Acute Grief Research Articles

Intensive Care Unit Diaries, Part 1: Constructing Illness Narratives to Promote Recovery After Critical Illness

Intensive Care Unit Diaries, Part 1: Constructing Illness Narratives to Promote Recovery After Critical Illness

Comparison of proposed diagnostic criteria for pathological grief using a sample of elderly bereaved spouses in Denmark: Perspectives on future bereavement research

BackgroundA distinct grief-specific disorder is included in the ICD-11. Lack of clarity remains regarding whether different proposed diagnostic criteria capture similar or different diagnostic entities. Our aim was to examine the specificity of four proposed diagnostic criteria-sets for pathological grief in a population-based sample. MethodsParticipants were 206 conjugally bereaved elderly Danes (59% female; mean age = 72.5 years, SD = 4.2; range 65–81) who completed self-report questionnaires six months post-loss. The main measure was the Danish version of Inventory of Complicated Grief-Revised. ResultsResults indicate substantial agreement between Prolonged Grief Disorder (PGD), Persistent Complex Bereavement Disorder (PCBD) and ICD-11-PGD (kappa's = 0.69–0.84), which found 6–9% of cases tested positive for pathological grief. Complicated Grief (CG) was partly in agreement with the three other symptom-diagnostic tests (kappa's = 0.13–0.20), and the prevalence-rate of pathological grief was 48%. LimitationsThe low response-rate of 39%. The selective inclusion of data ≥6 months post-loss prevents a comparison of acute and prolonged grief reactions. Using self-reported data, not diagnostic interviews, challenges the validity of our findings. Using a sample of elderly people may limit the generalizability of our results to other age groups. ConclusionWe suggest that PGD, PCBD and ICD-11-PGD may be more discriminative in identifying a specific grief-related psychopathology, while CG may identify a broader set of grief reactions.

Le Chiisme. Clés historiques et théologiques by Ameer Jaje

Reviewed by: Le Chiisme. Clés historiques et théologiques by Ameer Jaje Brian Welter Le Chiisme. Clés historiques et théologiques by Ameer Jaje, 2019. Paris: Domuni Press. 130 pp., £31.00. isbn: 978-2366480470 (pbk). Readers who are unfamiliar with Shi'a Islam or confused about its differences with Sunni Islam will benefit most from Le Chiisme. Clés historiques et théologiques, although first-hand accounts and the author's linking of ritual with belief make this book interesting and relevant for even more educated readers. The mixture of first-hand accounts and scholarly analysis provides a brief, yet at times, detailed overview of the history, practices, beliefs, and culture of Shi'a Islam. Jaje connects historical events with hadiths, rituals, and doctrinal development within this energetic and passionate branch of Islam. By the end of the book, readers clearly see that the religion has such a strong hold on believers because of the persons of Ḥusayn and the other Imams and members of the Holy Family. Shi'a Islam fosters an intensely personal relationship with God and God's servants, the Imams and Holy Family, to help believers in the here and now and at the time of the final judgement. According to the author, the Shi'a tend to emphasise the merciful nature of God. Jaje points out the many parallels with Christianity, but carefully highlights points of significant difference. People should not make too much out of certain similarities, in other words. Nonetheless, intercessory prayer is commonly practised by the Shi'i. The Imams and members of the Holy family such as Fātima receive these intercessory prayers. They receive great honour from the Shi'i in return for their roles. Faith in these intercessors plays a crucial part in each individual's salvation. Jaje details Shi'a beliefs about Ḥusayn and his pivotal role: "The Shi'i consider Ḥusayn as a model of sanctity. Many popular histories attribute miracles to him, which make him into an extraordinary personage who is assimilated to the prophets. He is compared to Jesus when he accomplishes miracles of healing and gives life to the dead" (43). Shi'a hagiography depicts Ḥusayn as a man who gave his life for God and the truth, like Jesus. The resulting sense of acute grief and guilt has led to an outpouring of writings on Ḥusayn's holiness over the centuries: [End Page 245] "The imaginations of writers run freely in all the stories of miracles that prove the extraordinary side of Ḥusayn's personality" (46). Such stories portray Ḥusayn's death as shaking all of creation, as even the animals weep. Ḥusayn continues to work miracles. His blood is healing. The author succeeds at showing us the tremendous religiously-inspired creativity generated by the tragedy at Karbalā. Shi'a Islam derives its beliefs, rituals, and sense of community from historical events and how these continue to be interpreted. The battle of Karbalā and the death of Ḥusayn there are the main historical events. The author helpfully notes the theological and spiritual significance of these events, which he sees as inspired by a revolutionary spirit. Ḥusayn aimed to correct the wrong direction that he believed the Muslim world, under usurpers, was taking. In this act, he became the focal point of the frustration of many Muslim peoples about the Umayyad caliphate, who in Shi'i belief are the chief antagonists. Ḥusayn voiced the disappointment of a certain group of Muslim people who believed that the Umayyads were betraying the Prophet and his work. The author leaves out the role of the other Imams, which would have enriched the discussion and perhaps shed light on the various branches of Shi'a Islam. These historical events led to the establishment of a sacred geography. The place of sainthood in Shi'a belief and spirituality turned the tombs of holy individuals into pilgrimage sites where ritual and religious feeling was and is most intense. They were the locations of profound grief, which is a central emotion for Shi'i. Pilgrimage sites became a vital and profound part of Shi'a identity, the author points out, in part because they were politicised. Shi'a...

