Bereaved Persons Research Articles

Alcohol-related mortality and all-cause mortality following bereavement in two successive generations.

Background and aimBereavement affects the health of the bereaved both emotionally and physically. Bereavement resulting from alcohol-related death of the previous generation (parents-first generation) may increase the risk of alcohol abuse and consequently alcohol-related mortality as well as all-cause mortality in the next generation (offspring-second generation). Furthermore, these associations can be bi-directional. However, there is no conclusive evidence of these effects, and studies exploring these intergenerational effects are rare. This study investigates these associations.MethodsA longitudinal data were constructed by linking participants from the Adolescent Health and Lifestyle Surveys (AHLS) from 1979 to 1997 with census and registry-based data from Statistics Finland containing the socioeconomic status of the survey participants and their parents (N = 78610) to investigate these associations. Multivariate Cox proportional hazards models were used to calculate hazard ratios with 95% confidence intervals to determine the effect of bereavement with alcohol-related mortality and all-cause mortality.ResultsThe findings suggest that bereavement following the death of an offspring increases the risk of both alcohol-related and all-cause mortality among both parents. The magnitude of the risk of mortality following the death of an offspring is higher for mothers than for fathers. There were no clear associations of a parent’s death with an offspring’s alcohol-related or all-cause mortality. However, generally, a father’s death seems to be protective of the risk of mortality among the offspring while a mother’s alcohol-related death slightly increased the risk of alcohol-related mortality among their offspring.ConclusionsThese findings emphasise the role of bereavement, particularly resulting from the death of an offspring, on alcohol-related and all-cause mortality and therefore inequalities in mortality. Furthermore, the findings highlighting the need for alcohol abuse intervention and emotional support for bereaved persons following the death of an offspring.

Patient-centered care during the last year of life: adaptation and validation of the German PACIC short form for bereaved persons as proxies (PACIC-S9-proxy)

BackgroundProviding patient-centered care (PCC) during the last year of life (LYOL) can be challenging due to the complexity of the patients’ medical, social and psychological needs, especially in case of chronic illnesses. Assessing PCC can be helpful in identifying areas for improvements. Since not all patients can be surveyed, a questionnaire for proxy informants was developed in order to retrospectively assess patient-centeredness in care during the whole LYOL. This study aimed to evaluate the feasibility and validity of an adapted version of the German Patient Assessment of Chronic Illness Care (PACIC) for surveying bereaved persons in order to assess PCC during the decedents’ LYOL.MethodsThe German PACIC short form (11 items) was adapted to a nine-item version for surveying bereaved persons on the decedent’s LYOL (PACIC-S9-Proxy). Items were rated on a five-point Likert scale. The PACIC adaptation and validation was part of a cross-sectional survey in the region of Cologne. Participants were recruited through self-selection and active recruitment by practice partners. Sociodemographic characteristics and missing data were analyzed using descriptive statistics. An exploratory factor analysis was conducted in order to assess the structure of the PACIC-S9-Proxy. Internal consistency was estimated using Cronbach’s alpha.ResultsOf the 351 informants who participated in the survey, 230 (65.52%) considered their decedent to have suffered from chronic illness prior to death. 193 of these informants (83.91%) completed ≥5 items of the questionnaire and were included in the analysis. The least answered item was item (74.09%) was item 4 (encouragement to group & classes for coping). The most frequently answered item (96.89%) was item 2 (satisfaction with care organization). Informants rated the item” Given a copy of their treatment plan” highest (mean 3.96), whereas “encouragement to get to a specific group or class to cope with the condition” (mean 1.74) was rated lowest. Cronbach’s alpha was 0.84. A unidimensional structure of the questionnaire was found (Kaiser-Meyer-Olkin 0.86, Bartlett’s test for sphericity p < 0.001), with items’ factor loadings ranging from 0.46 to 0.82.ConclusionsThe nine-item questionnaire can be used as efficient tool for assessing PCC during the LYOL retrospectively and by proxies.Trial registrationThe study was registered in the German Clinical Trials Register (DRKS00011925) on 13 June 2017.

