Bereaved Person Research Articles

Correlates of public stigma towards prolonged grief disorder

BackgroundPublic stigma for grief may reduce the social support provided to bereaved persons and increase bereavement-related distress. The general public reports more stigmatizing responses towards bereaved persons with prolonged grief disorder (PGD) than towards persons experiencing non-clinical grief. No studies to date have investigated whether personal characteristics of the general public relate to public stigma towards PGD. The present study examined whether participants’ socio-demographic characteristics and personal bereavement experiences are associated with stigmatizing responses towards PGD. MethodWe combined data of three previously published vignette experiments to conduct a secondary analysis. All studies presented members of the general public (N = 452) with a description of a male bereaved person with PGD symptoms and a PGD diagnosis. Participants rated three indicators of public stigma - negative attributes (competence, warmth), emotional reactions (fear, anger), and preferred social distance. First, we examined whether gender, age, and educational level related to public stigma towards PGD. Second, we examined the association of participants’ personal bereavement experiences with public stigma. ResultsRegression analyses demonstrated that participants’ socio-demographic characteristics explained a significant amount of variance for warmth (ΔR² = .03; p < .05) and anger (ΔR² = .05; p < .01): Male participants rated the person in the vignette as less warm (β = -.13, p < .05). Being older related to lower ratings of warmth (β = -.12, p < .05) and higher ratings of anger (β = .18, p < .01). Participants’ educational level was not associated with stigma. Participants’ bereavement experiences explained a significant amount of variance for preferred social distance (ΔR² = .11; p <. 05): Participants reporting higher personal grief severity preferred less social distance from a person with PGD (β = -.29, p < .05). A higher number of experienced losses, the recency of the bereavement, and the cause of death (natural vs. unnatural) did not relate to public stigma. ConclusionsMale and older persons are more likely to demonstrate public stigma towards PGD. Experiencing severe grief oneself is associated with less preferred social distance from a person with PGD. Anti-stigma interventions may advance the public's knowledge about grief and PGD and address specific target groups (men and older persons).

Understanding the needs for support and coping strategies in grief following the loss of a significant other: insights from a cross-sectional survey in Sweden.

Grief has previously been described in pathological terms, characterized by several stages. In the past three decades, new perspectives on grief as a reaction to the loss of a significant other have emerged. It shows that grief is an individual process based on circumstances surrounding the death and the bereaved person's life situation, rather than being predetermined. The aim of the study was to show how grief is perceived by people who have lost a significant other, and it focuses on bereavement support, how the death affects the bereaved person's living conditions, how the bereaved person deals with grief, and if grief is expressed differently depending on whether it was an expected death (ED) or an unexpected death (UED). A cross-sectional design was used with data collected anonymously using an online survey with semi-structured answers and options for participants to add their own comments, and it was analyzed descriptively. Support in grief was mainly given by family and friends, and the perceived need was primarily for emotional support or emotional support combined with practical support, and to a greater extent for UEDs and women. For some bereaved persons, health caregivers and religious institutions provided support outside their own network. Grief can affect how people socialize with others and change social relationships. People can deal with grief in social as well as religious ways in the company of friends, through everyday conversations, spending time in nature, and having a spiritual outlook on life, and with the help of pets. The results can contribute to an increased understanding of grief after the loss of a significant other and how grief affects the bereaved person's life depending on whether it is an ED or a UED. There was a difference between the genders, with women perceiving a need for and receiving different forms of support and to a greater extent than men.

How grief moved from culture to psychiatry

Bereavement has been debated among psychiatric experts since 2000. In addition to its precise manifestations, its duration is discussed: six months for the ICD-1, one year for the DSM-5-TR. Grief is not an illness but a process that can be blocked in the announcement phase of the death or in the depression phase following the absence. In all cases, acceptance of the loss is impossible. Psychiatric treatment can define a bereaved person who is suffering too much, and can reduce his or her suffering, but it cannot accelerate the process of remembering and then resuming a life without the loved one. Social rituals and psychosocial support have had this place for millennia in cultures throughout humanity.

Précis: Concern, Respect, and Cooperation

Précis: <i>Concern, Respect, and Cooperation</i>

Public Stigma of Prolonged Grief Disorder: An Experimental Replication and Extension.

