancer Continued Into Bereavement.

PubMed

Kissane, David W; Zaider, Talia I; Li, Yuelin; Hichenberg, Shira; Schuler, Tammy; Lederberg, Marguerite; Lavelle, Lisa; Loeb, Rebecca; Del Gaudio, Francesca

2016-06-01

Systematic family-centered cancer care is needed. We conducted a randomized controlled trial of family therapy, delivered to families identified by screening to be at risk from dysfunctional relationships when one of their relatives has advanced cancer. Eligible patients with advanced cancer and their family members screened above the cut-off on the Family Relationships Index. After screening 1,488 patients or relatives at Memorial Sloan Kettering Cancer Center or three related community hospice programs, 620 patients (42%) were recruited, which represented 170 families. Families were stratified by three levels of family dysfunction (low communicating, low involvement, and high conflict) and randomly assigned to one of three arms: standard care or 6 or 10 sessions of a manualized family intervention. Primary outcomes were the Complicated Grief Inventory-Abbreviated (CGI) and Beck Depression Inventory-II (BDI-II). Generalized estimating equations allowed for clustered data in an intention-to-treat analysis. On the CGI, a significant treatment effect (Wald χ(2) = 6.88; df = 2; P = .032) and treatment by family-type interaction was found (Wald χ(2) = 20.64; df = 4; P < .001), and better outcomes resulted from 10 sessions compared with standard care for low-communicating and high-conflict groups compared with low-involvement families. Low-communicating families improved by 6 months of bereavement. In the standard care arm, 15.5% of the bereaved developed a prolonged grief disorder at 13 months of bereavement compared with 3.3% of those who received 10 sessions of intervention (Wald χ(2) = 8.31; df = 2; P =.048). No significant treatment effects were found on the BDI-II. Family-focused therapy delivered to high-risk families during palliative care and continued into bereavement reduced the severity of complicated grief and the development of prolonged grief disorder. © 2016 by American Society of Clinical Oncology.

Randomized Controlled Trial of Family Therapy in Advanced Cancer Continued Into Bereavement

PubMed Central

Zaider, Talia I.; Li, Yuelin; Hichenberg, Shira; Schuler, Tammy; Lederberg, Marguerite; Lavelle, Lisa; Loeb, Rebecca; Del Gaudio, Francesca

2016-01-01

Purpose Systematic family-centered cancer care is needed. We conducted a randomized controlled trial of family therapy, delivered to families identified by screening to be at risk from dysfunctional relationships when one of their relatives has advanced cancer. Patients and Methods Eligible patients with advanced cancer and their family members screened above the cut-off on the Family Relationships Index. After screening 1,488 patients or relatives at Memorial Sloan Kettering Cancer Center or three related community hospice programs, 620 patients (42%) were recruited, which represented 170 families. Families were stratified by three levels of family dysfunction (low communicating, low involvement, and high conflict) and randomly assigned to one of three arms: standard care or 6 or 10 sessions of a manualized family intervention. Primary outcomes were the Complicated Grief Inventory-Abbreviated (CGI) and Beck Depression Inventory-II (BDI-II). Generalized estimating equations allowed for clustered data in an intention-to-treat analysis. Results On the CGI, a significant treatment effect (Wald χ2 = 6.88; df = 2; P = .032) and treatment by family-type interaction was found (Wald χ2 = 20.64; df = 4; P < .001), and better outcomes resulted from 10 sessions compared with standard care for low-communicating and high-conflict groups compared with low-involvement families. Low-communicating families improved by 6 months of bereavement. In the standard care arm, 15.5% of the bereaved developed a prolonged grief disorder at 13 months of bereavement compared with 3.3% of those who received 10 sessions of intervention (Wald χ2 = 8.31; df = 2; P =.048). No significant treatment effects were found on the BDI-II. Conclusion Family-focused therapy delivered to high-risk families during palliative care and continued into bereavement reduced the severity of complicated grief and the development of prolonged grief disorder. PMID:27069071

Palliative care for patients with Parkinson's disease: study protocol for a mixed methods study.

PubMed

Lennaerts, Herma; Groot, Marieke; Steppe, Maxime; van der Steen, Jenny T; Van den Brand, Marieke; van Amelsvoort, Dorian; Vissers, Kris; Munneke, Marten; Bloem, Bastiaan R

2017-11-25

Parkinson's disease (PD) is a chronic, progressive neurological disorder with many intractable consequences for patients and their family caregivers. Little is known about the possibilities that palliative care could offer to patients and their proxies. Guidelines strongly recommend palliative care to improve the quality of life and - if needed - the quality of dying. However, providing palliative care to persons with PD involves specific challenges. For example, a timely initiation of palliative interventions is difficult because due to the gradually progressive nature of PD, there is often no clear marker for the transition from curative towards palliative care. Furthermore, there is little evidence to indicate which palliative care interventions are effective. Here, we describe the contours of a study that aims to examine the experiences of patients, (bereaved) family caregivers and professionals, with the aim of improving our knowledge about palliative care needs in PD. We will perform a mixed methods study to evaluate the experiences of patients, (bereaved) family caregivers and palliative care professionals. In this study, we focus on Quality of Life, Quality of Care, perceived symptoms, caregiver burden and collaboration between professionals. In phase 1, we will retrospectively explore the views of bereaved family caregivers and professionals by conducting individual interviews and focus group interviews. In phase 2, 5-15 patients with PD and their family caregiver will be followed prospectively for 8-12 months. Data collection will involve semi-structured interviews and questionnaires at three consecutive contact moments. Qualitative data will be audio recorded, transcribed and analyzed using CAQDAS. If patients pass away during the study period, a bereavement interview will be done with the closest family caregiver. This study will offer a broad perspective on palliative care, and the results can be used to inform a palliative care protocol for patients with PD. By describing the experiences of patients, (bereaved) family caregivers and professionals with palliative care, this investigation will also establish an important ground for future intervention research.

Timing of Survey Administration After Hospice Patient Death: Stability of Bereaved Respondents.

PubMed

DiBiasio, Eleanor L; Clark, Melissa A; Gozalo, Pedro L; Spence, Carol; Casarett, David J; Teno, Joan M

2015-07-01

The Centers for Medicare & Medicaid Services have elected to include a bereaved family member survey in public reporting of hospice quality data as mandated in the Affordable Care Act. However, it is not known what time point after death offers the most reliable responses. To examine the stability of bereaved family members' survey responses when administered three, six, and nine months after hospice patient death. Bereaved family members from six geographically diverse hospices were interviewed three, six, and nine months after patient death. All respondents completed a core survey. Those whose family member died at home, in a freestanding inpatient unit, or in a nursing home also completed a site-specific module. Stability was based on top-box scoring of each item with kappa statistics, and multivariable regression models were used to assess directionality and predictors of change. To analyze the effects of grief, we assessed response stability among respondents at least one SD from the mean change in grief between three and six months. We had 1532 surveys (536 three-month surveys, 529 six-month surveys, and 467 nine-month surveys) returned by 643 respondents (average age 61.7 years, 17.4% black, and 50.5% a child respondent) about hospice decedents (55.3% females, average age 78.6 years, 57.0% noncancer, and 40.0% at home). The average kappa for core items between three and nine months was 0.54 (range 0.42-0.74), 0.58 (0.41-0.69) for home-specific items, and 0.54 (0.39-0.63) for nursing home. Even among individuals demonstrating large grief changes, core items demonstrated moderate to high stability over time. Bereaved family member responses are stable between three and nine months after the death of the patient. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Self-Identity After Bereavement: Reduced Self-Clarity and Loss-Centrality in Emotional Problems After the Death of a Loved One.

PubMed

Boelen, Paul A

2017-05-01

There is evidence that both the centrality of a loss-event as well as reduced self-concept clarity are involved in emotional problems after the death of a loved one. One issue that is still unexplored is the relative importance of these two concepts in predicting bereavement outcome. The current study examined the degree to which both concepts contribute to emotional distress after loss, both concurrently and longitudinally. Data were available from 124 individuals, all bereaved within the previous half year, who completed measures of prolonged grief, posttraumatic stress, and depression at inclusion into the study and again 6 months later. Loss-centrality and self-unclarity were associated with all three outcome measures, in cross-sectional analyses. Longitudinal analyses indicated that loss-centrality predicted symptom levels of prolonged grief, self-unclarity predicted symptom levels of depression, and both loss-centrality and self-unclarity were associated with posttraumatic stress 6 months after baseline. Implications of these findings are discussed.

Healing the social self: how parents whose children were killed in terror attacks construct the experience of help.

PubMed

Possick, Chaya; Shamai, Michal; Sadeh, Ruth Ann

2014-05-01

This study focuses on expressed needs and structures of assistance received by Israeli parents whose children were killed in terror attacks. The loss takes place within a multi-systemic network that can be a healing force and/or a distorting factor in the grief process. The qualitative research paradigm employed privileges the knowledge of the parents themselves. In-depth interviews were conducted with 16 parents. (1) The primary criterion that determines the parents' attribution of helpfulness is perceived inclusiveness. (2) The subsystem of "family of the bereaved" is salient in the healing process. (3) There is a clear preference for the services provided by NGO's as opposed to governmental agencies. (4) The bereaved parents engage the symbolic level of the macro-system-the heritage of the Jewish people. The article concludes with the practical implications of the findings for the development and delivery of psychosocial services to parents bereaved in terror attacks.

Abnormal Grief: Should We Consider a More Patient-Centered Approach?

PubMed

Moayedoddin, Babak; Markowitz, John C

2015-01-01

Grief, the psychological reaction to the loss of a significant other, varies complexly in its cause, experience, evolution, and prognosis. Although most bereaved individuals experience a normal grieving process, some develop complicated grief (CG) or major depressive disorder (MDD). The DSM-5, which controversially altered the nosology, recognizes grief-related major depression (GRMD) as a diagnostic subtype if a patient meets MDD criteria two weeks post bereavement. The (DSM-5) tries to distinguish between grief and MDD, but remains a symptom-based, centered approach to grief that is not patient centered. This article reviews grief in its normal and abnormal dimensions. Using an illustrative clinical case in which interpersonal psychotherapy (IPT) was employed, we discuss the need for a more patient-centered approach to treating abnormal grief, considering the patient's personal history, perceptions, experiences of bereavement, and interpersonal environment. Clinical studies need to better identify subgroups of individuals susceptible to abnormal grief and to evaluate their response to early interventions.

Challenging the myths about parents' adjustment after the sudden, violent death of a child.

PubMed

Murphy, Shirley A; Johnson, L Clark; Lohan, Janet

2003-01-01

To examine three commonly held myths: (a) a child's death by suicide results in the worst parental outcomes compared with other causes of violent death, (b) divorce is not only more common among bereaved than nonbereaved married couples, it might be inevitable, and (c) "letting go and moving on" is an essential bereavement task needed for a satisfactory adjustment following the violent death of a child. Review of empirical evidence and critical reviews, review of Internet resources available to the general public, and the inclusion of original data obtained from a longitudinal, prospective study conducted by the authors. Conclusive evidence was found to dispel two of the three myths, but sufficient evidence was not found to draw conclusions about the third myth regarding parents' adjustment to a child's suicidal death. Myths in regard to parental bereavement are resistant to disconfirming evidence and they appear to persist among professional practitioners and the general public despite contrary empirical evidence.