English

Widowhood has been on increase globally and Kenya as nation is not exceptional. The state of widowhood globally has been made worse during this period of Corona Virus Disease which started in Wuhan in China in December 2019 (WHO, 2019). Losing a spouse through death is quite emotive and may affect the bereaved persons&rsquo; psychosocial wellbeing as well as coping mechanism. In Meru community of Kenya, few researches have been done on counselling as a coping mechanism of widowhood. The study&rsquo;s main purpose was to determine how loss and grief&nbsp;&nbsp; counselling is used as a coping mechanism by comparing widowers and widows in Meru County Kenya. A descriptive survey was employed in the study where ex post facto&rsquo;s causal-comparative research design was appropriately used. A total population of 80,332 widowed persons&nbsp;&nbsp; in Meru County was targeted. For comparison purposes, a total sample size of 384 respondents was used; half from each gender. Questionnaires and Focus Group Discussions were used to collect data from respondents based on gender. Both descriptive and inferential statistics were employed. Widows sought for loss and grief counselling more at 61% than widowers&nbsp;&nbsp; at 47 % and from FGDs more than 70% and less than 20% respectively. From t-test results there was a statistically significant difference which favored widows than widowers in seeking for counselling services. In conclusion, the study findings may assist the widows and widowers to seek timely loss and grief counselling services as a positive coping mechanism. &nbsp; Key words: Widowhood, loss and grief counselling, coping mechanism, psychosocial wellbeing, widow/ widowers. &nbsp

Grief Before and During the COVID-19 Pandemic: Multiple Group Comparisons

ContextGrief researchers are concerned that the coronavirus disease 2019 (COVID-19) pandemic will precipitate increases in severe, persistent, and disabling grief, termed prolonged grief disorder or persistent complex bereavement disorder. We recently demonstrated that higher grief levels are experienced after COVID-19-related bereavement than natural bereavement. Death circumstances during the pandemic (e.g., reduced social support, limited opportunities for death rituals) may also hamper the grief process for non-COVID-19-related bereavement, yet no quantitative research has specifically addressed this issue. ObjectivesTo test if grief severity is higher during than before the lockdown after non-COVID-19-related bereavement. MethodsA cross-sectional survey including questions on sociodemographic and loss-related variables and a grief measure was conducted among a sample of 1600 bereaved adults (78% females), participating before (n = 731) or during (n = 869) the pandemic, including people who had experienced a loss before the pandemic (n = 456) or during the pandemic (n = 200) recently (five months ago or less). ResultsNo significant differences emerged between grief levels in people participating before or during the pandemic. However, being recently bereaved during the pandemic elicited more severe grief than before it (d = 0.17; d = 0.18). Effects remained significant after controlling analyses for relevant loss-related variables. ConclusionAmong all bereaved persons, grief severity was no different during the pandemic compared with before the pandemic. However, experiencing a recent loss during the pandemic elicited more severe acute grief reactions than before the pandemic, suggesting that dealing with loss may be more difficult during this ongoing health crisis.

How Grief, Funerals, and Poverty Affect Bereaved Health, Productivity, and Medical Dependence in Japan

Grief has been shown to weaken bereaved persons' health, but measurements of their lost time and medical expense remain rare. Funerals traditionally managed and assuaged grief through ritual expression, approval, and social support. Research suggests that satisfying funeral participation reduces grief, while poverty exacerbates it. We hypothesized that: (1) psycho-physical symptoms of grief, (2) abbreviation/dissatisfaction in the funeral, and (3) poverty, correlate with decreased productivity and increased medical and social services use. We collected data from 165 mourning families about their grief, funerals, and subsequent medical conditions. (1) Deeper grief after bereavement in Japan correlated with more physical problems, more down time, and more medical dependency. (2) Low satisfaction with funerals correlated with higher hospital, pharmacy, and counseling costs. (3) Low income families lost more time, while declining incomes showed increased pharmaceutical costs. This suggests that satisfying funerals and income safeguards may reduce costs of low productivity and increased public services dependency.

How Do Drug-Death-Bereaved Parents Adjust to Life Without the Deceased? A Qualitative Study.

Knowledge about how bereaved persons grieve can enhance quality in providing the support and potential services that they need. We aimed to identify ways in which drug-death-bereaved Norwegian parents go on with their lives and what inhibits or promotes adaptation during their grieving. Reflexive thematic analysis was used to analyze 14 semistructured in-depth interviews. We generated three themes: (I) processing grief emotions, (II) proactive coping, and (III) giving and receiving support and assistance. Processing guilt rumination, reflections on blame and a burden of grief emotions characterized grieving early on. Using cognitive strategies and functional-support-giving were found to be the most frequently used strategies. Oscillation between processing stressors and reorientation to the world promoted adjustment to ongoing life. We discuss characteristics of parents who struggle to reorient and outline important implications for policy and practice.