Circumstances and consequences of care: a prospective study in palliative care

The sundry circumstances that affect end-of-life care can have a determining role in the result of this experience, particularly in psychological morbidity levels before and after bereavement. The aim of this study is to describe the prevalence of psychopathological symptoms and overburden among family caregivers in palliative care and to identify the circumstances associated with care provision. An attempt was made to evaluate the progress of psychopathological symptoms, identifying circumstantial factors that can interfere in acute grief. The sample consisted of 75 Portuguese caregivers, mostly women and patients' daughters. The results show that caregivers more involved with patient care bear a greater burden and are more likely to manifest psychopathological symptoms, which persist in acute grief. Moreover, the existence of peritraumatic symptoms seem to contribute significantly to the overall state of distress in acute grief. Social support has a protective effect in the different symptomatologic situations and are closely related to family dynamics. These results suggest the possibility of early identification of the most vulnerable caregivers and the adverse circumstances that affect them.

Mending the heart and mind during times of loss: A review of interventions to improve emotional well-being during spousal bereavement.

Spousal loss is one of life's greatest stressors. Bereaved spouses are at risk for aberrant cognitive and affective processing. Recent work in psychoneuroimmunology and cognitive neuroscience reveals physiological biomarkers and neural mechanisms underlying acute distress and grief during bereavement that may represent targets for future interventions. We review evidence from existing pharmacological and psychotherapeutic treatment approaches for normal bereavement, complicated grief, and bereavement-related depression. We propose promising future directions, namely the development and empirical validation of novel, personalised cognitive and neurostimulatory interventions to promote adaptive emotion regulation and reduce depressive symptoms following spousal loss. Future work may substantiate which interventions to improve emotional and physical health will be best matched to the needs of a particular surviving spouse.

Psychiatrists Go Beyond Call of Duty to Respond to Harvey’s Victims

Psychiatrists Go Beyond Call of Duty to Respond to Harvey’s Victims

Clinical and psychopathological features of formation and course of depressive disorders and suicidal behavior in cancer patients