Positive experiences for participants in suicide bereavement groups: a grounded theory model.

PubMed

Groos, Anita D; Shakespeare-Finch, Jane

2013-01-01

Grounded Theory was used to examine the experiences of 13 participants who had attended psycho-educational support groups for those bereaved by suicide. Results demonstrated core and central categories that fit well with group therapeutic factors developed by I. D. Yalom (1995) and emphasized the importance of universality, imparting information and instilling hope, catharsis and self-disclosure, and broader meaning-making processes surrounding acceptance or adjustment. Participants were commonly engaged in a lengthy process of oscillating between loss-oriented and restoration-focused reappraisals. The functional experience of the group comprised feeling normal within the group, providing a sense of permission to feel and to express emotions and thoughts and to bestow meaning. Structural variables of information and guidance and different perspectives on the suicide and bereavement were gained from other participants, the facilitators, group content, and process. Personal changes, including in relationships and in their sense of self assisted participants to develop an altered and more positive personal narrative.

When avoiding unpleasant emotions might not be such a bad thing: verbal-autonomic response dissociation and midlife conjugal bereavement.

PubMed

Bonanno, G A; Keltner, D; Holen, A; Horowitz, M J

1995-11-01

It has been widely assumed that emotional avoidance during bereavement leads to either prolonged grief, delayed grief, or delayed somatic symptoms. To test this view, as well as a contrasting adaptive hypothesis, emotional avoidance was measured 6 months after a conjugal loss as negative verbal-autonomic response dissociation (low self-rated negative emotion coupled with heightened cardiovascular activity) and compared with grief measured at 6 and 14 months. The negative dissociation score evidenced reliability and validity but did not evidence the assumed link to severe grief. Rather, consistent with the adaptive hypothesis, negative dissociation at 6 months was associated with minimal grief symptoms across 14 months. Negative dissociation scores were also linked to initially high levels of somatic symptoms, which dropped to a low level by 14 months. Possible explanations for the initial cost and long-term adaptive quality of emotional avoidance during bereavement, as well as implications and limitations of the findings, are discussed.

Migration, cultural bereavement and cultural identity

PubMed Central

BHUGRA, DINESH; BECKER, MATTHEW A

2005-01-01

Migration has contributed to the richness in diversity of cultures, ethnicities and races in developed countries. Individuals who migrate experience multiple stresses that can impact their mental well being, including the loss of cultural norms, religious customs, and social support systems, adjustment to a new culture and changes in identity and concept of self. Indeed, the rates of mental illness are increased in some migrant groups. Mental health practitioners need to be attuned to the unique stresses and cultural aspects that affect immigrants and refugees in order to best address the needs of this increasing and vulnerable population. This paper will review the concepts of migration, cultural bereavement and cultural identity, and explore the interrelationship between these three aspects of the migrant's experience and cultural congruity. The complex interplay of the migration process, cultural bereavement, cultural identity, and cultural congruity, along with biological, psychological and social factors, is hypothesized as playing a major role in the increased rates of mental illness in affected migrant groups. PMID:16633496

Think adult-think child! Why should staff caring for dying adults ask what the death means for children in the family?

PubMed

Aynsley-Green, Sir Al

2017-09-01

Bereaved children and young people in the UK are 'hidden mourners'. Review of primary and secondary evidence on childhood bereavement. Children experience grief that varies according to the circumstance of death and their cognitive ability. Voluntary organizations can be supportive, but provision is patchy and vulnerable to austerity. Adult-centric denial of the importance and long-term consequences of childhood grief; uncertainty in how best to relate to bereaved children in faiths and in schools. Increased awareness of the immediate and long-term consequences of childhood bereavement; even young children can experience loss through death. Better knowledge of the numbers of affected children; longitudinal data to track experiences and outcomes; measuring effectiveness of different approaches; identifying risk factors for early intervention in complicated or prolonged grief; the importance of faith and rituals around death; mapping the provision of services to monitor the impact of austerity. 'Think adult-think child' means that all staff caring for dying adults should take responsibility for asking what the death means for the children in the family, with schools, primary care and faith organizations having protocols and expertise available to support grieving children; recent catastrophes expose need for agencies to have management plans that focus on vulnerable children and young people. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Organ retention and communication of research use following medico-legal autopsy: a pilot survey of university forensic medicine departments in Japan.

PubMed

Tsujimura-Ito, Takako; Inoue, Yusuke; Yoshida, Ken-ichi

2014-09-01

This study investigated the circumstances and problems that departments of forensic medicine encounter with bereaved families regarding samples obtained from medico-legal autopsies. A questionnaire was posted to all 76 departments of forensic medicine performing medico-legal autopsies in Japan, and responses were received from 48 (63.2%). Of the respondents, 12.8% had approached and communicated with bereaved families about collecting samples from the deceased person during an autopsy and the storage of the samples. In addition, 23.4% of these had informed families that samples might be used in research. Eighteen departments had received enquiries and requests from families about the samples, with most requests concerning their return. The response to such requests varied according to the department. Few departments interacted with the bereaved families regarding the procedure for obtaining autopsy samples, and their methods for handling family concerns differed depending on the person within the department authorised to contact the family. Moreover, the procedures for engaging in such communication have long been unclear, and no legal or ethical consensus or agreement with the general public has been established. It is important for researchers to further discuss the correct way for forensic medicine departments to communicate with bereaved families. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Normal Grief and Complicated Bereavement among Traumatized Cambodian Refugees: Cultural Context and the Central Role of Dreams of the Dead

PubMed Central

Hinton, Devon E.; Peou, Sonith; Joshi, Siddharth; Nickerson, Angela; Simon, Naomi

2013-01-01

This article profiles bereavement among traumatized Cambodian refugees and explores the validity of a model of how grief and PTSD interact in this group to form a unique bereavement ontology, a model in which dreams of the dead play a crucial role. Several studies were conducted at a psychiatric clinic treating Cambodian refugees who survived the Pol Pot genocide. Key findings included that Pol Pot deaths were made even more deeply disturbing owing to cultural ideas about “bad death” and the consequences of not performing mortuary rites; that pained recall of the dead in the last month was common (76% of patients) and usually caused great emotional and somatic distress; that severity of pained recall of the dead was strongly associated with PTSD severity (r = .62); that pained recall was very often triggered by dreaming about the dead, usually of someone who died in the Pol Pot period; and that Cambodians have a complex system of interpretation of dreams of the deceased that frequently causes those dreams to give rise to great distress. Cases are provided that further illustrate the centrality of dreams of the dead in the Cambodian experiencing of grief and PTSD. The article shows that not assessing dreams and concerns about the spiritual status of the deceased in the evaluation of bereavement results in “category truncation,” i.e., a lack of content validity, a form of category fallacy. PMID:23868080

The Social Meaning in Life Events Scale (SMILES): A preliminary psychometric evaluation in a bereaved sample.

PubMed

Bellet, Benjamin W; Holland, Jason M; Neimeyer, Robert A

2018-06-05

A mourner's success in making meaning of a loss has proven key in predicting a wide array of bereavement outcomes. However, much of this meaning-making process takes place in an interpersonal framework that is hypothesized to either aid or obstruct this process. To date, a psychometrically validated measure of the degree to which a mourner successfully makes meaning of a loss in a social context has yet to be developed. The present study examines the factor structure, reliability, and validity of a new measure called the Social Meaning in Life Events Scale (SMILES) in a sample of bereaved college students (N = 590). The SMILES displayed a two-factor structure, with one factor assessing the extent to which a mourner's efforts at making meaning were invalidated (Social Invalidation subscale), and the other assessing the extent to which a mourner's meaning-making process was validated (Social Validation subscale). The subscales displayed good reliability and construct validity in reference to several outcome variables of interest (complicated grief, general health, and post-loss growth), as well as related but different variables (social support and meaning made). The subscales also demonstrated group differences according to two demographic variables associated with complications in the mourning process (age and mode of loss), as well as incremental validity in predicting adverse bereavement outcomes over and above general social support. Clinical and research implications involving the use of this new measure are discussed.

Normal grief and complicated bereavement among traumatized Cambodian refugees: cultural context and the central role of dreams of the dead.

PubMed

Hinton, Devon E; Peou, Sonith; Joshi, Siddharth; Nickerson, Angela; Simon, Naomi M

2013-09-01

This article profiles bereavement among traumatized Cambodian refugees and explores the validity of a model of how grief and post-traumatic stress disorder (PTSD) interact in this group to form a unique bereavement ontology, a model in which dreams of the dead play a crucial role. Several studies were conducted at a psychiatric clinic treating Cambodian refugees who survived the Pol Pot genocide. Key findings included that Pol Pot deaths were made even more deeply disturbing owing to cultural ideas about "bad death" and the consequences of not performing mortuary rites; that pained recall of the dead in the last month was common (76 % of patients) and usually caused great emotional and somatic distress; that severity of pained recall of the dead was strongly associated with PTSD severity (r = .62); that pained recall was very often triggered by dreaming about the dead, usually of someone who died in the Pol Pot period; and that Cambodians have a complex system of interpretation of dreams of the deceased that frequently causes those dreams to give rise to great distress. Cases are provided that further illustrate the centrality of dreams of the dead in the Cambodian experiencing of grief and PTSD. The article shows that not assessing dreams and concerns about the spiritual status of the deceased in the evaluation of bereavement results in "category truncation," i.e., a lack of content validity, a form of category fallacy.

Missing memories of death: Dissociative amnesia in the bereaved the day after a cancer death.

PubMed

Ishida, Mayumi; Onishi, Hideki; Toyama, Hiroaki; Tsutsumi, Chizuko; Endo, Chieko; Tanahashi, Iori; Takahashi, Takao; Uchitomi, Yosuke

2015-12-01

The death of a loved one is one of the most stressful events of life, and such stress affects the physical and psychological well-being of the bereaved. Dissociative amnesia is characterized by an inability to recall important autobiographical information. Dissociative amnesia in the bereaved who have lost a loved one to cancer has not been previously reported. We discuss herein the case of a patient who developed dissociative amnesia the day after the death of here beloved husband. A 38-year-old woman was referred for psychiatric consultation because of restlessness and abnormal behavior. Her 44-year-old husband had died of pancreatic cancer the day before the consultation. On the day of the death, she looked upset and began to hyperventilate. The next day, she behaved as if the deceased were still alive, which embarrassed her family. At her initial psychiatric consultation, she talked and behaved as if her husband was still alive and in the hospital. Her psychiatric features fulfilled the DSM-V criteria for dissociative amnesia. The death of her husband had been very traumatic for her and was considered to have been one of the causes of this dissociation. This report adds to the list of psychiatric symptoms in the bereaved who have lost a loved one to cancer. In an oncology setting, we should consider the impact of death, the concomitant defense mechanisms, and the background of the families.

Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample.

PubMed

Gold, Katherine J; Leon, Irving; Boggs, Martha E; Sen, Ananda

2016-03-01

Perinatal loss is often a traumatic outcome for families. While there are limited data about depressive outcomes in small populations, information about depression and posttraumatic stress disorder among large racially and economically diverse populations is sparse. We collaborated with the Michigan Department of Community Health to conduct a longitudinal survey of bereaved mothers with stillbirth or infant death under 28 days of life and live-birth (control) mothers in Michigan. The study assessed 9-month mental health outcomes including self-reported symptoms of depression and posttraumatic stress disorder along with information about demographics, pregnancy and loss experience, social support, and past and present mental health and treatment. Of 1400 women contacted by the State of Michigan, 609 completed surveys and were eligible to participate for a 44% response rate (377 bereaved mothers and 232 control mothers with live births). In multivariable analysis, bereaved women had nearly 4-fold higher odds of having a positive screen for depression and 7-fold higher odds of a positive screen for post-traumatic stress disorder after controlling for demographic and personal risk variables. A minority of screen-positive women were receiving any type of psychiatric treatment. This is the largest epidemiologically based study to date to measure the psychological impact of perinatal loss. Nine months after a loss, bereaved women showed high levels of distress with limited rates of treatment. Symptoms need to be monitored over time for persisting disorder and further research should identify women at highest risk for poor outcomes.

Media exposure and prolonged grief: A study of bereaved parents and siblings after the 2011 Utøya Island terror attack.

PubMed

Kristensen, Pål; Dyregrov, Kari; Dyregrov, Atle; Heir, Trond

2016-11-01

After terror attacks, the media coverage can be a potential secondary stressor for bereaved families. In the present study, we aimed to examine the level of prolonged grief (PG), and to explore the association between media exposure and PG in parents and siblings of individuals who were killed in a terror attack. Parents and siblings (n = 103) from 42 different families bereaved by the 2011 Utøya Island mass shooting participated in a survey 18 months after the attack. The survey measured the amount of media exposure experienced by the bereaved during the first month after the attack. PG was self-reported using the Inventory of Complicated Grief (ICG). Data was analyzed with multilevel methods with mixed effects models. Of the total sample of participants, 78.6% (n = 81/103) had sum scores higher than the designated cutoff >25 on ICG, indicating a probable prolonged grief disorder (PGD). Multilevel analysis showed significantly higher level of PG among those who reported high exposure to the media coverage (>4 hours daily) the first month after the attack, among females, and among those who were in contact with their son/daughter/brother/sister by telephone during the attack. With the cross-sectional design, caution should be taken about making interpretations about causal effects. Media exposure may trigger or maintain prolonged grief reactions. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Religious care required for Japanese terminally ill patients with cancer from the perspective of bereaved family members.

PubMed

Okamoto, Takuya; Ando, Michiyo; Morita, Tatsuya; Hirai, Kei; Kawamura, Ryo; Mitsunori, Miyashita; Sato, Kazuki; Shima, Yasuo

2010-02-01

The aim of this study was to explore the most suitable religious care for Japanese terminally ill patients with cancer based on the opinions of bereaved family members. A multicenter questionnaire survey on palliative care service was sent to 592 bereaved family members of patients with cancer who were admitted to palliative care units in Japan, and 430 responded by mail. In the section of the questionnaire about religious care, 382 responses were used for quantitative analysis, and 71 responses about religious care for qualitative analysis. In the current study, the 71 responses were grouped into families with and without a religion and were analyzed qualitatively. Families with a religion (N = 28) chose answers such as ''Instrumental care'' such as music or a religious event, ''Freedom of choice of kinds for religious care,'' ''Staff involvement of religious care,'' ''Meeting with a pastoral care workers,'' and ''Burden of offering a different kind of personal religion.'' In contrast, families without a religion (N = 44) chose answers such as ''Instrumental care,'' ''Freedom of choice whether patients receive religious care or not,'' ''Spiritual care,'' ''Not being able to accept religious care,'' and ''Burden of thinking about a religion and nuisance.'' These findings suggest that Japanese bereaved families with a religion generally regard religious care positively and prefer care through their own religion, whereas some families without a religion require religious care but some do not prefer it.

Case-Mix Adjustment of the Bereaved Family Survey.

PubMed

Kutney-Lee, Ann; Carpenter, Joan; Smith, Dawn; Thorpe, Joshua; Tudose, Alina; Ersek, Mary

2018-01-01

Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was -0.6 with a range of -2.6 to 0.6. Fifty-five (38%) facilities changed within ±0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum-endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.

Evaluation of a pilot police-led suicide early alert surveillance strategy in the UK.

PubMed

McGeechan, Grant James; Richardson, Catherine; Weir, Kevin; Wilson, Lynn; O'Neill, Gillian; Newbury-Birch, Dorothy

2017-07-19

Those bereaved by suicide are at increased risk of psychological harm, which can be reduced with the provision of timely support. This paper outlines an evaluation of a pilot police-led suicide strategy, in comparison to a coroner-led suicide strategy looking at the number, and length of time it takes for deaths to be recorded for each strategy. Additionally, the police-led strategy offers timely contact from support services for bereaved individuals. We examined what impact this offer of support had on the capacity of support services. A mixed methods evaluation compared how long it took for suspected suicides to be recorded using both strategies. The number of referrals received by support services during the pilot strategy were compared with those from previous years. A feedback focus group, and interviews, were held with key stakeholders. The coroner strategy was more consistent at identifying suspected suicides; however, reports were filed quicker by the police. Bereaved individuals were willing to share contact details with police officers and consent for referral to support services which lead to increased referrals. The focus group and interviews revealed that the pilot police strategy needs better integration into routine police practice. This strategy has the potential to deliver a real benefit to those bereaved by suicide; however, there are still aspects which could be improved. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

And then the dog died.

PubMed

Kaufman, Kenneth R; Kaufman, Nathaniel D

2006-01-01

Childhood grief and mourning of family and friends may have immediate and long-lasting consequences including depression, anxiety, social withdrawal, behavioral disturbances, and school underachievement. Childhood pet bereavement is no less important, because the pet is often considered a member of the family by the child. However, society does not always acknowledge the significance of pet bereavement, which can result in unresolved grief. This article, a case analysis with literature review, addresses childhood pet bereavement in the context of multiple prior losses (K. R. Kaufman & N. D. Kaufman, 2005). This case mirrors both old and new findings in grief research and therapy: (a) beneficial response to emotional expression of grief in context of search for meaning; (b) beneficial response to cognitive approach toward grief with ability to prevent development of complicated grief even in the face of multiple losses; (c) beneficial effects associated with supportive family and with positive self-concept; (d) intensity of grief magnified by the child's degree of attachment to the pet, the suddenness of the pet's death, the multiple prior losses, and the role of the pet in the child's life; and (e) resiliency. This case further emphasizes the need for parents not to trivialize death of pets, to appreciate the role pets have in children's lives, and to assist the child in multiple approaches toward expression (be it verbal, written, or artistic). Finally, this case reinforces the ability of the child to assist in family bereavement and to serve as teacher.

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

PubMed

Karydi, Evangelia

2018-08-01

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.

Bereavement: The Role of the Family Physician

PubMed Central

Secundy, Marian G.

1977-01-01

Much has been written regarding attitudes of patients, families, and physicians in managing death and subsequent grief reactions. Here at Howard University College of Medicine, we are constantly aware of our educational responsibility to insure that our students and residents achieve certain levels of awareness, acquire certain basic and specific information, and be afforded an opportunity to ventilate and discuss issues of death, dying, and bereavement as they relate to their current or future encounters with patients and their families. We are specifically interested in the roles and responsibilities of the family physician. PMID:904017

Teacher ratings of resilience and peer relationships of preschoolers whose fathers died unexpectedly.

PubMed

Gülay Ogelman, Hülya; Gündoğan, Aysun; Erten Sarıkaya, Hatice; Erol, Ahmet

2016-08-01

This study endeavors to compare resilience and peer relationships of children who lost their fathers in a major mining accident in Soma with those who did not. Teachers rated 51 preschoolers whose fathers died, and 53 preschoolers whose fathers were alive. On the negative side, bereaved children had lower resilience and higher exclusion; on the positive side, bereaved children had lower peer victimization and higher prosocial behavior. Death of fathers is associated with lower resilience and more exclusion among young children, but others treat them better as well.

The health impact of health care on families: a matched cohort study of hospice use by decedents and mortality outcomes in surviving, widowed spouses.

PubMed

Christakis, Nicholas A; Iwashyna, Theodore J

2003-08-01

Alternative ways of caring for seriously ill patients might have implications not only for patients' own outcomes, but also, indirectly, for the health outcomes of their family members. Clinical observation suggests that patients who die "good deaths" may impose less stress on their spouses. Consequently, we sought to assess whether hospice use by a decedent is associated with decreased risk of death in surviving, bereaved spouses. We conducted a matched retrospective cohort study involving a population-based sample of 195,553 elderly couples in the USA. A total of 30,838 couples where the decedent used hospice care were matched using the propensity score method to 30,838 couples where the decedent did not use hospice care. Our principal outcome of interest was the duration of survival of bereaved widow/ers. After adjustment for other measured variables, 5.4% of bereaved wives died by 18 months after the death of their husband when their deceased husband did not use hospice and 4.9% died when their deceased husband did use hospice, yielding an odds ratio (OR) of 0.92 (95% CI: 0.84-0.99) in favor of hospice use. Similarly, whereas 13.7% of bereaved husbands died by 18 months when their deceased wife did not use hospice, 13.2% died when their deceased wife did use hospice, yielding an OR of 0.95 (95% CI: 0.84-1.06) in favor of hospice use. Our findings suggest a possible beneficial impact of hospice--as a particularly supportive type of end-of-life care--on the spouses of patients who succumb to their disease. Hospice care might attenuate the ordinarily increased mortality associated with becoming widowed. This effect is present in both men and women, but it is statistically significant and possibly larger in bereaved wives. The size of this effect is comparable to the reductions in the risk of death seen in a variety of other modifiable risk factors in women. Health care may have positive, group-level health "externalities": it may affect the health not only of patients but also of patients' family members.

[Family function and depression in relatives of earthquake victims: a survey conducted one year after China's Wenchuan Earthquake].