Cremation and Grief: Are Ways of Commemorating the Dead Related to Adjustment Over Time?

Funeral services are known to serve multiple functions for bereaved persons. There is also a common, intuitively reasonable assumption of positive associations between engaging in funeral activities and adjustment to bereavement. We examined whether restricting ceremonial cremation arrangements to a minimum has a negative association with grief over time. Bereaved persons in the United Kingdom completed questionnaires 2 to 5 months postloss and again a year later (N = 233 with complete data; dropout = 11.4%). Neither type nor elaborateness of the cremation service, nor satisfaction with arrangements (typically high), emerged as significantly related to grief; no major subgroup differences (e.g., according to income level) were found. Results suggested that it does not matter to grief whether a more minimalistic or elaborate funeral ceremony was observed. We concluded that the funeral industry represented in this investigation is offering bereaved people the range of choices regarding cremation arrangements to meet their needs. Limits to generalizability are discussed.

Stillbirth at Term: Grief Theories for Care of Bereaved Women and Families in Intrapartum Settings.

Death in intrapartum settings poses a paradox for providers, whose expertise may be limited in assisting bereaved women and families facing the trauma of stillbirth. Many providers are familiar with Kübler-Ross' stage theory of grief; however, more recent theories augment her early work in care of bereaved persons. Through an evolving case study of a couple for whom pregnancy ends in stillbirth at term, 4 theories of grief-loss of the assumptive world, the dual process model, continuing bonds, and complicated grief-are presented to assist intrapartum care providers toward more comprehensive understanding of the complexities of grief responses not fully explained by simple stage theory. These 4 theories are not prescriptive, nor are they comprehensive; however, they are highly relevant and foundational for current understanding of responses and needs of bereaved women and families for whom pregnancy ends in death.

Substance use and suicide among men in Ghana: A qualitative study

A known risk factor for suicide globally is substance use. Despite being public health problems across the globe, research on the association between suicide and substance use have often ignored the socio-cultural context in which these behaviors play out. This qualitative study examines bereaved persons’ perception of the roles of substance use in the lifestyles and the suicides of their deceased relations. We conducted an in-depth qualitative interview with between two to seven close relations of nine men who killed themselves in Ghana in the period 2014 and 2015. A qualitative content analysis of bereaved persons’ accounts shows three themes: Behavioral changes connected with substance use, Consequences of substance use and misuse, and Alcohol presence in the suicide act. Thus, novel and excessive alcohol or drug use followed economic, financial, or relational stressors faced by the men. Personal disruption and social disintegration occurring as consequences of continued substance use triggered suicidal behaviors, which in turn appeared to have shaped in particular, use of alcohol as ingredients or tools in the suicide acts itself in some of the suicides. Contextual nuances shaping a dynamic interrelationship between substance use and suicide calls attention to viewing substances as ingredients with shifting functions during the suicidal process. We propose that encouraging emotional disclosure, supporting men with problem-solving skills, and regulating the availability and use of substances through effective alcohol and drug policies may be vital for an integrative public health approach towards suicide prevention in Ghana.

When does grief become pathological? Evaluation of the ICD-11 diagnostic proposal for prolonged grief in a treatment-seeking sample

ABSTRACT Background: Prolonged grief disorder (PGD) will be newly included in the ICD-11, while a clinically similar diagnosis, persistent complex bereavement disorder (PCBD), has already been added to the DSM-5. Only few studies have evaluated these criteria-sets for prolonged grief. Objective: The aim of this study was to evaluate the ICD-11 accessory symptom threshold and compare the diagnostic performance of the two criteria-sets in treatment-seeking bereaved persons. Method: 113 grief treatment-seeking bereaved persons completed the Interview for Prolonged Grief-13. We used receiver operator characteristic analysis to determine an optimum ICD-11 accessory symptom threshold. We calculated diagnostic rates for PGD and PCBD and examined associations of PGD and PCBD caseness with concurrently assessed psychopathology and prolonged grief symptoms assessed one month later. Results: An ICD-11 threshold of six accessory symptoms distinguished optimally between interview-diagnosed participants with and without prolonged grief. The prevalence of PGD (69%) was significantly higher than that of PCBD (48%) and of PGD with a 6-symptom threshold (47%). PGD caseness was associated with the relation to the deceased, 6-symptom threshold PGD and PCBD caseness with the time since loss. All criteria-sets were linked to concurrent prolonged grief, depression, and general mental distress. PCBD and 6-symptom threshold PGD but not PGD were associated with prolonged grief severity one month later. Conclusions: The results support the validity of PGD and PCBD but, at the same time, they provide further support for differing prevalence rates. Using an empirically determined ICD-11 accessory symptom threshold could prevent the pathologisation of grief reactions.

