“I Can’t Go On. I’ll Go On.”: Reflections of a Death Studies Scholar on Grief and Mourning Without End After Watching His Entire Family Die

Background. The death of a family member is a stressful life event and can result in an increased level of depressive symptoms. Previous American research has shown inverse relationships between religious involvement and depression. European investigations are few and findings inconsistent; different contexts may have an important influence on findings. We therefore investigated the relationship between attendance at church/prayer house and depressive symptoms, and whether this relationship was moderated by the death of a close family member, in Norway. Methods. A population-based sample from the Nord-Trøndelag Health Study, Norway (HUNT 3, N = 37,981), was the population examined. Multiple regression and interaction tests were utilised. Results. Religious attendees had lower scores on depressive symptoms than non-attendees; death of a close family member moderated this relationship. The inverse relationships between attendance at church/prayer house and depressive symptoms were greater among those experiencing the death of an immediate family member in the last twelve months compared to those without such an experience, with men's decrease of depressive symptoms more pronounced than women's. Conclusion. In a population-based study in Norway, attendance at church/prayer house was associated with lower depressive symptoms, and the death of a close relative and gender moderated this relationship.

Background: Death is one of life’s few certainties and a universal experience for all individuals. When death occurs there is usually an impact on the family and friends of the deceased, the magnitude of which often depends on whether death was expected or unexpected. The grieving experiences of the elderly are rarely discussed. The purpose of this study was to describe experiences of grief and reactions to the death of family members amongst the elderly.Methods: A qualitative phenomenological approach was used to obtain data from elderly women in Ga-Rankuwa, Gauteng, to gain insight into the experiences of grief in this age group. Purposive sampling was used to conduct in-depth interviews with 10 elderly women whose family members had died. The data were analysed using a thematic approach.Results: The findings show that the elderly were exposed to multiple deaths of family members. The participants helplessly experienced with sorrow the death of family members, had experienced death anxiety, and relinquished control to God in terms of deaths.Conclusions: The response to death of the elderly affirms that it cannot be assumed that multiple death experiences establish their readiness or ability to handle these experiences and to grieve successfully. It can be concluded that the grieving process of the elderly is not different from any other age group and that they will also require the type of support and assistance considered for younger persons in times of grieving.

While previous studies evince a strong link between family bereavement and worse cardiovascular functioning, factors that may influence the association remain unexplored. This study examined the relation between experiencing the death of an immediate family member and heart rate variability (HRV) and whether the associations differed by sleep quality. The sample included respondents from the Midlife in the United States (MIDUS) Biomarker Project who reported losing an immediate family member – parents, spouse, siblings, or children – within a year before project (n = 94) and those who did not experience any deaths (n = 872). Results showed that the death of a family member was associated with worse HRV only among those who reported having a poor sleep quality and not for those with good sleep quality. These findings suggest that poor sleep quality may indicate psychophysiological vulnerability for those who experienced the death of an immediate family member.

Bereavement and Prognosis in Heart Failure: A Swedish Cohort Study

This study explored the grief experiences of surviving family with immediate family member death in Mountain Province, Cordillera Region, Philippines, focusing on differences in grief levels based on family roles, gender, cause of death of immediate family member, and ethnicity, as well as identifying coping strategies. Using an Explanatory Sequential Mixed-Method (ESMM) design, quantitative data were collected from 380 respondents through the Grief Experience Questionnaire, while qualitative data were gathered from 15 participants and analyzed using Braun and Clarke's thematic analysis. Findings revealed that the overall level of grief of the participants was low, with significant differences in grief based on family roles, gender, and cause of death, but not ethnicity. Mothers exhibited higher levels of grief, including somatic reactions and a stronger search for explanations, compared to fathers and children. Females generally reported higher grief levels than males, and grief was more pronounced among those who experienced sudden death compared to lingering illnesses. Coping strategies were categorized into intrapersonal and socio-spiritual mechanisms. Intrapersonal strategies included pre-accepting the death to lessen the suffering, distracting oneself, employing self-care strategies, introspective questioning, recalling memories of the deceased, and appreciating the present and acceptance. Socio-spiritual mechanisms highlighted the role of practicing cultural rituals, receiving socio- emotional support, and praying and being faithful to God in fostering emotional resilience and spiritual healing. The study concludes that while grief is a universal experience, its intensity varies by demographic factors, and coping mechanisms are multifaceted, combining personal resilience with social and spiritual support. Recommendations include encouraging family- centered counseling and psychotherapy to address complex emotions, developing tailored grief support programs sensitive to demographic differences, and promoting community-based and socio-spiritual support systems through local government initiatives. These strategies aim to reduce isolation and foster collective and individual resilience among grieving families.