PubMed

Hu, Xiao-Lin; Li, Xiao-Lin; Jiang, Xiao-Lian; Li, Rong; Dou, Xin-Man

2012-10-01

The Wenchuan Earthquake that hit Sichuan, China in 2008 not only caused huge losses in terms of human life and economic damage. It also caused psychological trauma in survivors, especially those who had lost relatives and close friends (bereaved). In the aftermath of earthquakes, bereaved individuals require family and spiritual renewal in addition to material assistance. This study investigated the status of and relationship between family function and depression in bereaved individuals living in areas devastated by the Wenchuan Earthquake. Results provide baseline information for post-disaster family reconstruction. This cross-sectional study surveyed 264 qualified bereaved individuals who lived in an area hard hit by the Wenchuan Earthquake. Face-to-face interviews were administered based on the family APGAR(adaptation, partnership, growth, affection, resolve) index and Hamilton depression (HAMD) scale. The mean family function score for participants was 6.52 ± 2.65. Results for half (50.0%) of participants indicated "good" family function. Results indicated marital status, family structure and status of having another baby as factors that significantly influence family function (p < .05). Participants' mean depression score was 40.41 ± 9.35, with all (100%) of participants demonstrating symptoms of depression. The 5 most prevalent depressive symptoms were: depressed mood, decreased interest in work, mental anxiety, diminished capacity and agitation. Results showed marital status, leisure frequency, economic status, and having another baby as factors that significantly influenced family function (p < .05). A Pearson's correlation analysis indicated no significant relationship between level of depression and family function (p >.05). Family functions of the bereaved living in areas hard hit by the Wenchuan Earthquake were all undermined to varying degrees. Although participants all exhibited depressive symptoms, this study found no affect of such symptoms on family functions. Interventions delivered in the months and years after an earthquake should be tailored to address each individual's depression status. Interventions should also help these individuals learn to improve and enhance family functions to effectively reduce negative behaviors and reactions in order to better promote physical and mental health.

Storytelling in the early bereavement period to reduce emotional distress among surrogates involved in a decision to limit life support in the ICU: A pilot feasibility trial

PubMed Central

Barnato, Amber E.; Schenker, Yael; Tiver, Greer; Dew, Mary Amanda; Arnold, Robert M.; Nunez, Eduardo R.; Reynolds, Charles F.

2017-01-01

Background Surrogate decision makers involved in decisions to limit life support for an incapacitated patient in the ICU have high rates of adverse emotional health outcomes distinct from normal processes of grief and bereavement. Narrative self-disclosure (storytelling) reduces emotional distress after other traumatic experiences. Objective To assess the feasibility, acceptability, and tolerability of storytelling among bereaved surrogates involved in a decision to limit life support in the ICU. Methods We conducted a pilot single-blind trial of storytelling among bereaved surrogates from 5 ICUs across 3 hospitals within a single health system between June 2013 and November 2014. Both storytelling and control conditions involved printed bereavement materials and follow-up assessments. Storytelling involved a single 1–2 hour home or telephone visit by a trained interventionist who elicited the surrogate’s story. The primary outcomes were feasibility (rates of enrollment, intervention receipt, 3- and 6-month follow up), acceptability (closed and open-ended end-of-study feedback at 6 months), and tolerability (acute mental health services referral). Results Of 53 eligible surrogates, 32 (60%) consented to treatment allocation. Surrogates’ mean age was 55.5 (SD=11.8) and they were making decisions for their parent (47%) spouse (28%), sibling (13%), child (3%) or other relation (8%). We allocated 14 to control and 18 to storytelling, 17/18 (94%) received storytelling, 14/14 (100%) and 13/14 (94%) control subjects and 16/18 (89%) and 17/18 (94%) storytelling subjects completed their 3- and 6-month telephone assessments. At 6-months, 9/13 (69%) control participants and 16/17 (94%) storytelling subjects reported feeling “better” or “much better,” and none felt “much worse”. One (8%) control subject and 1 (6%) storytelling subject said the study was burdensome, and 1 (8%) control subject wished they had not participated. No subjects required acute mental health services referral. Conclusion A clinical trial of storytelling in this study population is feasible, acceptable, and tolerable. PMID:27618273

Storytelling in the Early Bereavement Period to Reduce Emotional Distress Among Surrogates Involved in a Decision to Limit Life Support in the ICU: A Pilot Feasibility Trial.

PubMed

Barnato, Amber E; Schenker, Yael; Tiver, Greer; Dew, Mary Amanda; Arnold, Robert M; Nunez, Eduardo R; Reynolds, Charles F

2017-01-01

Surrogate decision makers involved in decisions to limit life support for an incapacitated patient in the ICU have high rates of adverse emotional health outcomes distinct from normal processes of grief and bereavement. Narrative self-disclosure (storytelling) reduces emotional distress after other traumatic experiences. We sought to assess the feasibility, acceptability, and tolerability of storytelling among bereaved surrogates involved in a decision to limit life support in the ICU. Pilot single-blind trial. Five ICUs across three hospitals within a single health system between June 2013 and November 2014. Bereaved surrogates of ICU patients. Storytelling and control conditions involved printed bereavement materials and follow-up assessments. Storytelling involved a single 1- to 2-hour home or telephone visit by a trained interventionist who elicited the surrogate's story. The primary outcomes were feasibility (rates of enrollment, intervention receipt, 3- and 6-mo follow-up), acceptability (closed and open-ended end-of-study feedback at 6 mo), and tolerability (acute mental health services referral). Of 53 eligible surrogates, 32 (60%) consented to treatment allocation. Surrogates' mean age was 55.5 (SD, 11.8), and they were making decisions for their parent (47%), spouse (28%), sibling (13%), child (3%), or other relation (8%). We allocated 14 to control and 18 to storytelling, 17 of 18 (94%) received storytelling, 14 of 14 (100%) and 13 of 14 (94%) control subjects and 16 of 18 (89%) and 17 of 18 (94%) storytelling subjects completed their 3- and 6-month telephone assessments. At 6 months, nine of 13 control participants (69%) and 16 of 17 storytelling subjects (94%) reported feeling "better" or "much better," and none felt "much worse." One control subject (8%) and one storytelling subject (6%) said that the study was burdensome, and one control subject (8%) wished they had not participated. No subjects required acute mental health services referral. A clinical trial of storytelling in this study population is feasible, acceptable, and tolerable.

Risk of suicide, deliberate self-harm and psychiatric illness after the loss of a close relative: A nationwide cohort study.

PubMed

Guldin, Mai-Britt; Ina Siegismund Kjaersgaard, Maiken; Fenger-Grøn, Morten; Thorlund Parner, Erik; Li, Jiong; Prior, Anders; Vestergaard, Mogens

2017-06-01

The loss of a close relative is a common event, yet it is associated with increased risk of serious mental health conditions. No large-scale study has explored up to now the importance of the bereaved person's relation to the deceased while accounting for gender and age. We performed a nationwide Danish cohort study using register information from 1995 through 2013 on four sub-cohorts including all persons aged ≥18 years exposed to the loss of a child, spouse, sibling or parent. We identified 1,445,378 bereaved persons, and each was matched by gender, age and family composition to five non-bereaved persons. Cumulative incidence proportions were calculated to estimate absolute differences in suicide, deliberate self-harm and psychiatric illness. Cox proportional hazard regression was used to calculate hazard ratios while adjusting for potential confounders. Results revealed that the risk of suicide, deliberate self-harm and psychiatric illness was increased in the bereaved cohorts for at least 10 years after the loss, particularly during the first year. During that year, the risk difference was 18.9 events in 1,000 persons after loss of a child (95% CI: 17.6-20.1) and 16.0 events in 1,000 persons after loss of the spouse (95% CI: 15.4-16.6). Hazard ratios were generally highest after loss of a child, in younger persons, and after sudden loss by suicide, homicide or accident. One in three persons with a previous psychiatric diagnosis experienced suicide, deliberate self-harm or psychiatric illness within the first year of bereavement. In conclusion, this study shows that the risk of suicide, deliberate self-harm and psychiatric illness is high after the loss of a close relative, especially in susceptible subgroups. This suggests the need for early identification of high-risk persons displaying adjustment problems after loss of a close family member, in order to reduce the risk of serious mental health outcomes. © 2017 World Psychiatric Association.

Voices that want to be heard: Using bereaved Danish students suggestions to update school bereavement response plans.

PubMed

Lytje, Martin

2018-04-01

This study explored how Danish students experienced returning to school following parental bereavement. Eighteen focus group interviews were conducted with 39 participants aged 9 to 17. All participants had experienced the loss of a primary caregiver. Data collection was divided into two phases. In Phase I, 22 participants from four grief groups were interviewed 4 times over the course of a year. During Phase II, confirmatory focus groups were undertaken with the 17 participants. This article explores the findings related to ideas and suggestions made by the students about how the Danish school response could be improved to better meet their needs. The presentation of data is divided into seven themes, which are: Desired school response; Desired support from teachers; Desired boundaries between students and teachers; Desired collaboration; Desired support from peers; Desired rules and structure, and; Desires related to gifts and rituals. Study findings indicate that most students want to be included and have a say when the school plans how to respond to their loss. Students further highlight a need for teacher support when having to reconnect with the class; a need for set rules in relation to leaving the class when feeling sad, and; a need for schools to see the loss as a life-changing event, and grief as something that does not simply disappear after a few months. The article concludes by discussing the ways in which the recommendations provided by the participants can be incorporated into a modern revision of Danish school bereavement response plans.

Spirituality and religious coping are related to cancer-bereaved siblings' long-term grief.

PubMed

Lövgren, Malin; Sveen, Josefin; Steineck, Gunnar; Wallin, Alexandra Eilegård; Eilertsen, Mary-Elizabeth B; Kreicbergs, Ulrika

2017-12-20

Many bereaved siblings have still not come to terms with their grief many years after the loss, but few studies have focused on what can help. The aims of this study were to identify cancer-bereaved adolescents' and young adults' ways of coping with grief after loss of a sibling, and examine whether these ways of coping were related to their experience of having worked through their grief. This nationwide survey of 174 cancer-bereaved siblings (73% participation rate) is based on one open-ended question about coping with grief ("What has helped you to cope with your grief after your sibling's death?") and one closed-ended question about siblings' long-term grief ("Do you think you have worked through your grief over your sibling's death?"). The open-ended question was analyzed with content analysis; descriptive statistics and Fisher's exact test were used to examine the relation between type of coping and siblings' long-term grief. Result The siblings described four ways of coping: (1) thinking of their dead brother/sister and feeling and expressing their grief; (2) distracting or occupying themselves; (3) engaging in spiritual and religious beliefs/activities; and (4) waiting for time to pass. One of these categories of coping with grief, namely, engaging in spiritual and religious beliefs and activities, was associated with siblings' experience of having worked through their grief two to nine years after the loss (p = 0.016). Significance of results Those siblings who had used spirituality, religious beliefs, and activities to cope were more likely to have worked through their grief than those who had not.

Death following partner bereavement: A self-controlled case series analysis.