Epidemiología enfermera del duelo en Canarias

Grief is a natural and self-limited process of adaptation to a new reality that arises after a significant loss, real or perceived, with a wide range of manifestations that produce an impact on the health of the mourner. Objective: To know and identify, broken down by diagnostic gradient, the prevalence of mourning in the Canary Islands, as well as the needs of care before the diagnosis of mourning of the mourners. Results: Significantly, more women than men are identified in the three diagnostic labels under study. Patients with bereavement complications previously presented depression, anxiety, and risk of loneliness. The result of the pattern assessment is paradoxical. Conclusion: Grief is a multidimensional phenomenon that can hardly be assessed from a reductionist tool such as functional patterns. The high prevalence of complications in women’s grief should be studied in-depth, associating it with their previous burdens of care and vulnerability. The association between loneliness and complicated grief is evident, and the role of community nurses in these patients may be essential. Further research is needed on the care needs of bereaved persons, both complicated and uncomplicated, as well as on their predictive and protective factors.

The special grief following drug related deaths

Background: In most European countries and in the US, there has been a negative trend with increasing incident rates of drug related deaths (DRD) during the last decade. In 2017, the mortality rate due to overdoses reached epidemic proportions in the United States; i.e. the age-adjusted rate of drug overdoses reached 21.7 per 100,000, being 9.6% higher than the 2016 rate. Increasing, still lower, rates are seen in European countries. Behind these figures are many bereaved persons left behind in quiet grief.Results: Research has shown that other kinds of unnatural deaths (e.g. resulting from accident, suicide, homicide) in particular, can lead to intense suffering and reduce quality of life for those left behind. Still, drug death bereaved persons seem to be an understudied, stigmatized and invisible social group. In this paper, we review previous research and deal with strain and stigmatization before drug related deaths and The Special Grief after such deaths.Discussion: We will discuss the possibility of different grief reactions as anticipated-, disenfranchized- and Prolonged Grief Disorder among family members and close friends. Furthermore, we focus on how the phenomenology of grief is connected to contextual and personal relations and interpersonal processes. Finally, we discuss the usefulness of a relational dialectics’ perspective and a family perspective for understanding and relating to The Special Grief.

Complicated grief therapy for clinicians: An evidence-based protocol for mental health practice.

In the United States alone, about 10 million persons are newly bereaved each year. Most do not require professional intervention or treatment, but many can benefit from targeted support. However, a significant minority of bereaved persons experience intense, prolonged and disabling grief symptoms associated with considerable morbidity and mortality (aka, "Complicated Grief"). Individuals with Complicated Grief require more formal interventions. In this article, we describe a compassionate and evidence-based approach to bereavement-care that can be provided in varied mental health settings. For individuals struggling with acute grief, clinicians can help by providing recognition and acceptance of the grief, eliciting and compassionately listening to their narratives of their relationship with the deceased and the death, and regularly "checking in" regarding their grief experiences. For bereaved persons who are experiencing Complicated Grief, we recommend an evidence-based approach to bereavement-care, complicated grief therapy (CGT), that involves helping the individual accept and cope with the loss while simultaneously assisting them with adaptation to life without the deceased. We describe ways of implementing CGT's seven core themes: (1) understanding and accepting grief, (2) managing painful emotions, (3) planning for a meaningful future, (4) strengthening ongoing relationships, (5) telling the story of the death, (6) learning to live with reminders, and (7) establishing an enduring connection with memories of the person who died. This work can be done in a variety of settings, taking into consideration the needs of the patient, the limitations of the setting, and the skills and experiences of each clinician.

Bereavement Support in Palliative Care: A National Survey of Australian Services.