Siamo sette Vidi una cara ch'aveva ott'anni, come mi disse bionda, ricciuta, bella, assai bella con le due grandi pupille tisse. Presso il cancello stava. Ed io; Figlia, quanti tra bimbi, siete, e bimbette? chiesi. Con atto di meraviglia, ella rispose: Quanti, noi? Sette. E dove sono? di, ti pare le dissi, ed ella mi disse: Ma ... noi siamo sette: due sono in mare; altri due sono nella citta; altri due sono nel camposanto, il fratellino, la sorellina: in quella casa che c'e daccanto io sto, con mamma, loro vicina. (Opere 2, 34) addition to his nine volumes of Italian poetry, his prize-winning Latin poetry, and his critical essays, most notably on Dante and Leopardi, Pascoli also translated much poetry, both from the classics (such as passages form the Iliad and Odyssey) and from modern poets such as Tennyson, Shelley, and Hugo. The Italian rendering of Are Seven, the beginning of which is reproduced above, is the only published translation from William Wordsworth's poetry that Pascoli undertook. Pascoli seems to have chosen to translate this particular poem not because it was Wordsworth's best-known piece, but because it resonates so strongly with Pascoli's own life experiences and poetic philosophy. The eight-year-old girl who speaks in the poem has suffered the deaths of two siblings. The biographical connections to Pascoli are clear. The fourth of ten children, he too suffered the deaths of several family members. Two sisters died in early childhood. His father, Ruggero Pascoli, was killed on August tenth, 1867, when Giovanni was only eleven, and his mother, Caterina Allocatelli Vincenzi, died in December of the following year. Within the space a few years, Giovanni also lost his older sister Margherita to typhus, his brother Luigi to cerebral meningitis in 1871, and finally his oldest brother Giacomo, who had assumed the paternal role in the family, in 1876. (1) These tragic losses pervade and indeed motivate a great part of Pascoli's Italian poetry. He dedicated his first collection, Myricae, to the memory of his father, and his later Canti di Castelvecchio to his mother, and explicitly bases several of his best-known poems (such as X agosto, La cavalla storna, and La voce) on these deaths. Even the poems that do not speak explicitly about the various lost family members are infused or haunted with the idea of unjust, premature death. We can think of Orfano and In ritardo to name just two such poems. The haunting of Pascoli's poetry by the ghosts of his family members reveal that the poems are not an exercise in working their deaths. (2) On the contrary, the poems are neither the symptoms nor the staging of an effective mourning, but rather a resistance to mourning. Wordsworth's contadinella, who resists the speaker's logical conclusion that there are only five in her family, personifies this active refusal to mourn and to work through the deaths of family members. She, like Pascoli, creates a psychic space for the living on of these undead loved ones. The young girl's insistence that are seven in spite of the fact, admitted by herself, that two of her siblings are dead and buried in the camposanto demonstrates a seeming failure of reason: the correct response, of course, would be were seven, or, as the grown-up and rational interlocutor explains, se que' due sono in cimitero, / cara bambina, cinque voi siete. It becomes clear through the course of the poem that the two protagonists are speaking at rather than with each other: despite a shared language, they are operating with two incompatible conceptualizations of the world. As readers, we are brought into sympathy with the transrational thought of the child, who continues to bring her dinner to the cemetery to eat with her two siblings that sleep together a mere ten paces from the home. The poem refigures her inability to see the truth as an ability to see more, and represents the reasonableness of the adult interlocutor as unsympathetic obtuseness. …

