Bereavement Grief Research Articles

Neural correlates of deceased-related attention during acute grief in suicide-related bereavement

BackgroundIndividuals who have lost a loved one to suicide demonstrate an attentional bias to deceased-related stimuli during early grief. Regulating attention toward reminders of the deceased during acute bereavement may be linked to grief trajectory and pathological grief development. Despite the potential prognostic importance, little is known about underlying neural circuitry correlates of deceased-related grief processing. The current study examines neural substrates of deceased-related attentional processing during acute grief in individuals bereaved by suicide. MethodsThirty-seven participants grieving the loss of a first-degree relative or partner to suicide in the prior six months, underwent functional magnetic resonance imaging (fMRI) while performing an emotional Stroop task using words related to the deceased and a living attachment figure, in order to examine neural correlates of deceased-specific attentional processing. Clinical interviews were conducted at baseline. ResultsDeceased-related attentional bias was associated with blood oxygen level-dependent (BOLD) activation in a brain network, including dorsolateral prefrontal cortex (dlPFC), ventrolateral prefrontal cortex (vlPFC), orbitofrontal cortex (OFC), and insula. Greater activation of a bilateral prefrontal cluster during deceased-specific attention was negatively correlated with self-reported grief avoidance behaviors. LimitationsLack of non-suicide grief control and small sample size. ConclusionsThese data, if confirmed, indicate a neural network specific to deceased-related attention, and that cognitive control regions within this network appear to be related to grief avoidance behaviors during acute bereavement.

B - 32 Grief in Neuropsychological Assessment among Culturally Diverse Middle-Old Older Adults.

Bereavement, exacerbated by losses stemming from the COVID-19 pandemic, contributes to high rates of grief and associated mood disturbances among older adults, potentially impacting neurocognition. Middle-old cohorts (ages 75-84) are particularly vulnerable, due to elevated levels of baseline depression, complicated grief, and perceived lower quality of life. The contributory role of grief and culturally-relevant manifestations of bereavement should be carefully considered as potential confounds or performance contributors. Four cases seen for neuropsychological assessment in the Department of Neurological Surgery: A 75-year-old bilingual (Russian, English) patient with a meningioma who noticed cognitive changes following spouse's death from COVID-19; A 77-year-old monolingual (English) patient with Parkinson's disease undergoing a pre-surgical work-up prior to Deep Brain Stimulator insertion. Mood reportedly worsened sharply since spouse's recent death; An 81-year-old monolingual (Cantonese) patient undergoing a pre-surgical work-up prior to DBS insertion. Shared grieving the recent death of younger sibling from COVID-19; An 84-year-old, monolingual (English) patient who was evaluated due to longstanding cognitive challenges in the context of cerebrovascular disease (monitored by Neurological Surgery). Cognitive deficits reportedly precipitously worsened following spouse's death. While levels of neurocognitive and adaptive dysfunction varied, mood disturbance and affective distress likely reduced engagement in the testing process. Reluctance to disclose depressive and anxious symptomatology on questionnaires as a function of culture was noted. Thorough, culturally-sensitive, clinical interviewing and metrics are needed to elicit nuanced information. Grief and associated mood disturbances are to be prioritized and carefully considered in the evaluation and treatment plan with middle-old older adults.

Pandemic Grief and Complications in Bereavement: From Research Evidence to Clinical Relevance

En raison de l’inquiétude générale suscitée par l’impact psychologique de la perte d’un proche victime du COVID-19, nous appliquons notre programme de recherche à multiples facettes sur cette cohorte vulnérable de personnes confrontées au deuil au cours de la pandémie. Nous commençons par un résumé de la construction et de la validation de la Pandemic Grief Scale, une mesure brève et fiable en cinq points des symptômes et des difficultés cliniquement significatifs au lendemain d’une telle perte. Nous poursuivons ensuite la revue d’une série d’études qui documentent l’impact sévère du deuil pandémique. Nous identifions dix facteurs de risque fondés sur des preuves et distincts de la perte dans le contexte des restrictions liées au coronavirus. Nous démontrons le fardeau des problèmes relationnels non résolus avec la personne décédée qui en résulte, et rapportons l’élaboration du premier outil de dépistage validé pour les niveaux cliniques de déficience fonctionnelle due au deuil. Nous concluons par les implications pratiques de cette recherche dans le contexte de la pratique clinique, allant du dépistage le plus large de l’impact psychologique délétère du deuil actuel à des questions spécifiques méritant une attention particulière dans la thérapie du deuil.