Prolonged grief disorder's (PGD's) recent recognition as a psychiatric diagnosis has elicited concerns about stigmatization. Although prior research demonstrated that PGD elicits public stigma, moderators of this effect are unclear, and the effect requires replication in an English-speaking population. Therefore, we investigated the effects of PGD, sex of the bereaved, and death expectedness on public stigma toward bereaved persons. We randomly assigned 195 Australian adults (77% female; mean age, 35.7 years) to read one of eight vignettes describing a bereaved male or female subject, with or without PGD, after an expected or unexpected death. Participants reported their emotional reactions and negative attributions toward, and desired social distance from, the bereaved person. A person with PGD (vs. without) elicited stronger emotional reactions, negative attributions, and desired social distance. No robust moderator effects emerged. Results validate concerns that PGD causes stigma. Stigmatization may be targeted by information campaigns or psychological treatment.

Validation of a German Version of the Grief Cognitions Questionnaire and Establishment of a Short Form.

BackgroundWhereas the majority of bereaved persons recover from their grief without professional assistance, a minority develops pathological grief reactions. Etiological models postulate that dysfunctional cognitions may perpetuate such reactions. The Grief Cognitions Questionnaire (GCQ) assesses thoughts after bereavement in nine interrelated domains. A short form (GCQ-SF) with four domains is often used. However, an evaluation of the psychometric properties of the GCQ-SF and its utility compared to the GCQ is lacking and these instruments have not been validated in German.MethodGerman bereaved persons (time since loss 35.3 ± 34.6 months) responded to an online survey containing the GCQ, measures of grief severity, grief rumination, symptoms of depression and anxiety, and optimism and pessimism. 585 participants (18–78 years, 88% women) were included. Item analyses and confirmatory factor analyses were conducted. Correlations between the GCQ and GCQ-SF and grief rumination, optimism and pessimism assessed construct validity. Criterion-related validity was assessed by comparing whether the correlation of the GCQ (and the GCQ-SF) with grief severity was higher than with anxious and depressive symptoms. Logistic regression and receiver-operator characteristics (ROC) compared the questionnaires on their ability to predict probable prolonged grief ‘caseness’ (ICG ≥ 25, time since loss ≥6 months).ResultsInternal consistencies for both questionnaires were identical and excellent (α = 0.96). Confirmatory factor analyses obtained a satisfactory fit for models with nine and four correlated subscales and respective higher-order factor models. The GCQ and the GCQ-SF correlated higher with grief severity than with other measures of psychopathology. The logistic regression showed a significant association between the GCQ-SF and prolonged grief ‘caseness’. Of the remaining subscales of the GCQ, only one subscale (‘Others’) contributed to the prediction. The ROC analyses showed nearly identical areas under the curve.ConclusionThe translated GCQ and GCQ-SF demonstrated very good psychometric properties. The correlations with grief severity highlight the questionnaires’ clinical relevance. The questionnaires possessed identical diagnostic specificity and sensitivity. Whenever a timesaving assessment of the most typical grief-specific cognitions is important, the GCQ-SF represents an alternative to the GCQ. The original GCQ may still be superior when a more detailed description of a bereaved person’s cognitions is desirable.

Memorial tattoos: Advancing continuing bonds theory

A memorial tattoo is a tattoo that honors a person who has died. We aimed to understand how memorial tattoos could be an expression of a bereaved person’s continuing relationship with the deceased person that the tattoo memorializes. We interviewed 41 people and used qualitative description grounded in a symbolic interactionist framework to analyze the transcripts. This research expands on continuing bonds theory by showing that memorial tattoos are an expression of the bond with the deceased as well as a way to communicate with others about their ongoing connection and to challenge stigma.

Learning to grieve: A preliminary analysis

In previous articles, I have analyzed the emotion of grief as a normative phenomenon, which is extended beyond the individual to encompass the bereaved person’s body and sociocultural affective niche. The present article complements these analyses with a developmental perspective, focusing on the phenomenon of learning to grieve. First, a distinction between reaction and response theories of emotion is introduced with arguments in favor of the latter. Next, different examples of childhood experiences of grief are analyzed, demonstrating that early experiences of loss are typically scaffolded socially, when the child finds herself in a situation of not understanding exactly what to do or how to feel. This lends support to the normative approach to grief specifically and to emotional life more broadly. Furthermore, early experiences of grief were found to be significantly linked to other emotions, particularly guilt.