Background: Bereavement support is an integral part of palliative care. However, audits of Australian palliative care services have consistently identified bereavement care as one of the highest priorities for improvement. Objective: We assessed equity of access to bereavement support across Australian palliative care services by using survey data to compare services according to location (metropolitan vs. regional). We also evaluated changes in bereavement support over the last decade by comparing findings to results of a previous Australian study. Design, Setting, and Participants: A national, cross-sectional online survey of Australian palliative care services conducted from August to September 2017. Main Outcome Measures: Services' self-reported provision of bereavement support. Results: One hundred and eighty services (84%) responded. Of these, 91% provided bereavement support. Most offered support to all bereaved persons connected to the service. More than 80% of services provided a wide range of support types. Metropolitan services were more likely than regional services to offer specialist bereavement interventions. The staff most involved in coordinating and delivering bereavement support were social workers, nurses (particularly in regional areas), and bereavement coordinators/counselors (particularly in metropolitan areas). Resource limitations presented barriers to provision of bereavement support. Conclusions: Across Australia, in principle, access to bereavement support through palliative care services remains largely equitable. Nevertheless, observed variations in the type of professional delivering care and the level of support indicate that a more consistent approach is required. An increase in the range of supports available compared with a decade ago signifies a more comprehensive approach to bereavement support by many Australian palliative care services.

Mental health impact and health care use of the bereaved persons 8-11 months after the November 2015 Paris terror attacks

Mental health impact and health care use of the bereaved persons 8-11 months after the November 2015 Paris terror attacks

Mental health impact and health care use of the bereaved persons 8-11 months after the November 2015 Paris terror attacks

Mental health impact and health care use of the bereaved persons 8-11 months after the November 2015 Paris terror attacks

Depressive symptoms and mental health-related quality of life in adolescence and young adulthood after early parental death.

Aims: Little is known about long-term mental health in young adults who participate in ongoing grief counseling programs after early parental death in childhood, adolescence or young adulthood. The purpose of this study was to examine mental health in young adults according to early parental death and participation in grief counseling. Methods: In a cross-sectional, questionnaire-based study, we included three samples of young adults age 18-41 years. One sample who had lost a parent between age 0 and 30 years and who had participated in grief counseling identified through four Danish grief-counseling organizations, and two registry-based samples of young adults included parentally bereaved and non-bereaved young adults. Multivariate-adjusted regression analyses were performed to characterize risk of depressive symptoms and mental health-related quality of life (HQoL) according to early parental death and participation in grief counseling. Results: A total of 2467 (45%) young adults participated. Bereaved young adults reported significantly more depressive symptoms (p<0.0001) and lower mental HQoL (p<0.0001) than non-bereaved young adults and than general population levels for both depressive symptoms (p<0.0001) and HQoL (p<0.0001). Bereaved young adults who had participated in grief counseling reported significantly more depressive symptoms (p<0.0001) and lower mental HQoL (p<0.0001) than bereaved persons who did not participate in grief counseling. Conclusions: Bereaved young adults report more mental health problems than non-bereaved young adults, and also after participation in grief counseling the death of a parent may be accompanied by subsequent mental health problems.

Prolonged grief disorder

Grief is anatural response to the loss of aloved one and its intensity usually lessens over time. Approximately 10% of bereaved persons, however, experience persistent symptoms resulting in the development of aprolonged grief disorder (PGD). APGD shows adistinct symptom cluster and is considered for inclusion as adiagnosis in the upcoming revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). It is distinct from other mental disorders but symptoms overlap, especially with major depression and posttraumatic stress disorder. In addition to diagnostic criteria and differential diagnosis, the following article also describes prevalence rates, comorbidities, risk factors as well as treatment options for PGD.

PC-FACS

PC-FACS

Guilt in bereavement: Its relationship with complicated grief and depression

This study investigated the relationship between guilt and well-being of bereaved persons, and explored potential differences in the associations between guilt-complicated grief (CG) and guilt-depression. In total, 1358 Chinese bereaved adults were recruited to fill out questionnaires. Participants (N = 194) who had been bereaved within 2years of the first survey, filled out the same questionnaires 1 year later. Higher guilt was associated with higher degrees of both CG and depression. The level of guilt predicted CG and depression symptoms 1 year later. Bereavement-related guilt has a closer association with CG than depression. Responsibility guilt, indebtedness guilt and degree of guilt feeling are more prominent aspects of guilt in CG than in depression. These findings demonstrate the significant role of guilt (perhaps a core symptom) in mental health of the bereaved, having implications for identifying persons with grief complications and depression.