For Graduate Students, When the Sadness is Unbelievable

This essay is a meditation on the place of grief in graduate student life, an accounting for the ways that the pandemic has shaped research and the work that disabled graduate students have had to do to stay afloat. I begin by meandering through the grief of a family bereavement into the range of other kinds of crip grief that emerged at the start of the COVID-19 pandemic. Thinking with grief across scales, I ask the following questions: what might it mean to research and to write when our fields of inquiry shift even as they are being studied? How might we hold on to hope as a political practice even as undercurrents of grief work to wash it away? Where and how might we find and work with methodologies and practices that prioritize our embodied experiences during precarious, difficult times? Drawing on Melissa Kapadia’s work on chronic illness methodology and Gökce Günel, Saiba Varma, and Chika Watanabe’s manifesto for patchwork ethnography, I attend to the place of patchwork as a survival strategy for and beyond field research. Ultimately, this essay works with grief’s non-linearity, patching together memories and experiences to document one experience of the early years of the pandemic as means of making the aloneness of our graduate journeys less commonplace.

Changing Funerals and Their Effects on Bereavement Grief in Japan.

Bereavement is an extremely personal feeling, but Japanese society tends to disapprove of displays of negative personal emotion or weakness. For ages, mourning rituals like funerals provided an exception where social permission was given to sharing grief and seeking support. However, the form and significance of Japanese funerals have changed rapidly over the past generation, and especially since the advent of COVID-19 restrictions on assembly and travel. This paper overviews the trajectory of changes and continuities in mourning rituals in Japan, looking at their psychological and social impacts. It goes on to summarize recent Japanese research showing that appropriate funerals are not merely of psychological and social benefit, but may have an important role in reducing or supporting grief that might otherwise require medical and social work intervention.

A scoping research literature review to explore bereavement humor.

The death of a loved one is extremely impactful. Although much of the focus now on helping people who are experiencing bereavement grief is oriented to distinguishing complicated from non-complicated grief for early pharmaceutical or psychiatric treatment, lay bereavement support comprises a more common and thus highly important but often unrecognized consideration. A wide variety of lay bereavement programs with diverse components have come to exist. This scoping research literature review focused on bereavement humor, one possible component. Humor has long been recognized as an important social attribute. Researchers have found humor is important for lifting the spirits of ill people and for aiding healing or recovery. However, humor does not appear to have been recognized as a technique that could benefit mourners. A multi-database search revealed only 11 English-language research articles have been published in the last 25 years that focused in whole or in part on bereavement humour. Although minimal evidence exists, these studies indicate bereaved people often use humor and for a number of reasons. Unfortunately, no investigations revealed when and why bereavement humor may be inappropriate or unhelpful. Additional research, multi-cultural investigations in particular, are needed to establish humor as a safe and effective bereavement support technique to apply or to use. Bereavement humor could potentially be used more often to support grieving people and bereaved people should perhaps be encouraged to use humor in their daily lives.

Risk factors for complicated grief among family members bereaved in intensive care unit settings: A systematic review.

BackgroundFamilies of intensive care unit (ICU) decedents are at increased risk of experiencing complicated grief. However, factors associated with complicated grief in ICU and bereavement needs assessment are not available routinely. We aimed to conduct a systematic review identifying risk factors associated with complicated grief among family members of ICU decedents.Materials and methodsMEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library and Web of Science were searched to identify relevant articles. Observational studies and randomised and non-randomised controlled trials were included. Studies were screened and quality appraised in duplicate. Risk of bias was assessed using Newcastle-Ottawa Scale. A narrative synthesis was undertaken.ResultsSeven studies conducted across three continents were eligible. Four studies were of high quality. 61 risk factors were investigated across the studies. Factors associated with a decreased risk of complicated grief included age, patient declining treatment and involvement in decision-making. Factors associated with increased risk included living alone, partner, dying while intubated, problematic communication, and not having the opportunity to say goodbye.ConclusionThis systematic review has identified risk factors which may help identify family members at increased risk of complicated grief. Many of the studies has small sample sizes increasing the risk of erroneously reporting no effect due to type II error. Some factors are specific to the ICU setting and are potentially modifiable. Bereavement services tailored to the needs of bereaved family members in ICU settings are required. (PROSPERO registration ID 209503)

A Multimethod Examination of Medical Students' Experiences With Bereavement and Complicated Grief.