Aim of research. The study of clinical and psychopathological features of formation and clinical course of depressive disorders and suicidal behavior in cancer patients.Materials and methods of research. For attaining the set aim, the complex examination of 154 patients of both genders with a cancer pathology of I and II degree and diagnosed depressive disorders was realized, with observing principles of bioethics and medical deontology. The main group included 103 patients with suicidal behavior signs, the control one - 51 men without suicidal behavior signs.Methods of research: clinical-anamnestic, psychodiagnostic, statistical.Results. There were described the features of the clinical picture of depressive disorders in cancer patients at adaptation disorders, such as depressive reaction, moderate or heavy depressive episode, organic depressive disorder.It was determined, that the true suicidal behavior prevailed in all patients (53,2 % of patients with depressive reaction, 56,5 % of patients with depressive episode, 51,2 % with organic depressive disorder), affective variant of suicidal disorder was observed in 38,1 %, 40,1 % and 44,1 % of patients, respectively; demonstrative-chantage suicidal behavior was observed in 8,7 % of patients with depressive reaction, 3,4 % of patients with depressive episode, 4,7 % – with organic depressive disorder.Patients from the main group demonstrated clinical manifestations of anxiety and depression by the hospital scale, high anxiety and depression by Hamilton scale, great depressive episode by Montgomery-Asberg scale, patients from the control group were characterized by clinical manifestations of anxiety and subclinical depression by the hospital scale, moderately expressed anxiety and depression by Hamilton scale, moderate depressive episode by Montgomery-Asberg scale.It was established, that the high level of suicidal risk and low level of consciousness of death in cancer patients with depressive disorders is a precondition of the suicidal behavior formation.Conclusions. 1. A malignant neoplasm it is a psychotraumatic factor for a patient and leads to the development of depressive disorders and suicidal behavior. 2. The clinical picture of depressive disorders in patients with a cancer pathology is characterized by the predomination of mood inhibition, effect of sorrow and anxiety, immersion into the felling of an acute grief because of a cancer diagnosis, with narrowing of cognitive functions and predomination of the content of a psychic trauma in consciousness.3. The main role in the formation of suicidal behavior of cancer patients is played by high indices of clinical scales of anxiety and depression, combined with the low level of death consciousness, burdened suicidal anamnesis З метою вивчення особливостей депресивних розладів та суїцидальної поведінки у онкологічно хворих було проведено комплексне обстеження 154 онкологічно хворих з депресивними розладами.Встановлено, що у формуванні суїцидальної поведінки онкологічно хворих провідну роль відіграють високі показники за клінічними шкалами тривоги і депресії, високий рівень суїцидального ризику та низький рівень самосвідомості смерті

‘How would you feel …?’: a reflective case study

‘How would you feel …?’: a reflective case study

Developing a scalable training model in global mental health: pilot study of a video-assisted training Program for Generalist Clinicians in Rural Nepal.

In low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Our objective is to develop and test a video-assisted training model addressing the shortcomings of traditional programs that affect scalability: failing to train all clinicians, disrupting clinical services, and depending on specialists. We implemented the program -video lectures and on-site skills training- for all clinicians at a rural Nepali hospital. We used Wilcoxon signed-rank tests to evaluate pre- and post-test change in knowledge (diagnostic criteria, differential diagnosis, and appropriate treatment). We used a series of 'Yes' or 'No' questions to assess attitudes about mental illness, and utilized exact McNemar's test to analyze the proportions of participants who held a specific belief before and after the training. We assessed acceptability and feasibility through key informant interviews and structured feedback. For each topic except depression, there was a statistically significant increase (Δ) in median scores on knowledge questionnaires: Acute Stress Reaction (Δ = 20, p = 0.03), Depression (Δ = 11, p = 0.12), Grief (Δ = 40, p < 0.01), Psychosis (Δ = 22, p = 0.01), and post-traumatic stress disorder (Δ = 20, p = 0.01). The training received high ratings; key informants shared examples and views about the training's positive impact and complementary nature of the program's components. Video lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants.

Examining Linkages Between Bereavement Grief Intensity and Perceived Death Quality

Some people experience more intense and prolonged bereavement grief after the death of a loved one. A mixed-methods study was undertaken out of concern that bereavement grief intensity may be associated with survivor perceptions of a “good” or “bad” death. The qualitative study phase was undertaken after a pilot study revealed bereavement grief intensity and perceived death quality were close to being negatively correlated ( R = −.156, p = .06). Through interviewing 41 bereaved volunteers, bereavement was found to be an individualized, contextualized, and multifaceted experience, but with three themes emerging through constant-comparative analysis: (a) the huge loss and enormous gap in life as a result of the death of a loved one, (b) extreme acute grief, and (c) the uncertain step-laddered journey of grieving to bereavement recovery. This recovery is impacted by both good and bad aspects of the death or dying process, as well as good and bad after-death events and developments.