PubMed

King, Michael; Lodwick, Rebecca; Jones, Rebecca; Whitaker, Heather; Petersen, Irene

2017-01-01

There is mixed evidence that older people bereaved of a spouse or partner are at risk of adverse outcomes. The main difficulty is to take account of other explanatory factors. We tested for an association between a patient's death and the timing of any bereavement of a cohabitee. Self-controlled case series study in which each case serves as his or her own control and which thereby accounts for all fixed measurable and unmeasurable confounders. We used the Health Improvement Network (THIN) primary care database to identify patients who died aged 50-99 years during the period 2003 to 2014. We used the household identifier in the database to determine whether they had an opposite sex cohabitee at the start of the observation period. 38,773 men and 23,396 women who had died and who had a cohabitee at the start of the observation period, were identified and included in male and female cohorts respectively. A higher risk of death was found in the 24 months after the death of the cohabitee than in the time classified as unexposed. The greatest risk was during the first 3 months after the death of the cohabitee (age-adjusted incidence rate ratio [IRR] 1.63, 95% CI 1.45-1.83 in the male cohort, and IRR 1.70, 95% CI 1.52-1.90 in the female cohort). Risk of death in men or women was significantly higher after the death of a cohabitee and this was greatest in the first three months of bereavement. We need more evidence on the effectiveness of interventions to reduce this increased mortality.

Treating Complicated Grief

PubMed Central

Simon, Naomi M.

2015-01-01

IMPORTANCE The death of a loved one is one of life’s greatest, universal stressors to which most bereaved individuals successfully adapt without clinical intervention. For a minority of bereaved individuals, grief is complicated by superimposed problems and healing does not occur. The resulting syndrome of complicated grief causes substantial distress and functional impairment even years after a loss, yet knowing when and how to intervene can be a challenge. OBJECTIVE To discuss the differential diagnosis, risk factors for and management of complicated grief based on available evidence and clinical observations. EVIDENCE REVIEW MEDLINE was searched from January 1990 to October 2012. Additional citations were procured from references of select research and review articles. Available treatment studies targeting complicated grief were included. RESULTS A strong research literature led to inclusion of complicated grief in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (termed persistent complex bereavement disorder as a subtype of other specified trauma and stressor-related disorders), although it is a condition for which more research is formally recommended, and there is still ongoing discussion about the optimal name and diagnostic criteria for the disorder. Reliable screening instruments are available, and the estimated prevalence rate is 7% of bereaved people. Randomized controlled data support the efficacy of a targeted psychotherapy including elements that foster resolution of complicating problems and facilitate the natural healing process. Preliminary studies suggest antidepressant medications may be helpful. CONCLUSION AND RELEVANCE Individuals with complicated grief have greater risk of adverse health outcomes, should be diagnosed and assessed for suicide risk and comorbid conditions such as depression and posttraumatic stress disorder, and should be considered for treatment. PMID:23917292

[The development of an instrument for the "evaluation of hospices from the bereaved family members perspective"].

PubMed

Lohe, Mandy; Zimmermann, Manja; Luderer, Christiane; Sadowski, Katharina

2011-06-01

Inpatient hospice settings as facilities of health services are obliged to the quality assurance and internal quality development in Germany. The meaning of the patient's satisfaction as one of the indirect indicators for the judgement of nursing and care quality is indisputable by now. However, a subjective evaluation of the hospices by guests is practically and ethically problematic. An alternative approach is to investigate the views of bereaved relatives and close friends after the guest's death. The present article describes the development of an inventory for the evaluation of inpatient hospice settings from the bereaved relatives' point of view in order to examine the satisfaction of family members with the end-of-life care their loved ones received. With help of the inventory the question should be answered how family members judge the end-of-life care which was given to them and their late family members by the hospice. The construction of the questions results from the basis of existing concepts to the assessment of the end-of-life care and an analysis of all identified instruments to the evaluation of inpatient hospice settings from the perspective of bereaved relatives. The development of the questionnaire enclosed the formation of an item pool, the item choice, the critical discussion of the questions in the body of experts as well as a standardised and cognitive pretest beside a comprehensive literature research. A five-dimension questionnaire was developed that integrates physical, psychological, social, spiritual, and organisational aspects of the care at the end of life. The instrument encompasses 53 items, predominantly closed questions.

Changes in Siblings Over Time After the Death of a Brother or Sister From Cancer.

PubMed

Akard, Terrah Foster; Skeens, Micah A; Fortney, Christine A; Dietrich, Mary S; Gilmer, Mary Jo; Vannatta, Kathryn; Barrera, Maru; Davies, Betty; Wray, Sarah; Gerhardt, Cynthia A

2018-02-27

Limited research has examined the impact of a child's death from cancer on siblings. Even less is known about how these siblings change over time. This study compared changes in siblings 1 (T1) and 2 (T2) years after the death of a brother or sister from cancer based on bereaved parent and sibling interviews. Participants across 3 institutions represented 27 families and included bereaved mothers (n = 21), fathers (n = 15), and siblings (n = 26) ranging from 8 to 17 years old. Participants completed semistructured interviews. Content analysis identified emerging themes and included frequency counts of participant responses. McNemar tests examined differences in the frequency of responses between T1 and T2 data. Participants reported similar types of changes in bereaved siblings at both time points, including changes in sibling relationships, life perspectives, their personal lives, and school performance. A new theme of "openness" emerged at T2. Frequencies of responses differed according to mother, father, or sibling informant. Overall, participants less frequently reported changes at T2 versus T1. Compared with findings in the first year, participants reported greater sibling maturity at follow-up. Overall changes in bereaved siblings continued over 2 years with less frequency over time, with the exception of increases in maturity and openness. Providers can educate parents regarding the impact of death of a brother or sister over time. Nurses can foster open communication in surviving grieving siblings and parents as potential protective factors in families going through their grief.

Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample

PubMed Central

Leon, Irving; Boggs, Martha E.; Sen, Ananda

2016-01-01

Abstract Introduction: Perinatal loss is often a traumatic outcome for families. While there are limited data about depressive outcomes in small populations, information about depression and posttraumatic stress disorder among large racially and economically diverse populations is sparse. Methods: We collaborated with the Michigan Department of Community Health to conduct a longitudinal survey of bereaved mothers with stillbirth or infant death under 28 days of life and live-birth (control) mothers in Michigan. The study assessed 9-month mental health outcomes including self-reported symptoms of depression and posttraumatic stress disorder along with information about demographics, pregnancy and loss experience, social support, and past and present mental health and treatment. Results: Of 1400 women contacted by the State of Michigan, 609 completed surveys and were eligible to participate for a 44% response rate (377 bereaved mothers and 232 control mothers with live births). In multivariable analysis, bereaved women had nearly 4-fold higher odds of having a positive screen for depression and 7-fold higher odds of a positive screen for post-traumatic stress disorder after controlling for demographic and personal risk variables. A minority of screen-positive women were receiving any type of psychiatric treatment. Conclusion: This is the largest epidemiologically based study to date to measure the psychological impact of perinatal loss. Nine months after a loss, bereaved women showed high levels of distress with limited rates of treatment. Symptoms need to be monitored over time for persisting disorder and further research should identify women at highest risk for poor outcomes. PMID:26258870

Effects of sacred music on the spiritual well-being of bereaved relatives: a randomized clinical trial.

PubMed

Silva, Vladimir Araujo da; Silva, Rita de Cássia Frederico; Cabau, Nubia Carla Ferreira; Leão, Eliseth Ribeiro; Silva, Maria Júlia Paes da

2017-01-01

OBJECTIVE To evaluate the effects of instrumental sacred music and sacred music with vocals on the spiritual well-being of bereaved relatives. METHOD This is a randomized clinical trial carried out with family members bereaving the death of loved ones to cancer. Participants were allocated into three groups: Group 1 (control), Group 2 (experimental using sacred music with vocals) or Group 3 (experimental using instrumental sacred music). Spiritual well-being was assessed through the Spiritual Well-Being Scale. RESULTS Sixty-nine (69) family members participated. Mean scores before and after the intervention indicated high levels of spiritual well-being (106.4 and 105.5 in Group 1; 103.2 and 105.2 in Group 2; 107.4 and 108.7 in Group 3) and religious well-being (57.9 and 56.9 in Group 1; 56.3 and 56.4 in Group 2; 57.4 and 58.1 in Group 3), and moderate levels of existential well-being (48.5 and 48.6 in Group 1; 46.9 and 48.9 in Group 2; 49.9 and 50.7 in Group 3), with the exception of Group 3 which presented a high level of existential well-being after the intervention. CONCLUSION The results show that there were no statistically significant differences in the spiritual well-being scores between the experimental groups and the control group. We evidence the need for further studies that use music therapy as a Nursing intervention for bereaved families. Brazilian Registry of Clinical Trials: RBR-2wtwjz.

Persistent Complex Bereavement Disorder Symptom Domains Relate Differentially to PTSD and Depression: A Study of War-Exposed Bosnian Adolescents.

PubMed

Claycomb, Meredith A; Charak, Ruby; Kaplow, Julie; Layne, Christopher M; Pynoos, Robert; Elhai, Jon D

2016-10-01

Persistent Complex Bereavement Disorder (PCBD) is a newly proposed diagnosis placed in the Appendix of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an invitation for further research. To date, no studies have examined the dimensionality of PCBD or explored whether different PCBD criteria domains relate in similar, versus differential, ways to other psychological conditions common to war-exposed bereaved youth, including symptoms of Posttraumatic Stress Disorder (PTSD) and depression. We evaluated the dimensionality of proposed PCBD B and C symptom domains, and their respective relations with measures of PTSD and depression, in 1142 bereaved Bosnian adolescents exposed to the 1992-1995 Bosnian civil war. Instruments included the UCLA PTSD Reaction Index, the Depression Self-Rating Scale, and the UCLA Grief Screening Scale (a prototype measure of PCBD symptoms). We investigated potential differences in grief, PTSD, and depression scores as a function of cause of death. We then examined hypothesized differential relations between PCBD B and C symptom domain subscales and selected external correlates, specifically measures of depression and the four-factor emotional numbing model of PTSD. Results of both analyses provide preliminary evidence of a multidimensional structure for PCBD in this population, in that the PCBD Criterion C subscale score covaried more strongly with each of the four PTSD factors and with depression than did PCBD Criterion B. We conclude by discussing theoretical, methodological, clinical, and policy-related implications linked to the ongoing study of essential features of PCBD.

Analysis of Lyrics from Group Songwriting with Bereaved Children and Adolescents.

PubMed

Fiore, Jennifer

2016-01-01

Songwriting is a group intervention that is often used to help bereaved children and adolescents express thoughts and feelings associated with grief experiences. Few studies have examined the lyrical content of songs written by bereaved children/adolescents and how thematic content may vary by age and developmental understanding of death. The purpose of this study was to determine whether experiences of songwriting and lyrical content of songs written by children and adolescents participating in a bereavement camp vary by age. Thirty-three participants, ages 6-16, were grouped according to age (child, tween, or teen) and asked to write a group song. Analysis of song lyrics was based on both inductive and deductive content analysis processes. A seven-item questionnaire was also used with the tween and teen groups to gather descriptive information about the songwriting process, including participant views on benefits, enjoyment, and preferences. Analyses revealed a total of five different themes among the three age groups, with two of the five themes present across the age groups. A majority of the participants enjoyed the songwriting process, but no clear indication of preference for verbal or written contribution was determined based on age or gender. The lyric content of the songs varied across the age groups, with the older groups providing more diverse content and demonstrating growth in their understanding of death. Providing participants both written and verbal options to contribute to the songwriting process allows for individual preferences among tweens and teens. © the American Music Therapy Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

From loss to loneliness: The relationship between bereavement and depressive symptoms.