Few studies have examined grief in medical students. This study used a multimethod approach to describe how bereavement and CG may impact medical students' educational experience and their perspectives on grief support and training. One hundred three medical students completed an online survey with quantitative and qualitative methods. Seventy-three (71%) students reported experiencing bereavement, of which 12 (18%) screened positive for CG. Medical students who screened positive for CG reported significantly more emotional and behavioral challenges (M = 3.58 [SD = 2.64]) compared to medical students without CG (M = 0.93 [SD = 1.58], p < .001). Qualitative analyses revealed that bereaved and nonbereaved students wanted more grief education and bereavement support from medical institutions. Therefore, it is crucial for medical institutions, to acknowledge that grief and bereavement may impact students' performance due to multifactorial causes.

Unexplored Costs of Bereavement Grief in Japan: Patterns of Increased Use of Medical, Pharmaceutical, and Financial Services.

Bereaved families may experience psychological and physical problems increasing their reliance on medical, pharmaceutical, and financial/legal services. Our Japan-wide survey (n = 1078) researched bereaved who showed increased reliance on medical, pharmaceutical, and financial/legal services. Increased use was most evident in the ‘50’s age bracket, and for unemployed widows; it corresponded less with low annual income than with high income declining significantly after bereavement. Increased users showed higher psychological and physical symptoms of grief, and reported their decline in physical health seriously influencing their work and lives, suggesting “presenteeism”—reduced productivity for those continuing to work. Increased users spent 2.7 times more for medical and pharmaceutical services than those reporting continual use, portending 4 to 10 times more Japanese government expense for this group, half of whom considered their own out-of-pocket expenses a financial burden. These findings warrant further research on cost-effectiveness of interventions to reduce declining health of the bereaved.

What Exactly Is "Complicated" Grief? A Scoping Research Literature Review to Understand Its Risk Factors and Prevalence.

Most people will experience bereavement grief, but some suffer from persistent or prolonged (PoP) grief, grief that used to be identified as "complicated" before recent DSM-5 and ICD-11 definitional developments. In 2020, a scoping literature review was undertaken to identify and consolidate contemporary evidence from research articles published in 2018 or 2019 in paper-based and open access peer-review journals on: (a) the incidence or prevalence of PoP grief, and (b) who develops it or is diagnosed as suffering from it, and correspondingly what causative factors or predictors are associated with PoP grief. All of the 11 identified research articles reported an incidence or prevalence rate, with these varying greatly, but with a much higher rate now that a 6-month post-death measurement timeframe is used. The predictors or factors among people who were identified as having PoP grief also varied considerably, although sudden and unexpected deaths were often implicated.

Mindfulness-based cognitive therapy on bereavement grief: Alterations of resting-state network connectivity associate with changes of anxiety and mindfulness.

Bereavement, the experience of losing a loved one, is one of the most catastrophic but inevitable events in life. It causes grief and intense depression‐like sadness. Recent studies have revealed the effectiveness and proficiency of mindfulness‐based cognitive therapy (MBCT) in emotional regulation among bereavement populations. MBCT improves the well‐being of the bereaved by enhancing cognitive performances. Regarding the neural correlates of bereavement grief, previous studies focused on the alleviation of emotion–cognition interferences at specific brain regions. Here, we hypothesized that the bereavement grief fundamentally triggers global alterations in the resting‐state brain networks and part of the internetwork connectivity could be reformed after MBCT intervention. We recruited 19 bereaved individuals who participated the 8‐week MBCT program. We evaluated (a) the large‐scale changes in brain connectivity affected by the MBCT program; as well as (b) the association between connectivity changes and self‐rated questionnaire. First, after MBCT, the bereaved individuals showed the reduction of the internetwork connectivity in the salience, default‐mode and fronto‐parietal networks in the resting state but not under emotional arousal, implying the alleviated attention to spontaneous mind wandering after MBCT. Second, the alterations of functional connectivity between subcortical (e.g., caudate) and cortical networks (e.g., cingulo‐opercular/sensorimotor) were associated with the changes of the mindfulness scale, the anxiety and the emotion regulation ability. In summary, MBCT could enhance spontaneous emotion regulation among the bereaved individuals through the internetwork reorganizations in the resting state.