Communication of support and critique in Swedish virtual community threads about prenatal diagnoses of fetal anomalies.

BackgroundA prenatal diagnosis of a fetal anomaly involves acute grief and psychological distress. The Internet has the potential to provide virtual support following the diagnosis. The overall aim was to explore communication of support and critique in Swedish virtual community threads about prenatal diagnoses of fetal anomalies.MethodsSystematic searches in Google resulted in 117 eligible threads. Fifteen of these were purposefully selected and subjected to deductive content analysis.ResultsThe virtual support involved mainly emotional support (meaning units n = 1,992/3,688, 54 %) and was described as comforting and empowering. Posters with experience of a prenatal diagnosis appreciated the virtual support, including the opportunity to gain insight into other cases and to write about one’s own experience. Critique of the decision to continue or terminate the pregnancy occurred, primarily against termination of pregnancy. However, it was met with defense.ConclusionsPeer support, mainly emotional, is provided and highly appreciated in threads about prenatal diagnoses of a fetal anomaly. Critique of the decision to terminate the pregnancy occurs in virtual community threads about prenatal diagnoses, but the norm is to not question the decision. Future studies need to investigate if virtual peer support promotes psychosocial function following a prenatal diagnosis and what medium would be most suitable for these types of supportive structures.

PC-FACS

PC-FACS

Challenging Aspects of Bereavement and Grief in Older Adults with Dementia: A Case Series and Clinical Considerations

Introduction: Bereavement is commonly experienced among older adults and has been shown to predict adverse health outcomes and may be linked to cognitive impairment. There is a paucity of literature on the impact of bereavement on older adults with dementia, contrasting extensive research on how dementia carers cope with their grief. Methods: 5 case studies of older adults with dementia and their bereavement reactions to losses are reported. The description of the phenomenology of bereavement distress in the case series help to shed light on its unique manifestations and how we can better understand this highly vulnerable group in their grief. Results: Normal grief reactions of denial, anger, bargaining, depression and acceptance can be experienced in early dementia. As the disease progresses, persons with dementia (PWD) may be too cognitively impaired to experience and express their grief. A vague sense that something is wrong with inner distress may manifest as behavioural disturbances, for although cognition declines, feelings and states of emotional pain remain. PWD may not be aware of the loss or may confuse the present loss with earlier losses. Seemingly nonreactions of mourning were noted to be much more common than those found among persons with normal intellectual ability. Conclusions: PWD and their families can be supported through the stages of grief by society and other support systems. Ethically, PWD have the right to grieve and mourn but the experiencing of acute grief and distress multiple times with ‘re-traumatization’ when the truth is revealed each time may be considered cruel and insensitive. It may be understandable why some family members and care staff try to shield PWD from reality. There may be questions as to whether or not to tell, how to tell and how the revelation will impact on their psychological well-being as well as their caregivers. PWD need to be approached differently when they experience bereavement and loss. If the grief response of the PWD is not sufficiently understandable in the context of the loss, there is the risk of them being inadvertently excluded from their family’s cycle of grief. Professional and family caregivers need to appreciate that PWD can be capable of grieving and we need to see how we can best support them and their loved ones in their grieving process.

Impact of Peer’s Suicide on Mental Health of Adolescents

Objectives : This study examined the impact of peer`s suicide on mental health of middle-school students. The aim of this study was to describe the course of posttraumatic stress and grief reaction, suicide ideation, and depression score among adolescents after exposure to peer`s suicide and to examine the relationship between posttraumatic stress and other mental health scores in these subjects. Methods : Thirty seven middle school students who were exposed to the suicidal death of a peer completed self-report measures to assess levels of depression, grief reaction, post-traumatic stress, and suicide ideation at 1 month and 8 months after the peer`s suicide. Results : There was no significant change in mental health scores between 1 month and 8 months. Level of posttraumatic stress after 8 months was related to acute grief response. Subjects who experienced a clinically significant level of suicidal ideation and posttraumatic stress showed more mental health problems. Conclusion : The results suggested that peer`s suicide strongly impacted mental health issues of adolescents at a critical time of adolescent development. Clinicians should perform a thorough evaluation of mental health problems for youth who experienced peer`s suicide and help them in management of their grief reaction.