The article presents the results of the ascertaining stage of the study of coping behaviour in students of medical college. The author carried out a theoretical analysis of generic concepts of sanogenic coping, such as sanogenic reflection, sanogenic thinking, coping strategies and coping behaviour. It has been investigated that the most frequent events that cause stress in medical college students are: the death of a close family member, changes in the financial situation, intersex relationships, starting college (for male respondents) and illnesses, changes in social activity, change of a place of residence, conflicts in a collective (dormitory), death of a family member or friend, change of a place of residence and study (for female respondents). The level of stress resistance was experimentally studied and coping strategies were chosen by students to overcome the current stressors. It has been found out that the threshold level of resistance to stress prevails in most students. Thus, students are forced to make a lot of effort and spend their own internal resources to fight against negative mental states that appear in the process of coping with stress. It was identified that there is a significant share of medical college students with low stress resistance – 25% of male respondents and 22% of female respondents, and quite a few individuals showed a high level of stress resistance – only 12% of male respondents and 12% of female respondents. It was found that problem-oriented coping and the search for social support are dominant among medical college students’ coping strategies; other types of strategies such as emotion-oriented coping, avoidance, and distraction are used somewhat less often by young people. It is emphasized that adaptive coping strategies contribute to effective coping with stressful situations. Based on the research, it was found that in most cases, the coping strategies chosen by the students led to an even greater increase in stress. Consequently, the problem of formation and development of productive copingstrategies among students of future medical workers remains relevant. The prospect of further research is the development of practical recommendations for effective coping with stressful and crisis situations in the activities of future medics.

Objective: This paper examines whether and how family events (cohabitation, marriage, separation, divorce, death of a close family member) affect individuals’ smoking behavior and body weight. Methods: Participants were 30,345 individuals (aged 20 to 64) from German Socio-Economic Panel data, resulting in 94,296 person-year observations. To account for differences between those affected by a specific family event and those who were not, regression-adjusted matching is employed for each family event separately. Results: Changes in family composition, such as moving together with or separating from the partner or the death of a family member, impact the probability to start or quit smoking and lead to changes in body weight. In particular, smoking behavior and body weight are predominantly affected by forming or dissolving a household, rather than by marriage or divorce: cohabitation leads to weight gain; separation from a partner leads to weight loss, increased smoking initiation, and decreased smoking cessation. Conclusion: This study takes steps towards disentangling causality from correlation with regard to the effects of family events on smoking behavior and body weight. As such, it extends previous results by showing that moving together with or separating from a partner (rather than marriage or divorce) are periods of special vulnerability to change one’s smoking behavior or body weight.

Three qualitative research studies have been undertaken in Australia into the bereavement experience following the suicide of a family member. Narrative inquiry was used to interpret the data gathered from the in-depth interviews with bereaved informants. This methodology allowed for the exploration of the complex and influential aspects of the informant’s grief experiences such as relatedness to the deceased, the informant’s age at the time of death, developmental influences, family patterning, and the environmental and social context in which the family lived. This analysis allowed in depth exploration of the meaning making undertaken by the bereaved family members following the loss of a family member to suicide. Stigma was a pervasive finding through all three studies, in relation to the end of life decisions of the deceased family member, along with those bereaved. It was common that all those bereaved by the suicide of a family member spoke of being silenced in their grief, of not being able to speak openly of their deceased family member, of shaming and blaming experienced from neighbours, their communities and family members. Frequently the stigma of a suicidal death resulted in fractures or breakdown in the wider family system. This presentation will inform participants of the wide ranging damaging effects of stigma in relation to suicide, in that it prevents those who have suicidal thoughts from seeking help prior to their decision to die, and for those bereaved by suicide from being able to share their grief and find understanding.

This study looked at the lived experiences of clinical nurse educators who work with undergraduate nursing students in a hospital setting. It employed a phenomenological approach to focus on nurses’ personal experiences of death and dying. In particular this paper examined how nurses perceive the way the experiences influences the way that they instruct their students Informal interviews with four nurses were audio taped and transcribed. Rich descriptions of emotions which emerged are discussed in detail. Data were analysed using the Colaizzi method of analysis and common themes were identified. They included remaining professional, Humanizing stories and teaching different levels of undergraduates. These themes were evaluated in terms of their value of meaning for students and the possible implication for clinical care. The literature examined relevant to the study has previously identified the importance of nurses knowing the meaning of end of life care; caring and empathy; student nurses’ perception and the need for student belongingness. The study has added to the field by identifying the importance of nurses sharing personal experiences to enhance student learning in this already difficult area of nursing.

This study looked at the lived experiences of clinical nurse educators who work with undergraduate nursing students in a hospital setting. It employed a phenomenological approach to focus on nurses’ personal experiences of death and dying. In particular this paper examined how nurses perceive the way the experiences influences the way that they instruct their students Informal interviews with four nurses were audio taped and transcribed. Rich descriptions of emotions which emerged are discussed in detail. Data were analysed using the Colaizzi method of analysis and common themes were identified. They included remaining professional, Humanizing stories and teaching different levels of undergraduates. These themes were evaluated in terms of their value of meaning for students and the possible implication for clinical care. The literature examined relevant to the study has previously identified the importance of nurses knowing the meaning of end of life care; caring and empathy; student nurses’ perception and the need for student belongingness. The study has added to the field by identifying the importance of nurses sharing personal experiences to enhance student learning in this already difficult area of nursing.