The potential impact of bereavement grief on workers, work, careers, and the workplace

ABSTRACT Bereavement grief is typically very painful and often highly consequential. People who are working could be significantly impacted by the death of someone they care about. A qualitative study sought an understanding of the lived experience of bereavement on the mourner’s ability to work and their work-related experiences following the death of a loved one. Three themes emerged: (a) grief is universal but individually impactful, (b) accommodation is needed to assist the return to work and to regain work abilities, and (c) there are many impediments to working again. These themes highlight the potential for bereavement grief to substantially effect mourners and thus their work, careers, and the workplace. Older workers could be particularly disadvantaged because of workplace ageism. Societal and other changes appear to be needed for the health and wellbeing of mourning workers, and to address related work and bereavement issues. Bereavement grief is highly relevant to the social work profession, given its involvement in providing information, developing supportive services, and making referrals.

Being there: A scoping review of grief support training in medical education.

IntroductionMedical education experts argue that grief support training for physicians would improve physician and patient and family wellness, and should therefore be mandatory. However, there is little evidence about the range of curricula interventions or the impact of grief training. The aim of this scoping review was to describe the current landscape of grief training worldwide in medical school, postgraduate residency and continuing professional development in the disciplines of pediatrics, family medicine and psychiatry.MethodsUsing Arksey and O’Malley’s scoping review principles, MEDLINE, EMBASE, ERIC, PsychInfo and Web of Science were searched by a librarian. Two levels of screening took place: a title and abstract review for articles that fit a predefined criteria and a full-text review of articles that met those criteria. Three investigators reviewed the articles and extracted data for analysis. To supplement the search, we also scanned the reference lists of included studies for possible inclusion.ResultsThirty-seven articles published between 1979 and 2019 were analyzed. Most articles described short voluntary grief training workshops. At all training levels, the majority of these workshops focused on transmitting knowledge about the ethical and legal dimensions of death, dying and bereavement in medicine. The grief trainings described were characterized by the use of diverse pedagogical tools, including lectures, debriefing sessions, reflective writing exercises and simulation/role-play.DiscussionGrief training was associated with increased self-assessed knowledge and expertise; however, few of the studies analyzed the impact of grief training on physician and patient and family wellness. Our synthesis of the literature indicates key gaps exist, specifically regarding the limited emphasis on improving physicians’ communication skills around death and dying and the limited use of interactive and self-reflexive learning tools. Most trainings also had an overly narrow focus on bereavement grief, rather than a more broadly defined definition of loss.

2206Prevalence and determinants of complicated grief in bereaved caregivers of patients admitted for cardiovascular diseases

Abstract Introduction Few studies have examined complicated grief in bereaved caregivers of patients with cardiovascular diseases (CVD), in contrast with studies in caregivers of patients with cancers. We examined the prevalence and determinants of complicated grief among bereaved caregivers of patients with CVD. Methods We conducted a cross-sectional survey using a self-administered questionnaire for bereaved family members of CVD patients who had died in the cardiology departments of 9 tertiary care centers in Japan. We assessed bereaved caregiver grief status using the Brief Grief Questionnaire (BGQ), and its association with their depression (Patient Health Questionnaire-9 [PHQ-9]). Questionnaire also covered following associated factors: bereaved family member and patient characteristics, end-of-life care (Care Evaluation Scale [CES], a scale for assessment of the structure and process of care); and the quality of the deceased patients' death (Good Death Inventory [GDI]). Results A total of 269 bereaved caregivers (mean age, 64±12 years; 35% male) of patients with CVD (heart failure n=155 myocardial infarction n=32, cardiopulmonary arrest n=15, arrhythmia n=8, and others n=59) were enrolled in the study. Overall, 14.1% of the bereaved caregivers had complicated grief (BGQ≥8), 32.3% had subthreshold complicated grief (BGQ=5–7), and 13.3% had depression (PHQ-9≥10). Bereaved caregivers with complicated grief frequently developed depression (58% vs. 6%, p&lt;0.001). Among the bereaved caregivers with complicated grief, the assessment of end-of-life care was worse (CES score: 28 [21–40] vs. 23 [19–39], p=0.04), and the assessment of the deceased patients' quality of death tended to be worse (GDI score: 4.0 [3.0–4.8] vs. 4.3 [3.7–4.9], p=0.05). The cause of admission as well as preferences of the patient and family (e.g., treatment [focusing on extending life vs. relieving discomfort], desire for information, place of end-of-life) were not associated with the prevalence of complicated grief. The prevalence of complicated grief was associated with loss of a spouse, poor psychological health during the deceased patients' admission, and poor preparation for the patient's imminent death (all p&lt;0.05). Bereaved caregivers with complicated grief had experienced more decisional burdens regarding the deceased patients' treatment (55% vs. 25%, p=0.001). Notably, 64% of bereaved caregivers with complicated grief were not treated (i.e., neither routine follow-up by psychiatrists/psychotherapist nor prescription for anti-depressants/tranquilizers). Conclusions The prevalence of complicated grief of bereavement was 14.0%. When subthreshold complicated grief was included, the prevalence of complicated grief increased to include half of the caregivers; therefore, routine screening of the bereaved could be recommended. Clinicians should pay particular attention to bereaved families with high risk factors to identify those at risk for future development of complicated grief.