\u201cDoctor, please don\u2019t say he died by suicide\u201d: exploring the burden of suicide survivorship in a developing country

BackgroundAnnually, 800, 000 die from suicide worldwide. However, suicide is believed to be rare in our environment. Suicide causes significant life disruptions in people bereaved by it. These disruptions result from associated complicated grieving pattern characterised by stigma, feeling of shame, responsibility, guilt, etc. People therefore usually want to be certain that their relation indeed died from suicide. Being certain can in part help survivors achieve closure. A pathologist is often called upon to diagnose the actual cause of death in suspected suicide. The aim of this paper is to highlight the perception and attitude of survivors to suicide in our environment.MethodsThis is a prospective study carried out in Enugu State University Teaching Hospital, Enugu, Nigeria. Data was obtained by audio-recording and transcription of face-to-face interviews of 8 groups of relatives who had presented to the pathologist for autopsy of their relation suspected to have committed suicide. Transcribed data was double checked for accuracy and analysed. Informed consent was obtained from participants. Ethical clearance was obtained from the Ethical Committee of the hospital.ResultsThere were 8 cases of suspected suicide over a 7-year period accounting for 0.6% of all violent deaths in the period. The central attitude of survivors in all the cases was denial of the event. At all the meetings survivors desired the pathologist to report cause of death differently than suicide. Also, in all cases, the extended family felt affected by the event. The following six themes in descending order of importance were identified to underlie survivors’ attitude to suicide: fear of stigma and its consequent isolation, fear of economic repercussions, a conflict of choice of cause of death stemming from religious beliefs about the afterlife, feeling of shame and anger against the deceased and fear that acknowledging the event may bring a repeat in the family.ConclusionThere is profound fear of stigma and associative concerns which leads to outright suicide-denial. There is a need to educate the society about the reality and dynamics of suicide. This will make a bereaved person open to receiving requisite care.

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

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.

Responding to bereaved people’s words about relationship system loss

People grieving a death may grieve not only the loss of the person who died but also relationship systems lost because of the death. Relationship systems can be defined as what goes on between or among people. In helping bereaved people who talk about systemic loss it is important to acknowledge and speak to that aspect of their loss and, if appropriate, to support them in finding ways to move forward in addressing their systemic losses. Failure to acknowledge and stay with a bereaved person’s words about systemic loss and instead to slide into talking about, for example, grief feelings could be taken as a lack of death competence and an empathic failure. The paper provides illustrations regarding systemic losses in the area of roles, including losses in the areas of collaboration in defining realities, memory-sharing, and mutual knowing and being known.

Risk of suicide, deliberate self-harm and psychiatric illness after the loss of a close relative: A nationwide cohort study.

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.

A walk through bereavement theory

This paper examines and discusses specific grief theories that have emerged over a number of years, resulting in an overview of some of the main theories for the reader. It aims to inform nurses and encourage further exploration of the subject, ultimately resulting in an evidence-based approach to bereavement support. The roots of bereavement theory, found in the health-related literature, lie mainly within psychiatry and psychology, which may explain some of the reluctance of general nurses to engage with this literature and area of health care. The application of bereavement support in practice is important and detailed discussion of a practical application will be discussed in another paper; however, initial understanding of bereavement theory enables staff to begin to support patients and carers in an informed manner. No theory is absolute, and it is unlikely that any bereaved person follows the pattern of an individual theory as written, instead presenting a unique individual adaptation of parts of theories to reflect their personality and history. Notably due to the limitations of this article some theorists are not included. Therefore, disenfranchised grief, although acknowledged as important to the bigger picture is omitted. Theoretical frameworks on death, dying and bereavement have been produced more frequently in the past 25 years than for many years previously. Although the classic theories of the last century continue to be quoted, some theorists such as Buckman (1993a,b), Copp (1996) and Stroebe and Schut (1999, 2005) challenge this early work, and question early assumptions. Bereavement theories reflected over many years consider the multifaceted nature of death and dying and the impact on the patient and families, as well as the gradual shift to holistic care in contemporary cultures (Copp 1998). Bereavement although not a new concept was only acknowledged and recognised by theorists and philosophers …

Ambiguous Loss and Complicated Grief: Understanding the Grief of Parents of the Disappeared in Northern Uganda

AbstractIn the bereavement literature, prolonged grief, described in the new DSM‐5 as persistent complex bereavement disorder, is considered a pathological disorder affecting a small but significant minority of bereaved persons. In the ambiguous loss literature, in contrast, prolonged grief is viewed as inevitably linked to the ambiguity of the bereaved person, and its causes are linked to the ambiguity, such as persistent hope, the absence of cultural and religious rituals to provide meaning to a loss, and the grief being so large as to disenfranchise community members. Based on a literature review and qualitative fieldwork with parents of missing persons in Uganda, this article examines the emotional, social, cultural, and socioeconomic aspects of the ambiguity that relatives of missing persons experience in the aftermath of wartime disappearances. I argue that, in such contexts, explanations of prolonged grief as a pathological disorder cannot be sustained.