The Mass-Observation Archive at the University of Sussex seeks to involve members of the British public in the recording of everyday life. A panel of several hundred correspondents responds regularly to open-ended 'directives' asking them to write about topics of contemporary interest. The April 1994 directive asked panel members to report their personal experiences of death and bereavement and to respond to questions about 'death and society'. A sample of 54 correspondents in the 65-80 age range (28 men and 26 women) was selected for detailed analysis of their personal experiences of death and bereavement and their views of changing societal attitudes towards death. Experiences of the Second World War appeared to have been of particular importance in shaping personal responses and attitudes towards death and dying. Religion also played a part, for both the religious and non-believers. While all correspondents acknowledged societal changes in behaviours and attitudes towards death in contemporary society as compared to their childhood, they varied in their assessment of these changes. Some welcomed new attitudes and behaviours, others saw them as generally bad and yet others liked some changes but disliked others. Correspondents did not generally describe any great personal fear of death, although there were concerns about the nature of their dying. However, neither were these older people ready to die; even those who accepted their nearness to death expressed the desire to continue living for as long as possible. The persistence of memory and loss is strikingly revealed by vivid accounts of deaths, bereavements and emotions that occurred in childhood, adolescence and young adulthood.

Although previous research has indicated some recurrent themes and similarities between what patients from different cultures regard as a good death, the concept is complex and there is lack of studies from the Nordic countries. The aim of this study was to explore the perception of a good death in dying cancer patients in Sweden. Interviews were conducted with 66 adult patients with cancer in the palliative phase who were recruited from home care and hospital care. Interviews were analysed using qualitative content analysis. Participants viewed death as a process. A good death was associated with living with the prospect of imminent death, preparing for death and dying comfortably, e.g., dying quickly, with independence, with minimised suffering and with social relations intact. Some were comforted by their belief that death is predetermined. Others felt uneasy as they considered death an end to existence. Past experiences of the death of others influenced participants' views of a good death. Healthcare staff caring for palliative patients should consider asking them to describe what they consider a good death in order to identify goals for care. Exploring patients' personal experience of death and dying can help address their fears as death approaches.

Studies of family history of cancer have contributed to knowledge about susceptibility to cancer and cancer genetics. The gold standard is to validate reported history of cancer by review of medical records and death certificates. Difficulties encountered in validating the history of cancer include the following: inaccuracy of diagnoses from death certificates when compared with medical records or autopsy data (75); coding inconsistencies, such as the report of nonspecific site of cancer on death certificates when compared with medical records (4); and inability to obtain records (5). Retrieval of medical records and accuracy of data obtained are higher if the history is given by firstdegree relatives (5,6). All patients diagnosed with tumors classified as Ewing's sarcomas and treated at the National Cancer Institute between 1965 and 1992 as well as their family members were enrolled in a genetic epidemiology study of Ewing's sarcoma. Approval of the institutional review board was obtained (7). The informant (i.e., living proband or next of kin), after providing written consent, was asked to report diagnoses of cancers in the proband's first- and second-degree relatives. We present results of validation of reported cancer diagnoses in a subset of 122 of 320 deceased family members. Confirmation of reported cancer diagnoses through medical documentation (death certificates and medical records) was attempted systematically for diagnoses of melanoma, cancers of the brain, stomach, and lung, and for all cancers for which the accuracy of diagnosis was questioned. The methods have been fully described (7). Requests for death certificates were sent to vital records departments of the 30 states where case subjects resided. The mean waiting period was 2.5 months

Sociological theory and research suggest that experiencing family members' deaths during childhood and adolescence is an important event subject to significant disparities. Previous research links immediate family members' deaths to poor life outcomes, but it considers a limited set of family members and has not tested the association of family member death with educational attainment. This study estimates the rates and educational impacts of experiencing the deaths of immediate (siblings, parents) and extended family members (aunts and uncles, cousins, and grandparents) during childhood and adolescence for Black and White Americans. We find that family death is associated with educational attainment, but the associations differ by family member type and gender, and child's race. Experiences of family death are unequally distributed by race and demonstrate complex associations with educational attainment. This research broadens life course and family systems theory by incorporating childhood family experiences of death on adult educational attainment and stratification.