Authenticity, ambivalence and recognition in caring at the end of life and beyond

Informal caring at the end of life is often a fraught experience that extends well beyond the death of the person receiving care. However, analyses of informal carers' experiences are frequently demarcated relative to death, for example in relation to anticipatory grief (pre-death) or grief in bereavement (post-death). In contrast to this tendency to epistemologically split pre- and post-death experiences, we analyse informal caring across two separate qualitative interviews with 15 informal carers in one metropolitan city in Australia—one before and one after the death of the person for whom they cared. In doing so, we focus on accounts of care across dying and bereavement including: the evolving ambivalence of carers’ social relations at the end of life and beyond; dying and death as a challenge to the ideal of authenticity; and, the potential for misrecognition and social estrangement in caring relations at the end of life. We draw on social theory addressing the themes of ambivalence, authenticity and recognition to enhance our understanding of caring as a social practice that occurs across dying and bereavement, rather than as structured primarily by the context of one or the other.

Listening to Sutra-Chanting Reduces Bereavement Stress in Japan

Buddhist Chaplains chanting sutras after the Great East Japan Earthquake in 2011 often encountered survivors who felt that hearing sutra chanting itself ameliorated their bereavement grief. This research is the first experimental examination of the effects of sutra chanting on listeners’ bereavement stress. Prior research demonstrates that sudden pet loss causes bereavement stress in students and that physiological stress can be noninvasively measured by salivary alpha-amylase. We asked Japanese college students to raise pet goldfish until they developed an attachment to them, then confiscated the fish, and told the students that they had to be killed. To compare the bereavement stress of groups listening and not listening to sutra chanting, we used psychological and salivary analyses. Perceived Stress Scale (PSS), Multidimensional Empathy Scale (MES), and State half of the State Trait Anxiety Inventory (STAI) psychological scales showed no statistically significant differences between sutra and control groups, but salivary analyses indicated measurable stress reduction in the sutra-listening group only. This pilot study tentatively confirmed the hypothesis that listening to Buddhist sutra chanting reduces Japanese bereavement stress. Further research is needed both to verify these stress-reduction effects and to determine whether such effects are primarily musical or cultural/spiritual.

Is the bereavement grief intensity of survivors linked with their perception of death quality?

Some people experience exceptionally severe bereavement grief, and this level of post-death grief could potentially be the result of a low quality dying process. A pilot study was conducted to determine if a relationship exists between perceived death quality and bereavement grief intensity. A questionnaire was developed and posted online for data on bereavement grief intensity, perceived death quality, and decedent and bereaved person characteristics. Data from 151 Canadian volunteers were analysed using bi-variate and multiple linear regression tests. Half had high levels of grief, and over half rated the death as more bad than good. Perceived death quality and post-death grief intensity were close to being negatively correlated. These findings indicate research is needed to explore possible connections between bereavement grief and the survivor's perceptions of whether a good or bad death took place. In the meantime, it is important for palliative care nurses to think of the quality of the dying process as being potentially very impactful on the people who will be left to grieve that death.