Complicated Grief Treatment: An Evidence-Based Approach to Grief Therapy

Complicated grief is a condition that occurs when something impedes the process of adapting to a loss. The core symptoms include intense and prolonged yearning, longing and sorrow, frequent insistent thoughts of the deceased and difficulty accepting the painful reality of the death or imagining a future with purpose and meaning. Complicated grief can cause substantial distress and impairment and it is important that clinicians learn to recognize and treat this condition. Complicated grief treatment is a 16-session evidence-based psychotherapy developed to release and facilitate a bereaved person’s natural adaptive response. The current paper clarifies the conceptual underpinnings of this approach, provides a description of the major treatment components, structure of each session, and suggestions for how clinicians can use the treatment to help clients suffering from complicated grief. A case example is also included to illustrate this discussion.

Being tough, being healthy: local forms of counselling in response to adult death in northwest Tanzania

While antiretroviral medicines have reduced AIDS-related deaths in sub-Saharan Africa, many people still lose multiple family members and struggle with the social and economic consequences of those deaths. This paper examines how older Tanzanians frame feelings of loss caused by the untimely death of young adults and how they advise other bereaved about how to manage loss. A local concept oyegumisilize – meaning ‘to move on and push grief and worries aside’ – is employed in offering bereaved persons advice about how to deal with feelings of loss. Older people try hard to manage memories of loss whilst simultaneously struggling to fulfil the social obligations around mourning that contribute to their ongoing bereavement. Oyegumisilize can be seen as a counselling practice that helps those who have lost loved ones to move on with life and feel normal. It is argued that this form of counselling is a form of therapeutic speech, where the emphasis is not on ‘talking through’ emotions, but on speech that is aimed at ‘toughening up’ the bereaved person. The findings presented here are based upon ethnographic research undertaken in Muleba District in Kagera Region, Tanzania, between 2003 and 2004, and follow-up research conducted in 2005, 2008 and 2012.

GETTING STRAIGHT ABOUT GRIEF

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.

Improving the Efficacy of Intervention for Bereaved Individuals: Toward a Process-Focused Psychotherapeutic Perspective

Professional psychotherapeutic intervention programs for bereaved individuals are not highly effective. We explore the range of possible reasons for this, based on arguments made in the literature and on further key considerations that have so far been neglected. Limited efficacy may be due to inclusion of bereaved individuals who do not need help; inappropriate types of intervention; inadequate quantity (too much or too little); or incorrect timing of the intervention (too soon or too late). Accordingly, we propose that effective intervention will require (1) motivated bereaved persons, (2) identifying and working on processes that cause or maintain the difficulties presented by the bereaved person, and (3) flexibility on the part of the therapist. We describe a number of processes underlying the difficulties encountered by bereaved people, which need consideration in therapy. In addition to these process-focused interventions, working on the therapeutic relationship will be a fundamental factor in helping bereaved individuals cope with their difficult grief.

Sadness and Loss: Toward a Neurobiopsychosocial Model

Sadness and Loss: Toward a Neurobiopsychosocial Model

Time of Change? The Spiritual Challenges of Bereavement and Loss

Coping with grief can include, in part, trying either to assimilate the loss into the existing worldview and its spiritual and religious components, or changing those components in congruence with the new reality. This spiritual or religious challenge can lead to loss of faith and a loss of spiritual meaning, but it can also provide a struggle that eventually leads to growth in the religious and spiritual domains. In a similar way, the bereaved person's experiences with their proximate culture and social world, particularly if their social systems include a religious community or shared spiritual beliefs with others, can lead to negative changes, but there is the possibility for growth in the social domain as well. Clinicians who work with bereaved persons need to be aware of the possibility that such themes may be important to their clients, and some suggestions are made to assist clinicians in this kind of work.