PubMed

Fried, Eiko I; Bockting, Claudi; Arjadi, Retha; Borsboom, Denny; Amshoff, Maximilian; Cramer, Angélique O J; Epskamp, Sacha; Tuerlinckx, Francis; Carr, Deborah; Stroebe, Margaret

2015-05-01

Spousal bereavement can cause a rise in depressive symptoms. This study empirically evaluates 2 competing explanations concerning how this causal effect is brought about: (a) a traditional latent variable explanation, in which loss triggers depression which then leads to symptoms; and (b) a novel network explanation, in which bereavement directly affects particular depression symptoms which then activate other symptoms. We used data from the Changing Lives of Older Couples (CLOC) study and compared depressive symptomatology, assessed via the 11-item Center for Epidemiologic Studies Depression Scale (CES-D), among those who lost their partner (N = 241) with a still-married control group (N = 274). We modeled the effect of partner loss on depressive symptoms either as an indirect effect through a latent variable, or as a direct effect in a network constructed through a causal search algorithm. Compared to the control group, widow(er)s' scores were significantly higher for symptoms of loneliness, sadness, depressed mood, and appetite loss, and significantly lower for happiness and enjoyed life. The effect of partner loss on these symptoms was not mediated by a latent variable. The network model indicated that bereavement mainly affected loneliness, which in turn activated other depressive symptoms. The direct effects of spousal loss on particular symptoms are inconsistent with the predictions of latent variable models, but can be explained from a network perspective. The findings support a growing body of literature showing that specific adverse life events differentially affect depressive symptomatology, and suggest that future studies should examine interventions that directly target such symptoms. (c) 2015 APA, all rights reserved).

Israeli mothers' meaning reconstruction in the aftermath of homicide.

PubMed

Mahat-Shamir, Michal; Leichtentritt, Ronit D

2016-01-01

This study is the first to our knowledge to provide an in-depth account of the meanings reconstructed by bereaved Israeli mothers of homicide victims. Homicide survivors tend to receive little or no support from society; this is especially true in Israel, where homicide victims are a neglected population whose voice is socially muted. Constructivist theories have informed understanding of grief, emphasizing the role of meaning reconstruction in adaptation to bereavement, as well as the role of social support in the process of meaning reconstruction. We derived 3 prototypes of meaning from interviews of 12 bereaved mothers: the existential paradox; a bifurcated worldview; and oppression, mortification, and humiliation. Most informants used all 3 prototypes in the process of reconstructing meaning, describing changes in the perception of themselves, the world, and society. However, change was also accompanied by continuity, because participants did not abandon their former worldview while adopting a new one. The findings suggest that meaning reconstruction in the aftermath of homicide is a unique, multifaceted, and contradictory process. Implications for practice are outlined. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Dreams of deceased children and countertransference in the group psychotherapy of bereaved mothers: clinical illustration.

PubMed

Begovac, Branka; Begovac, Ivan

2012-09-01

This article presents, in the form of a clinical illustration, a therapeutic group of bereaved mothers with special reference to their dreams about their deceased children. The article presents descriptions of the emotions of these mothers and countertransference feelings, a topic that, to our knowledge, has not been frequently studied. The group was small, analytically oriented, slow-open, comprised of women bereaved by the death of a child, and conducted by a female therapist. Over more than three years, the group included 20 members in total. This article describes a number of dreams recorded during a period when the group included seven members. Dreams helped the group members access their emotional pain, helplessness, yearning for a relationship with the deceased, guilt, and feelings of survival guilt. The transference-countertransference relationships were characterized by holding. Countertransference feelings of helplessness predominated. The therapist and the group as a whole contained various emotions, allowing the group members to return to the normal mourning processes from the parallel encouragement of group development and interpersonal relationships.

The deceased child in the psychic and social worlds of bereaved parents during the resolution of grief.

PubMed

Klass, D

1997-01-01

A core dynamic by which grief is resolved by parents in Bereaved Parents, a self-help group, is a series of transformations of the inner representation of the dead child in the parent's inner world and in the parent's social world. As the reality of the child's death as well as the reality of the parent's continuing bond with the child are made part of the socially shared reality, the inner representation of the child can be transformed in the parent's psychic life. The end of grief is not severing the bond with the dead child, but integrating the child into the parent's life in a different way than when the child was alive. This article traces the course of the inner representation of the child in the parent's inner life and social world as the parent progresses through Bereaved Parents. It concludes with some comments on the differences that should be maintained between scholarly and popular understandings of phenomena in the continuing bonds survivors maintain with the dead.

Optimizing the use of video-tapes of clinical sessions: the data-mining approach for scale construction and theory building for bereaved persons in Hong Kong.

PubMed

Chow, Amy Yin Man

2010-01-01

Video-taping clinical sessions is a common practice among social workers so that the tapes may be used for clinical supervision and reviewed with the individuals or families involved. They are usually underused for research purposes. This article reports on an innovative research method using such tapes as a basis for clinical data mining to explore the bereavement experience of Chinese people in Hong Kong. Using this data, a rich item pool, containing both negative and positive reactions, was generated to allow the development of a culturally relevant measurement tool of grief reactions. The data also facilitated theory building in the area of grief and bereavement. This study extended the use of video-tapes in clinical sessions for research purposes and helped to collect reliable and timely data in a non-intrusive way. It has also advanced the use of quantitative data in the clinical data-mining approach. The study encouraged collaboration between clinicians and researchers to develop knowledge and skills about their special target group of clients.

Bereavement and spiritual change.

PubMed

Balk, D E

1999-09-01

The thesis of this article is that bereavement is a life crisis that challenges one's assumptions about human existence and provides the grounds for spiritual change. Construing a new understanding of the meaning of human existence and revising assumptions about one's place in the universe is a singular form that indicates spiritual change at work. Three aspects must be present for a life crisis to produce spiritual change: The situation must create a psychological imbalance or disequilibrium that resists readily being stabilized; there must be time for reflection; and the person's life must forever afterwards be colored by the crisis. The premise of this article links spiritual change to what J.W. Fowler (1981) termed transformed faith consciousness and argues that the dual process model of coping with loss (M.S. Stroebe & H. Schut, 1995; M.S. Stroebe, H. Schut, & W.A. Stroebe, 1995; M.S. Stroebe, H. Schut, & J. Van Den Bout, 1994) provides a means to understand how dealing with grief can evoke spiritual change. Some brief case examples are used to examine the thesis that bereavement triggers spiritual change.

The dual process model of coping with bereavement: rationale and description.

PubMed

Stroebe, M; Schut, H

1999-01-01

There are shortcomings in traditional theorizing about effective ways of coping with bereavement, most notably, with respect to the so-called "grief work hypothesis." Criticisms include imprecise definition, failure to represent dynamic processing that is characteristic of grieving, lack of empirical evidence and validation across cultures and historical periods, and a limited focus on intrapersonal processes and on health outcomes. Therefore, a revised model of coping with bereavement, the dual process model, is proposed. This model identifies two types of stressors, loss- and restoration-oriented, and a dynamic, regulatory coping process of oscillation, whereby the grieving individual at times confronts, at other times avoids, the different tasks of grieving. This model proposes that adaptive coping is composed of confrontation--avoidance of loss and restoration stressors. It also argues the need for dosage of grieving, that is, the need to take respite from dealing with either of these stressors, as an integral part of adaptive coping. Empirical research to support this conceptualization is discussed, and the model's relevance to the examination of complicated grief, analysis of subgroup phenomena, as well as interpersonal coping processes, is described.

Restoration and loss after disaster: Applying the dual-process model of coping in bereavement.

PubMed

McManus, Ruth; Walter, Tony; Claridge, Leon

2018-08-01

The article asks whether disasters that destroy life but leave the material infrastructure relatively intact tend to prompt communal coping focusing on loss, while disasters that destroy significant material infrastructure tend to prompt coping through restoration/rebuilding. After comparing memorials to New Zealand's Christchurch earthquake and Pike River mine disasters, we outline circumstances in which collective restorative endeavor may be grassroots, organized from above, or manipulated, along with limits to effective restoration. We conclude that bereavement literature may need to take restoration more seriously, while disaster literature may need to take loss more seriously.

Towards a model of loss navigation in adolescence.

PubMed

Lytje, Martin

2017-01-01

Researchers today consider childhood bereavement one of the most traumatic experiences that can befall a child. Nevertheless, most models of bereavement currently limit themselves to dealing with adult grief and primarily explores the internal processes associated with recovery. Based on a study which conducted focus groups with 39 Danish adolescents (aged 9-17), this article presents The Model of Loss Navigation in Adolescence. Centered on the three factors-Being Different, Being in Control, and Being in Grief-the model highlight the social conventions children have to navigate and how these influences both their day-to-day lives and their road to recovery.

Sudden cardiac death in adults: causes, incidence and interventions.

PubMed

Walker, Wendy Marina

Many nurses will be familiar with the unexpected death of an adult patient following a sudden, life-threatening cardiac event. It is a situation that demands sensitive nursing care and skilled interventions to provide a foundation for recovery and promote healthy bereavement. This article examines the causes and incidence of sudden cardiac death in adults. Possible reactions of those who are suddenly bereaved are described and immediate care interventions aimed at dealing with the grief process are discussed. The article concludes by identifying ways in which the incidence of sudden cardiac death may be reduced.

[The influence of unreconciled grief in the family on the functioning and development of a child].

PubMed

Janusz, Bernadetta; Drozdzowicz, Lucyna

2013-01-01

The aim of the work is to present the influence of unreconciled grief in a family for functioning and growth of a child. The paper is based on some examples of clinical work from the field of family therapy, where developmental problems of children followed their carer's inability to cope with death and bereavement. Presented cases from family therapy serve as examples of possible therapeutic interventions in such situations. They show examples of developmental disturbances and psychopathology of the child who stays in relationship with deeply bereaved intimates.

Incidence of Suicide Among Persons Who Had a Parent Who Died During Their Childhood: A Population-Based Cohort Study.