Increasing support for the treatment of complicated grief in adults of all ages.

The loss of a lovedone is inevitable yet remains one of themost intenseandpainfulstressorsapersonwillexperience.Nonetheless,most people navigate through the pain and intensity of acute grief without clinical intervention. As individuals adapt to loss, the level of distress generally diminishes over time with a return to an altered but meaningful lifewithout thedeceased.Aminority,approximately7%,1 will continue to have amore severe and persistent form of grief, referred to as complicated grief. Recently, complicated grief was included in the Diagnostic and Statistical Manual of Mental Disorders (FifthEdition)2asapersistentcomplexbereavementdisorder requiring additional research, but also within trauma and stressor-related disorders, consistent with the notion that complicated grief is a stressor-relatedcondition.3Althoughproposeddiagnosticcriteriasets havesomedifferences (eg, requiring6or 12monthssince thedeath), the core constructs are shared. Common symptoms include yearningor longing for thedeceased,difficultyacceptingoradaptingtothe loss, self-blame,avoidanceof remindersof thedeceased, andpreoccupationwith the circumstances of the death. Complicatedgrief ismore common inolder adults (variablydefined as older than 55 or 61 years), with prevalence estimates from 9% to 25%.1,4 Complicated grief is associated with functional impairment, medical morbidity, cognitive impairments, and suicidal ideation.3,4 It is thus a condition in need of identification and treatment by health care professionals, yet relatively limited research is available toguide the treatmentofcomplicatedgrief,5withdataspecific to older adults particularly lacking. In a recent article in JAMAPsychiatry, Shear andcolleagues6 reported a randomized clinical trial of a 16-week targeted psychoJAMAPSYCHIATRY

Bereavement and Complicated Grief

Bereavement is a common experience in adults aged 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 CG detection and treatment in older adults is needed.

Autonomy and Social Norms in a Three Factor Grief Model Predicting Perinatal Grief in India

Perinatal grief following stillbirth is a significant social and mental health burden. We examined associations among the following latent variables: autonomy, social norms, self-despair, strained coping, and acute grief—among poor, rural women in India who experienced stillbirth. A structural equation model was built and tested using quantitative data from 347 women of reproductive age in Chhattisgarh. Maternal acceptance of traditional social norms worsens self-despair and strained coping, and increases the autonomy granted to women. Greater autonomy increases acute grief. Greater despair and acute grief increase strained coping. Social and cultural factors were found to predict perinatal grief in India.

DSM‐5 grief scorecard: Assessment and outcomes of proposals to pathologize grief

Where does grief stand diagnostically, now that the dust has settled and the DSM-5 has been approved? The DSM-5 Task Force considered an unprecedented series of proposals to identify grief-related mental disorders where now there are assumed to be normal variations. The proposals taken together had the potential to transform psychiatry's conceptualization of grief and the clinician's response to bereaved patients. Targets for pathologization included both depressive symptoms during grief and grief itself – the yearning, disbelief, and other experiences distinctive of grief. Four grief-related proposals made it to the final leg of the DSM-5 revision process, a major event in itself. Here I review the proposals, assess their validity, and present the Task Force's final decisions, providing an overview of the status of grief post-DSM-5.

Preparedness Key to Effectively Helping Children After Disasters

Preparedness Key to Effectively Helping Children After Disasters

Immunological and neuroimaging biomarkers of complicated grief

Complicated grief (CG) is a disorder marked by intense and persistent yearning for the deceased, in addition to other criteria. The present article reviews what is known about the immunologic and neuroimaging biomarkers of both acute grief and CG, Attachment theory and cognitive stress theory are reviewed as they pertain to bereavement, as is the biopsychosocial model of CG. Reduced immune cell function has been replicated in a variety of bereaved populations. The regional brain activation to grief cues frequently includes the dorsal anterior cingulate cortex and insula, and also the posterior cingulate cortex. Using theory to point to future research directions, we may eventually learn which biomarkers are helpful in predicting CG, and its treatment.