Клініко-психологічні аспекти переживання втрати та діагностики ускладненого горювання

The actual studies of scienti0xFB01c and psychological approaches to the concept of experiencing bereavement and complicated grief are considered in the article. It is emphasized that the optimal trajectory of recovery afetr the death of a signi0xFB01cant person consists in the successful resolution of nonlinear «tasks», caused by the loss, and passes with minor functional impairments, involves ef-fective coping strategies and activities that allow a healthy way of expres sing emotions, remembering the deceased and overcome current life problems.The information on clinical and psychological features and diagnostic signs of complicated grief are generalized. It is proved that the core of the complicated grief is a complex of symptoms of intense and persistent sepa-ration distress, which does not lead to the elaboration of the experience of loss, but is replaced by stereotyped, repeated thinking strategies and beha­vior strategies, which increase psychosocial disturbances. The diagnostic cri-teria for the di0exFB00rence between healthy and pathological (complicated) grief, covering the intensity, duration, and complexity of symptoms are identi0xFB01ed. The relevance and complexity of the di0exFB00rential diagnosis of complicated grief among other bereavement­related mental health disorders are emphasized. It is noted that due to the communion of a clinical picture with a major de-pressive disorder and post­traumatic stress disorder, people with complicated grief remain inadequately diagnosed or misdiagnosed, and that leads to the using of treatment as usual that partly reduces comorbid symptoms without a0exFB00cting the complicated grief symptoms. The di0exFB00rences between compli-cated grief, major depressive disorder, and post­traumatic stress disorder are generalized, which may be useful for di0exFB00rential diagnosis by mental health professionals.The author concluded that there is a need to develop educational and training programs directed at increasing professional knowledge and com-petencies in diagnostics and di0exFB00rential diagnostics of complicated grief and adaptation of screening methods for assessing complicated grief in Ukraine.

Grief, Mindfulness and Neural Predictors of Improvement in Family Dementia Caregivers.

Background: Family dementia caregivers often suffer from an immense toll of grief while caring for their loved ones. We sought to identify the clinical relationship between grief, depression and mindfulness and identify neural predictors of symptomatology and improvement.Methods: Twenty three family dementia caregivers were assessed at baseline for grief, mindfulness and depression, of which 17 underwent functional magnetic resonance imaging (fMRI). During fMRI, caregivers were shown faces of either their dementia-stricken relative or that of a stranger, paired with grief-related or neutral words. In nine subjects, post fMRI scans were also obtained after 4 weeks of either guided imagery or relaxation. Robust regression was used to predict changes in symptoms with longitudinal brain activation (BA) changes as the dependent variable.Results: Grief and depression symptoms were correlated (r = 0.50, p = 0.01), and both were negatively correlated with mindfulness (r = −0.70, p = 0.0002; r = −0.52, p = 0.01). Relative to viewing strangers, caregivers showed pictures of their loved ones (picture factor) exhibited increased activation in the dorsal anterior cingulate gyrus and precuneus. Improvement in grief but not mindfulness or depression was predicted by increased relative BA in the precuneus and anterior cingulate (different subregions from baseline). Viewing grief-related vs. neutral words elicited activity in the medial prefrontal cortex and precuneus.Conclusions: Caregiver grief, depression and mindfulness are interrelated but have at least partially nonoverlapping neural mechanisms. Picture and word stimuli related to caregiver grief evoked brain activity in regions previously identified with bereavement grief. These activation foci might be useful as biomarkers of treatment response.

A Study to Understand the Impact of Bereavement Grief on the Workplace.

Although most employees and business owners or operators will likely experience the death of one or more loved ones over their work lives, attention has not focused on how bereavement grief impacts the workplace. A study was conducted for foundational information. Data on the annual incidence of bereavement leaves and related matters were collected from a relatively representative sample of small, medium, and large Canadian organizations. Two of every three organizations had 1+ employees take a bereavement leave last year, with 3.2% of all employees taking a bereavement leave consisting of 2.5 days on average and often with additional travel and accommodation days. The findings suggest that more should be done by organizations to prepare for bereavement leaves and assisted work returns. This preparation is essential for the tsunami of bereavement grief in the years ahead as deaths increase rapidly in number with population aging.