Traumatic loss and the reconstruction of meaning.

The aim of this study was to confirm and extend the authors' previous work indicating that symptoms of traumatic grief are predictors of future physical and mental health outcomes. The study group consisted of 150 future widows and widowers interviewed at the time of their spouse's hospital admission and at 6-week and 6-, 13-, and 25- month follow-ups. Traumatic grief was measured with a modified version of the Grief Measurement Scale. Mental and physical health outcomes were assessed by self-report and interviewer evaluation. Survival analysis and linear and logistic regressions were used to determine the risk for adverse mental and physical health outcomes posed by traumatic grief. Survival and regression analyses indicated that the presence of traumatic grief symptoms approximately 6 months after the death of the spouse predicted such negative health outcomes as cancer, heart trouble, high blood pressure, suicidal ideation, and changes in eating habits at 13- or 25-month follow-up. The results suggest that it may not be the stress of bereavement, per se, that puts individuals at risk for long-term mental and physical health impairments and adverse health behaviors. Rather, it appears that psychiatric sequelae such as traumatic grief are of critical importance in determining which bereaved individuals will be at risk for long-term dysfunction.

This study sought to determine whether a set of symptoms interpreted as complicated grief could be identified and distinguished from bereavement-related depression and whether the presence of complicated grief would predict enduring functional impairments. Data were derived from a study group of 82 recently widowed elderly individuals recruited for an investigation of physiological changes in bereaved persons. Baseline data were collected 3-6 months after the deaths of the subjects' spouses, and follow-up data were collected from 56 of the subjects 18 months after the baseline assessments. Candidate items for assessing complicated grief came from a variety of scales used to evaluate emotional functioning (e.g., the Hamilton Depression Rating Scale, the Brief Symptom Inventory). The outcome variables measured were global functioning, medical illness burden, sleep, mood, self-esteem, and anxiety. A principal-components analysis conducted on intake data (N = 82) revealed a complicated grief factor and a bereavement-depression factor. Seven symptoms constituted complicated grief: searching, yearning, preoccupation with thoughts of the deceased, crying, disbelief regarding the death, feeling stunned by the death, and lack of acceptance of the death. Baseline complicated grief scores were significantly associated with impairments in global functioning, mood, sleep, and self-esteem in the 56 subjects available for follow-up. The symptoms of complicated grief may be distinct from depressive symptoms and appear to be associated with enduring functional impairments. The symptoms of complicated grief, therefore, appear to define a unique disorder deserving of specialized treatment.

The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire. Subjects were recruited from several sources so that they would vary in their extent of contact with the fire. Of 187 participants who completed self-report measures about their experiences in the aftermath of the firestorm, 154 completed a follow-up assessment. Of these 154 subjects, 97% completed the follow-up questionnaires 7-9 months after the fire. The questionnaires included measures of posttraumatic stress and life events since the fire. Dissociative and loss of personal autonomy symptoms experienced in the fire's immediate aftermath, as well as stressful life experiences occurring later, significantly predicted posttraumatic stress symptoms measured 7-9 months after the firestorm by a civilian version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Impact of Event Scale. Dissociative symptoms more strongly predicted posttraumatic symptoms than did anxiety and loss of personal autonomy symptoms. Intrusive thinking differs from other kinds of posttraumatic symptoms in being related directly to the trauma and previous stressful life events. These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.

The authors examined the effect of patients' style of clinical presentation on primary care physicians' recognition of depression and anxiety. The subjects were 685 patients attending family medicine clinics on self-initiated visits. They completed structured interviews assessing presenting complaints, self-report measures of symptoms and hypochondriacal worry, the Diagnostic Interview Schedule (DIS), and the Center for Epidemiologic Studies Depression Scale (CES-D). Physician recognition was determined by notation of any psychiatric condition in the medical chart over the ensuing 12 months. The authors identified three progressively more persistent forms of somatic presentations, labeled "initial," "facultative," and "true" somatization. Of 215 patients with CES-D scores of 16 or higher, 80% made somatized presentations; of 75 patients with DIS-diagnosed major depression or anxiety disorder, 76% made somatic presentations. Among patients with DIS major depression or anxiety disorder, somatization reduced physician recognition from 77%, for psychosocial presenters, to 22%, for true somatizers. The same pattern was found for patients with high CES-D scores. In logistic regression models education, seriousness of concurrent medical illness, hypochondriacal worry, and number of lifetime medically unexplained symptoms each increased the likelihood of recognition, while somatized presentations decreased the rate of recognition. While physician recognition of psychiatric distress in primary care varied widely with different criteria for recognition, the same pattern of reduction of recognition with increasing level of somatization was found for all criteria. In contrast, hypochondriacal worry and medically unexplained somatic symptoms increased the rate of recognition.