PubMed

Guldin, Mai-Britt; Li, Jiong; Pedersen, Henrik Søndergaard; Obel, Carsten; Agerbo, Esben; Gissler, Mika; Cnattingius, Sven; Olsen, Jørn; Vestergaard, Mogens

2015-12-01

Parental death from suicide is associated with increased risk of suicide in the bereaved child, but little is known about the long-term risks of suicide after parental death from other causes. A better understanding of this association may improve suicide prevention efforts. To examine the long-term risks of suicide after parental death and how the risk trajectories differed by cause of parental death while accounting for major potential confounding variables. A population-based matched cohort study was performed using information from nationwide registers (data from 1968 to 2008) in 3 Scandinavian countries (for a total of 7,302,033 persons). We identified 189,094 children (2.6%) who had a parent who died before the child reached 18 years of age (ie, the bereaved cohort). Each bereaved child was matched by sex and age to 10 children who did not have a parent who died before they reached 18 years of age (for a total of 1,890,940 children) (ie, the reference cohort). Both cohorts were followed for up to 40 years. Poisson regression was used to calculate the incidence rate ratio (IRR), while accounting for age at parental death, sex, time since bereavement, maternal/paternal death, birth order, family history of psychiatric illness, and socioeconomic status. Data analyses were finalized June 24, 2015. The main exposure was death of a parent within the first 18 years of life. Incidence of suicide among persons who had a parent who died during their childhood. During follow-up, 265 bereaved persons (0.14%) and 1342 nonbereaved persons (0.07%) died of suicide (IRR = 2.02 [95% CI, 1.75-2.34]); IRR = 3.44 (95% CI, 2.61-4.52) for children who had a parent who died of suicide, and IRR = 1.76 (95% CI, 1.49-2.09) for children who had a parent who died of other causes. The IRR tended to be higher for children who had a parent who died before they reached 6 years of age, and the IRR remained high for at least 25 years. During 25 years of follow-up, the absolute risk of suicide was 4 in 1000 persons for boys who experienced parental death and 2 in 1000 persons for girls who experienced parental death. Parental death in childhood is, irrespective of cause, associated with an increased long-term risk of suicide. The consequences of parental death in childhood are far-reaching, and suicide risk trajectories may be influenced by early-life conditions. Future public health efforts should consider helping highly distressed children to cope with bereavement.

Complicated grief associated with hurricane Katrina.

PubMed

Shear, M Katherine; McLaughlin, Katie A; Ghesquiere, Angela; Gruber, Michael J; Sampson, Nancy A; Kessler, Ronald C

2011-08-01

Although losses are important consequences of disasters, few epidemiological studies of disasters have assessed complicated grief (CG) and none assessed CG associated with losses other than death of loved one. Data come from the baseline survey of the Hurricane Katrina Community Advisory Group, a representative sample of 3,088 residents of the areas directly affected by Hurricane Katrina. A brief screen for CG was included containing four items consistent with the proposed DSM-V criteria for a diagnosis of bereavement-related adjustment disorder. Fifty-eight and half percent of respondents reported a significant hurricane-related loss: Most-severe losses were 29.0% tangible, 9.5% interpersonal, 8.1% intangible, 4.2% work/financial, and 3.7% death of loved one. Twenty-six point one percent respondents with significant loss had possible CG and 7.0% moderate-to-severe CG. Death of loved one was associated with the highest conditional probability of moderate-to-severe CG (18.5%, compared to 1.1-10.5% conditional probabilities for other losses), but accounted for only 16.5% of moderate-to-severe CG due to its comparatively low prevalence. Most moderate-to-severe CG was due to tangible (52.9%) or interpersonal (24.0%) losses. Significant predictors of CG were mostly unique to either bereavement (racial-ethnic minority status, social support) or other losses (prehurricane history of psychopathology, social competence.). Nonbereavement losses accounted for the vast majority of hurricane-related possible CG despite risk of CG being much higher in response to bereavement than to other losses. This result argues for expansion of research on CG beyond bereavement and alerts clinicians to the need to address postdisaster grief associated with a wide range of losses. © 2011 Wiley-Liss, Inc.

A Bereavement Support Group Intervention Is Longitudinally Associated with Salutary Effects on the CD4 Cell Count and Number of Physician Visits

PubMed Central

Goodkin, Karl; Feaster, Daniel J.; Asthana, Deshratn; Blaney, Nancy T.; Kumar, Mahendra; Baldewicz, Teri; Tuttle, Raymond S.; Maher, Kevin J.; Baum, Marianna K.; Shapshak, Paul; Fletcher, Mary Ann

1998-01-01

A randomized, controlled, clinical trial was conducted to examine the impact of a semistructured, 10-week, once weekly, 90-min/session bereavement support group intervention on immunological, neuroendocrine, and clinical health status in human immunodeficiency virus type 1-seropositive (HIV-1+) and HIV-1-seronegative (HIV-1−) homosexual men, compared to a standard of care control condition. A total of 119 homosexual men (74 HIV-1+ and 45 HIV-1−) were assessed at baseline, 10 weeks, and 6 months follow-up. At the 6-month follow-up assessment, the intervention groups exhibited significant beneficial effects compared to controls on changes in CD4 cell, total T-lymphocyte, and total lymphocyte counts, when baseline levels, antiretroviral medication use, CDC stage of disease, and other potentially confounding factors were accounted for. There was no statistically significant effect on the CD4/CD8 ratio or on the CD8 cell count. The effect on CD4 cell count was associated with group attendance and with changes in plasma cortisol level. Plasma cortisol levels decreased significantly among intervention subjects, compared to controls. A significantly reduced number of health care visits over the 6-month follow-up period among the intervention subjects supported the clinical relevance of the immunological changes observed for both HIV-1+ and HIV-1− individuals. These results indicate that behavioral interventions may have salutary immunological and clinical health effects following bereavement among HIV-1-infected individuals. The effect in HIV-1− individuals suggests that this bereavement support group intervention might have similar salutary effects in the general population. Potential effects of such interventions on clinical HIV disease progression are of interest and should be studied. PMID:9605995

[A Clinical Case of Grief Hallucination through the Mourning Work Normal Grief and Spiritual Care].

PubMed

Kurotori, Isaku; Kato, Satoshi

2015-01-01

Auditory or visual hallucinations of a deceased person are well known in the normal course of the bereavement process. According to DSM-5, this symptom is included in the associated features supporting diagnosis of persistent complex bereavement disorder. In Japan, however, little is known about these hallucinatory experiences during grieving, and few reports on their prevalence are available. Here, we have reported a clinical case of such experiences following the loss of a spouse. A 66-year-old patient presented to the outpatient department with insomnia after her husband's death. She was preoccupied with a sense of loss and absolute loneliness. One day, she confessed to regularly encountering her husband's ghost at night; the ghost was distinguishable from a dream and provided the bereaved wife with some degree of comfort. The appearances lasted for 15 months and occurred several times a week without disturbing her social functioning. She gradually became aware that her husband was returning from the spirit world to give her solace. Her treatment was focused on resolving her conflicting feelings concerning her grief at his death and her relief at his no longer suffering from disease. While accepting her experiences, she started to review the days they spent together and appreciated his attachment. Therefore she completed the work of mourning and the ghost no longer appeared. One year after the departure of the ghost, she still attends the hospital regularly and there has been no recurrence. A reconstruction of her internal world leads us to conclude that the support of normal grief with such hallucinations prevents the intense experience of loss from generating pathological grief. Furthermore, we suggest reconsidering the importance of the mourning work and the inclusion of both the bereaved and deceased person in the medical context.

Exploring the experiences of bereaved families involved in assisted suicide in Southern Switzerland: a qualitative study.

PubMed

Gamondi, Claudia; Pott, Murielle; Forbes, Karen; Payne, Sheila

2015-06-01

In Switzerland, helping with assisted suicide under certain conditions is not prosecuted. With approximately 300 cases annually, this leaves behind a large group of bereaved people where its consequences are mostly unknown. The study aimed to explore family involvement in decision making prior to assisted suicide, and to examine their ways of coping during the bereavement period. A qualitative interview study used the principles of Grounded Theory analysis. Eleven relatives of eight patients, who died in Southern Switzerland after assisted suicide, participated in semistructured interviews. The large majority of family members faced moral dilemmas during the decision-making phase. Their respect for patient's autonomy was a key justification to resolve dilemmas. Two types of involvement were identified: categorised as 'passive' when the decision making was located with the patient, and 'active' when assisted suicide was proposed by the family member and/or the relative was involved in some way. The relatives reported feelings of isolation during and after assisted suicide. Family members reported fear of social stigma and did not openly disclose assisted suicide as the cause of death. None of those interviewed received formal psychological support. Bereaved families express moral dilemmas, feelings of isolation and secrecy in the management of assisted suicide in Southern Switzerland. These features seem underestimated and not sufficiently recognised by the healthcare professionals. Management of assisted suicide requests should include consideration of family members' needs, in addition to those of the patient. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Indirect Effect of Positive Parenting on the Relationship Between Parent and Sibling Bereavement Outcomes After the Death of a Child.

PubMed

Morris, Adam T; Gabert-Quillen, Crystal; Friebert, Sarah; Carst, Nancy; Delahanty, Douglas L

2016-01-01

Families are referred to pediatric palliative care (PPC) programs when a child is diagnosed with a medical condition associated with less than a full life expectancy. When a child dies, PPC programs typically offer a range of bereavement interventions to these families, often focusing on parents. Currently, it is unclear which factors increase the likelihood that bereaved siblings will experience negative outcomes, limiting the development of empirically supported interventions that can be delivered in PPC programs. The present study explored the relationship between parents' and surviving sibling's mental health symptoms (i.e., post-traumatic stress disorder [PTSD], prolonged grief disorder (PGD), and depression symptoms) after a child's death. Additionally, the extent to which parent functioning indirectly impacted sibling functioning through parenting behaviors (i.e., positive parenting and parent involvement) was also examined, with a specific focus on differences based on parent gender. Sixty bereaved parents and siblings (aged 8-18) who enrolled in a PPC program from 2008 to 2013 completed measures of PTSD, PGD, and depression related to the loss of a child/sibling. Siblings also completed a measure of general parenting behaviors. Maternal, but not paternal, symptoms of PTSD and PGD were directly associated with sibling outcomes. Paternal symptoms were associated with sibling symptoms indirectly, through parenting behaviors (i.e., via decreasing positive parenting). These results underscore the importance of examining both maternal and paternal influences after the death of a child, demonstrate differential impact of maternal vs. paternal symptoms on siblings, and stress the importance of addressing postloss symptoms from a family systems perspective. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Racial Differences in Outcomes of an Advance Care Planning Intervention for Dialysis Patients and Their Surrogates.