At first glance, acute grief would not seem to be a medical or psychiatric disorder in the strict sense of the word but rather a normal reaction to a distressing situation. However, the understanding of reactions to traumatic experiences whether or not they represent clear-cut neuroses has become of ever-increasing importance to the psychiatrist. Bereavement or the sudden cessation of social interaction seems to be of special interest because it is often cited among the alleged psychogenic factors in psychosomatic disorders. The enormous increase in grief reactions due to war casualties, furthermore, demands an evaluation of their probable effect on the mental and physical health of our population. The points to be made in this paper are as follows: i. Acute grief is a definite syndrome with psychological and somatic symptomatology. 2. This syndrome may appear immediately after a crisis; it may be delayed; it may be exaggerated or apparently al)sent. 3. In place of the typical syndrome there may appear distorted pictures, each of which represents one special aspect of the grief syndrome. 4. By appropriate techniques these distorted pictures can be successfully transformed into a normal grief reaction with resolution. Our observations comprise tot patients. Included are (i) psychoneurotic patients who lost a relative during the course of treatment, (2) relatives of patients who uied in the hospital, (3) bereaved disaster victims (Cocoanut Grove Fire) and their close relatives, ( ) relatives of members of the armed forces.

Distressing and intrusive reexperiencing of the trauma is a hallmark symptom of posttraumatic stress disorder (PTSD; American Psychiatric Association, 1994). However, unwanted memories of trauma are not a sign of pathology per se. In the initial weeks after a traumatic experience, intrusive memories are common. For most trauma survivors, intrusions become less frequent and distressing over time. A central question for understanding and treating patients with PTSD is therefore what maintains distressing intrusive reexperiencing in these people. Three factors appear to be important: (1) memory processes responsible for the easy triggering of intrusive memories, (2) the individuals’ interpretations of their trauma memories, and (3) their cognitive and behavioral responses to trauma memories.

National Consensus Project for Quality Palliative Care: Clinical Practice Guidelines for Quality Palliative Care, Executive Summary

Seventeen definitions of the severely and persistently mentally ill have appeared in the literature over the past decade. These definitions have been used by 13 authors to formulate service programs and to estimate the prevalence of serious mental illness in the population. To test the applicability of these definitions, the authors operationalized each definition and applied it to a representative sample of 222 patients receiving services in one of Philadelphia's inner-city neighborhoods. The analysis showed estimates of prevalence of serious mental illness ranging from 4% to 88% of the treated population, depending on the definition applied. The NIMH (1987) definition was representative of the middle-range estimates of 45% to 55% arrived at by eight authors.

Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.

The authors evaluated changes in symptoms and levels of perceived distress of 21 Cambodian, 13 Hmong/Laotian, and 18 Vietnamese patients before and after a 6-month treatment period. Most of the patients improved significantly. Cambodians had the greatest and Hmong/Laotians had the least reductions in depressive symptoms. Although psychological symptoms improved, many somatic symptoms worsened. The authors conclude that refugee survivors of multiple traumata and torture can be aided by psychiatric care. They recommend investigations with larger samples and suitable control groups to further clarify the relative contributions of trauma, diagnosis, and acculturation stress to treatment outcome.

Psychologists are increasingly interested in the life cycle as the unit for study and in such questions as whether adult development, like child development, is to be perceived as a succession of stages. A stage theory of adult life seems oversimplified for several reasons. First, the timing of life events is becoming less regular, age is losing its customary social meanings, and the trends are toward the fluid life cycle and an age-irrelevant society. Second, the psychological themes and preoccupations reported by young, middle-aged, and older persons are recurrent ones that appear and reappear in new forms and do not follow in a single fixed order. Third, intrapsychic changes occur slowly with age and not in stepwise fashion. These factors may have implications for the psychiatrist who, in helping the patient make a meaningful life story from a life history, deals always with issues of time, timing, and aging.

Cyberpsychology, Behavior, and Social NetworkingVol. 23, No. 7 EditorialConnecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”Brenda K. WiederholdBrenda K. WiederholdBrenda K. Wiederhold, Editor-in-Chief Search for more papers by this authorPublished Online:10 Jul 2020https://doi.org/10.1089/cyber.2020.29188.bkwAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail View article"Connecting Through Technology During the Coronavirus Disease 2019 Pandemic: Avoiding “Zoom Fatigue”." 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June 2022 | Cyberpsychology, Behavior, and Social Networking, Vol. 25, No. learning Review of Education, Vol. May 2022 | Vol. 12, No. in the experiences and to and reflections the year of January 2022 | The Clinical Vol. 36, No. Psychological and Academic M. and May 2022 | Cyberpsychology, Behavior, and Social Networking, Vol. 25, No. of via videoconference on fatigue and Implications for the March 2022 | Healthcare Management Vol. No. Policy of Technology April 2022 | Education Sciences, Vol. 12, No. under A July 2021 | Journal of Family Vol. 44, No. Strategies During the COVID-19 Pandemic: Virtual Learning for Public Health and Cancer Health April 2022 | Frontiers in Public Health, Vol. during How a to online interaction and social April 2022 | Journal of Research on Vol. 16, No. a Roadmap for Technology in Social Training the of Social February 2022 | in Social Vol. No. Psychological for with Learning during the Pandemic: The Experiences of in the March 2022 | Journal of Mental Health Research in Vol. 15, No. to education and communication the and intensive community during the COVID-19 Vol. No. to education and communication the and intensive community during the COVID-19 Vol. No. and implementation of a virtual pain management programme to COVID-19: a September 2021 | British Journal of Vol. 16, No. Video Conference Fatigue of in the on Video Conference Social and April 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. of in during the COVID‐19 pandemic: the and of and challenges and the of mental health and in December 2021 | Journal of Research in Educational Vol. 22, No. New with COVID-19 and A Qualitative Study on Zoom Fatigue30 March 2022 | Vol. 19, No. distance une No. Social in Remote Social A for of When the Social of Interactions via Videoconferencing March 2022 | Frontiers in Psychology, Vol. the stress of and of Zoom December 2021 | Electronic Vol. 32, No. social as of A study under in Human Behavior, Vol. the of to an online in to February 2022 | Sciences Education, Vol. 15, No. changes in social during COVID pandemic in the United December 2021 | Vol. 29, No. in Journal of and Vol. 13, No. or How online February 2022 | PLOS Vol. No. in Zoom Fatigue B. and February 2022 | Cyberpsychology, Behavior, and Social Networking, Vol. 25, No. of on mental August 2021 | Vol. 19, No. 1Videoconference Fatigue: A February 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. 4The Use of Videoconferencing in Higher January and digital communication in Australian December 2021 | Journal of the International for Business, Vol. No. and in Industry August Zoom Learning February and in During Coronavirus January of Leadership on June Online Social a from a of February An Approach to Social During Online June Virtual Reality August in a Mediated July – und February Teaching as an for Vol. 22, No. Video During the COVID-19 Pandemic and Effects on May 2021 | and Vol. No. During Remote Teaching in through a pandemic: impact of on and of Clinical Medicine, Vol. 18, No. during the pandemic A Systematic Review using April 2022 | Information Science, Vol. 6, No. Hybrid Learning Challenges and February de de de December 2022 | Vol. 4, No. of COVID‐19 with and variables in An analysis of September 2021 | The International Journal of Health and Management, Vol. 37, No. Design With Research for the Development of a Digital Platform for and August 2022 | Journal of Research Vol. No. to Equity, and in Science and December 2021 | Frontiers in Science, Vol. December 2021 | Vol. 25, No. reality during the COVID-19 pandemic: A and and Vol. for study for a randomized controlled September 2021 | Pilot and Studies, Vol. 7, No. and A Design December in social of and mothers during the COVID-19 Vol. “Zoom A November 2021 | Applied Psychology, Vol. The from to of Human - and Psychology of the Pandemic November Through the October 2021 | Education, Vol. No. Practice During COVID-19 to and of November 2021 | Vol. 36, No. as the of Exploring and Perspectives of of Telehealth by a Australian Service during COVID-19 October 2021 | International Journal of Environmental Research and Public Health, Vol. 18, No. with The of technology and consumer July 2021 | International Journal of Consumer Studies, Vol. 45, No. of June 2021 | Annals of Surgery, Vol. No. and of Virtual in Video and Effects on of the ACM on Human-Computer Interaction, Vol. 5, No. How a Virtual Network during the COVID-19 of the ACM on Human-Computer Interaction, Vol. 5, No. May 2021 | American Journal of Clinical Vol. No. to and Education in the of December 2021 | Journal of Education, Vol. No. between social communication and during the early of September 2021 | Journal of Social and Vol. No. September 2021 | Vol. 11, No. Bir September 2021 | Vol. 5, No. of During the COVID-19 Pandemic by the of Medical of A Survey September 2021 | Frontiers in Medicine, Vol. student under remote learning using digital A June 2021 | Education and Information Vol. No. of the COVID-19 Pandemic on Higher Education: the

The authors gave the CES-D, a self-report depression symptom scale, to 515 people drawn from a longitudinal community survey. The subjects were also interviewed using the Schedule for Affective Disorders and Schizophrenia (SADS). From the information collected on the SADS, the subjects were given diagnoses based on Research Diagnostic Criteria. The results indicate a modest relationship between self-reported symptoms of depression and the diagnosis of a major or minor depression. However, the groups defined as "cases" by such reports also include many people with other diagnoses or with no diagnoses at all. Thus, symptom scales are useful for the screening of depressed persons in research studies but are only rough indicators of clinical depression in the community.

Little attention outside the therapeutic setting has been given to specifying the aspects of social relationships that might be helpful for patients recovering from psychotic episodes. The authors studied 20 patients who had been hospitalized for a psychotic episode for 1 year following discharge to examine the role their social relationships played during this period. The data show that 12 functions of social relationships were important and that there were two phases of social needs--convalescence and rebuilding--over the recovery period. The authors discuss the theoretical and clinical implications of these findings.

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