PubMed

Song, Mi-Kyung; Ward, Sandra E; Lin, Feng-Chang; Hamilton, Jill B; Hanson, Laura C; Hladik, Gerald A; Fine, Jason P

2016-02-01

African Americans' beliefs about end-of-life care may differ from those of whites, but racial differences in advance care planning (ACP) outcomes are unknown. The aim of this study was to compare the efficacy of an ACP intervention on preparation for end-of-life decision making and post-bereavement outcomes for African Americans and whites on dialysis. A secondary analysis of data from a randomized trial comparing an ACP intervention (Sharing Patient's Illness Representations to Increase Trust [SPIRIT]) with usual care was conducted. There were 420 participants, 210 patient-surrogate dyads (67.4% African Americans), recruited from 20 dialysis centers in North Carolina. The outcomes of preparation for end-of-life decision making included dyad congruence on goals of care, surrogate decision-making confidence, a composite of the two, and patient decisional conflict assessed at 2, 6, and 12 months post-intervention. Surrogate bereavement outcomes included anxiety, depression, and post-traumatic distress symptoms assessed at 2 weeks, and at 3 and 6 months after the patient's death. SPIRIT was superior to usual care in improving dyad congruence (odds ration [OR] = 2.31, p = 0.018), surrogate decision-making confidence (β = 0.18, p = 0.021), and the composite (OR = 2.19, p = 0.028) 2 months post-intervention, but only for African Americans. SPIRIT reduced patient decisional conflict at 6 months for whites and at 12 months for African Americans. Finally, SPIRIT was superior to usual care in reducing surrogates' bereavement depressive symptoms for African Americans but not for whites (β = -3.49, p = 0.003). SPIRIT was effective in improving preparation for end-of-life decision-making and post-bereavement outcomes in African Americans.

Capturing the Palliative Home Care Experience From Bereaved Caregivers Through Qualitative Survey Data: Toward Informing Quality Improvement.

PubMed

Bainbridge, Daryl; Bryant, Deanna; Seow, Hsien

2017-02-01

Measuring palliative care experience using patient-reported outcomes is becoming important for assessing and improving quality, although most validated outcome tools solely use scaled questions. We analyzed open-text survey responses from bereaved caregivers to identify strengths and weaknesses in the quality of end-of-life care services and to assess the usefulness of qualitative survey data for quality improvement. This was a retrospective observational study involving bereaved caregivers of decedents who had received palliative home care services in one of six health care regions in Ontario, Canada. Using the U.K.'s validated Views of Informal Carers-Evaluation of Services survey, respondents were asked what was good and what was bad about the services provided in the last three months of life as separate open-text questions. A qualitative constant comparison approach was used to derive themes from the responses. Among 330 caregivers who completed the survey, 271 (82%) caregivers responded to the open-text questions: 93% of those commented on something that was good about care and 55% on something that was bad. The care experiences were generally positive, with the exception of specific individuals or settings that were perceived as adverse. The qualitative data were more informative about deficiencies in care compared with the quantitative data. The qualitative survey data in this study provided key recommendations toward making care more responsive to the needs of dying patients and their families. Capturing the narrative responses of bereaved caregivers is feasible and informative for palliative care program development. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Sudden death: bereavement sequelae and interventions.

PubMed

Davidson, G P

1981-10-14

Just the phrase "sudden death' carries its sense of trepidation and even horror. So fear-inducing is its reality and prospect, that we have attempted to sanitise it by the colloquialisms such as a "sudden death play off' in sport, and even (recalling my days in military service) as the name of a particularly ferocious mix of alcoholic beverage. One of the reasons why the phrase is so evocative is the force of the unexpected bereavement that follows sudden death. This paper purports to examine, using a systems approach, the psychological sequelae of the emotionally involved survivors of sudden death, and to relate this to possible intervention strategies.

Death: the ultimate social construction of reality.

PubMed

Brabant, Sarah

Using Berger and Luckmann's thesis (1966) on the social construction of reality as rationale, this research analyzes the death drawings of 946 university students enrolled in a Death and Dying course between 1985 and 2004 to investigate the basic constructs elicited by the word "death": dying, moment of death, after death, after life, and bereavement. Consistent with earlier research, gender, race, religion, and religiosity proved to be significant factors. As expected, personal experience with grief was strongly correlated with drawings focused on bereavement. In contrast to earlier studies, fear of death was not significantly related to a particular construct. Implications for research, education, and counseling are discussed.

Comprehending childhood bereavement by parental suicide: a critical review of research on outcomes, grief processes, and interventions.

PubMed

Hung, Natalie C; Rabin, Laura A

2009-09-01

The experience of bereavement by parental suicide is not well understood, as evidenced by the lack of empirically supported interventions for this underserved population. This article reviews quantitative and qualitative research on the psychopathological outcomes and thematic characteristics of childhood and adolescent suicide survivorship and moderating variables such as life stressors, stigma, the manner of communication about the suicide, and the surviving parent's functioning. The authors outline several approaches to intervention and address conceptual and methodological challenges within the field. With the ultimate goal of efficacious intervention, recommendations for future priorities and the use of unconventional research methods are offered.

Meaning-making through psychological autopsy interviews: the value of participating in qualitative research for those bereaved by suicide.

PubMed

Dyregrov, Kari Madeleine; Dieserud, Gudrun; Hjelmeland, Heidi Marie; Straiton, Melanie; Rasmussen, Mette Lyberg; Knizek, Birthe Loa; Leenaars, Antoon Adrian

2011-09-01

Too often ethical boards delay or stop research projects with vulnerable populations, influenced by presumed rather than empirically documented vulnerability. The article investigates how participation is experienced by those bereaved by suicide. Experiences are divided into 3 groups: (a) overall positive (62%), (b) unproblematic (10%), and (c) positive and painful (28%). The positive experiences are linked to processes of meaning-making, gaining new insight, and a hope to help others. Objective factors concerning the gender of participants, their relationship to the deceased, the method of suicide, and time since loss were largely unrelated to their experience of the interview.

The suffering in silence of older parents whose child died of cancer: A qualitative study.

PubMed

Van Humbeeck, Liesbeth; Dillen, Let; Piers, Ruth; Grypdonck, Mieke; Van Den Noortgate, Nele

2016-01-01

As life expectancy grows, the death of an adult child becomes a highly prevalent problem for older adults. The present study is based on nine interviews and explores the experience of parents (≥70 years) outliving an adult child. The bereaved parents described some silencing processes constraining their expression of grief. When an adult dies, the social support system nearly automatically directs its care towards the bereaved nuclear family. Parental grief at old age is therefore often not recognized and/or acknowledged. Health care providers should be sensitive to the silent grief of older parents both in geriatric and oncology care settings.

Music therapy with bereaved teenagers: a mixed methods perspective.

PubMed

McFerran, Katrina; Roberts, Melina; O'Grady, Lucy

2010-07-01

Qualitative investigations have indicated that music therapy groups may be beneficial for bereaved teenagers. The existing relationship between young people and music serves as a platform for connectedness and emotional expression that is utilised within a therapeutic, support group format. This investigation confirms this suggestion through grounded theory analysis of focus group interviews. Changes in self-perception were not found as a result of participation, however practically significant results were found on adolescent coping. These cannot be generalized because of the small sample size. Grief specific tools are recommended for use in future investigations in order to capture the emotional impact of music therapy grief work with adolescents.

The year of magical thinking: Joan Didion and the dialectic of grief.

PubMed

Brennan, F; Dash, M

2008-06-01

Joan Didion is a prominent American writer. In late 2003, while her only child lay critically ill, her husband, John, died suddenly. Theirs was a marriage of great intimacy and love. Grief enveloped her. Eventually she began to write an account of the first 12 months of her bereavement and the vigil for her child: The year of magical thinking. Raw, insightful and challenging, it is a rich, generous and graceful document. Didion draws on the literature of grief, personal and professional. Here, those readings are examined and reflections are made on the singular, unique grief of the author in the context of current theories on bereavement.

Health-Related Quality of Life in Bereaved HIV-Positive Adults: Relationships between HIV Symptoms, Grief, Social Support, and Axis II Indication

PubMed Central

Hansen, Nathan B.; Vaughan, Ellen L.; Cavanaugh, Courtenay E.; Connell, Christian M.; Sikkema, Kathleen J.

2008-01-01

Objective This study evaluated a model of the impact of borderline and antisocial personality disorder indications on HIV symptoms and health-related quality of life (HRQoL) in AIDS-bereaved adults, accounting for grief severity, social support and years since HIV diagnosis. Design Structural Equation modeling was used to test the proposed model in a sample of 268 HIV-seropositive adults enrolled in an intervention for coping with AIDS-related bereavement. Main Outcome Measures Functional Assessment of HIV Infection, HIV symptoms. Results The proposed model demonstrated excellent fit with study data and all hypothesized paths were supported. Personality disorder indication was directly related to HIV symptoms and HRQoL, and indirectly related through both social support and grief severity. Social support was negatively related to HIV symptoms and positively related to HRQoL, while grief severity was positively related to HIV symptoms and negatively related to HRQoL. Finally, HIV symptoms had a direct negative relationship with HRQoL. Conclusion Personality disorders have a direct negative effect on HIV symptoms and HRQoL, and indirect effects through grief severity and social support. PMID:19290717

Guilt in Bereavement: The Role of Self-Blame and Regret in Coping with Loss

PubMed Central

Stroebe, Margaret; Stroebe, Wolfgang; van de Schoot, Rens; Schut, Henk; Abakoumkin, Georgios; Li, Jie

2014-01-01

Despite the apparent centrality of guilt in complicating reactions following bereavement, scientific investigation has been limited. Establishing the impact of specific components associated with guilt could enhance understanding. The aim of this study was to examine the relationships between two guilt-related manifestations, namely self-blame and regret, with grief and depression. A longitudinal investigation was conducted 4–7 months, 14 months and 2 years post-loss. Participants were bereaved spouses (30 widows; 30 widowers); their mean age was 53.05 years. Results showed that self-blame was associated with grief at the initial time-point and with its decline over time. Such associations were not found for depression. Initial levels of regret were neither associated with initial levels of grief and depression, nor were they related to the decline over time in either outcome variable. These results demonstrate the importance of examining guilt-related manifestations independently, over time, and with respect to both generic and grief-specific outcome variables. A main conclusion is that self-blame (but not regret) is a powerful determinant of grief-specific difficulties following the loss of a loved one. Implications for intervention are considered. PMID:24819238

Determinants of the effect of existential behavioral therapy for bereaved partners: a qualitative study.

PubMed

Kögler, Monika; Brandl, Jürgen; Brandstätter, Monika; Borasio, Gian Domenico; Fegg, Martin Johannes

2013-11-01

Informal caregivers of palliative patients took part in existential behavioral therapy (EBT), a group intervention comprising mindfulness exercises to reduce psychological distress and improve quality of life. This study examined what the participants perceived as helpful to cope with their loss during the first year of bereavement, particularly with regard to the EBT intervention. Sixteen problem-centered, semi-structured interviews were evaluated with content analysis. Two main categories were found: social support and self-regulation. Social support includes sense of belonging as well as emotional, cognitive, and practical help experienced from others. Mindfulness and acceptance, a clear focus on the positive, and orientation toward the future were helpful strategies of self-regulation; these were also part of the EBT intervention. Mindfulness was understood as permitting emotions and acceptance of one's inner processes, even if they were not pleasant, and was found to be helpful to stop ruminative thinking. The categories considered as being helpful parallel core elements of EBT and recent grief theories. The intervention was found to be supportive and met the needs of the participants. The interviewees appreciated the continuity of EBT support from palliative care into bereavement.