Complicated Grief Symptoms Research Articles

The association of family functioning and psychological distress in the bereaved families of patients with advanced cancer: a nationwide survey of bereaved family members.

Family conflict and family functioning were regarded as changeable factors associated with complicated grief (CG) and major depressive disorder (MDD) in the bereaved families of patients with advanced cancer, although the evidence is limited. We explored the family functioning associated with CG and MDD developing either independently or co-morbidly in the bereaved families of patients with advanced cancer who died in palliative care units (PCUs). This study comprised a nationwide cross-sectional questionnaire survey of bereaved family members of cancer patients who died in Japanese PCUs participating in evaluation of the quality of end-of-life care. A total of 529 questionnaires (69.2%) were returned, and we analyzed a total of 458 responses. A total of 14.2% of participants were considered as having CG, 22.5% as having moderate to severe depression, and 9.6% as having co-morbid symptoms. Multivariate logistic regression analysis revealed that many family members insulted or yelled at one another (odd ratio [OR]: 2.99, p = 0.046; OR:2.57, p = 0.033), and conflict regarding what is meant by a good death (OR:3.60, p = 0.026; OR:4.06, p = 0.004) was significantly positively associated with CG, MDD, and co-morbid symptom. Specific family conflicts may increase the incidence of CG, MDD, and co-morbid symptoms in the bereaved families of patients with advanced cancer. Our results may encourage health care providers to approach discussions about end-of-life issue with the patient and their family in advance, especially focusing on what is considered a good death for the patient, which may prevent or resolve the family conflict.

Attachment style and experiencing the symptoms of complicated grief after the death of a spouse – preliminary research among widowed women

Attachment style and experiencing the symptoms of complicated grief after the death of a spouse – preliminary research among widowed women

The pain of grief: Exploring the concept of psychological pain and its relation to complicated grief, depression, and risk for suicide in bereaved adults.

Emotional or psychological pain is a core symptom of complicated grief (CG), yet its correlates are largely unexamined among bereaved individuals. Bereaved adults (N = 135) completed self-reports regarding psychological pain, CG, depression, and suicidality. We assessed correlations among these variables and tested whether psychological pain was elevated among individuals with CG and individuals with current or past suicidal thoughts and behaviors. Using logistic regression, we also assessed psychological pain, depression, and CG symptom severity as predictors of suicide risk. Psychological pain was strongly associated with both CG and depression severity and was elevated among subjects reporting current or past suicidality. CG and depression were not statistically significant predictors of suicidal ideation after accounting for the effects of psychological pain. Psychological pain is strongly associated with bereavement-related psychopathology and warrants further investigation in studies examining the nature and treatment of CG.

Complicated grief following job loss: Risk factors for its development and maintenance.

Increasing evidence shows that job loss can lead to symptoms of complicated grief (CG). However, little is known about which factors relate to the development and maintenance of CG symptoms following job loss. This study aimed to examine risk factors for the development and maintenance of job loss‐related CG symptoms. For this study 485 Dutch workers who had lost their job were recruited (239 men and 246 women), with an average age of 50.2 years. A subsample of 128 participants also completed questionnaires at a six‐month follow‐up. We conducted correlational and multiple regression analyses (MRA) to examine the influence of the former work situation, coping strategies, and negative cognitions on job loss‐related CG symptoms. MRA results showed that belief in an unjust world was related to job loss‐related CG symptoms, cross‐sectionally and longitudinally. Further, there was a significant relationship between CG symptoms following job loss and a preference for maladaptive coping over adaptive coping styles and a low level of self‐esteem. This effect remained stable over time. These findings can inform the development of interventions for and early detection of job loss‐related CG symptoms.

Effects of a problem drinking monitoring program for bereaved older men: A pilot study

본 논문은 사별 후 알콜 관련 문제를 겪고 있는 남성 노인을 대상으로 하는 단기프로그램의 알콜 문제와 심리적 문제 경감의효과성을 검증한 파일럿 연구이다. 연구 참가자는 최근에 배우자를 사별한 남성 노인이고 이들에 대해서는 연구에 관한 정보를 전하고동의를 구하였다. 총 참가자는 26명으로 무작위로 두 그룹으로 나누었다. 13명은 알콜문제모니터링 프로그램에 나머지 13명은 비교그룹에 속하였다. 프로그램 집단에 속한 연구 참가자들은 알콜 관련 문제와 복잡성비애를 포함한 심리문제가 비교 집단에 비해 통계적으로 유의한 수준으로 경감되는 결과를 보였다.Purpose: The aim of this study is to test a brief modified version of intervention for problem drinking monitoring program for bereaved men who lost their loved one. Methods: Inclusion criteria were experiencing the recent loss of a spouse and providing informed consent for participation. Of the 32 referred individuals who met the inclusion criteria, 26 participants were recruited. Study participants were randomly assigned into Alcohol problem monitoring(APM) group (N=13) or comparison group (N=13). Results: Older men receiving APM substantial decreased in problem drinking during three months of intervention. Improvement over time was observed on the outcomes, particularly in the Short Michigan Alcoholism Screening Test-Geriatric Version(SMAST-G). Conclusion: The findings that a modified version of APM for bereavement helped improve complicated grief symptoms and social impairments and reduce levels of problem drinking, provide important insights into the interventions for psychological and alcohol-related difficulties in bereavement.

Wish you were here: The Dutch, German, and English Yearning in Situations of Loss Short Form.

Objective(s)Yearning, a hallmark of grief disorders, relates to rumination and potentially to cognitive avoidance. We developed an 8‐item short form of the only existing validated yearning measure, the Yearning in Situations of Loss Scale (YSL), to improve its validity and administration ease.MethodCross‐sectional surveys were conducted among bereaved Dutch (N = 313) and German (N = 235) community samples and an American treatment‐seeking sample (N = 95). All samples completed the YSL, and community samples additionally measures of rumination, loss‐related avoidance, complicated grief (CG), and depression.ResultsA one‐factor model provided a good fit to the YSL Short Form (YSL‐SF) in the community samples. A two‐factor structure (cognitive and emotional yearning)best fitted the YSL‐SF in the treatment‐seeking sample. YSL‐SF scores correlated positively with rumination, loss‐related avoidance, and with CG symptoms whilst controlling for rumination and loss‐related avoidance.ConclusionThe YSL‐SF appears an easy‐to‐administer and valid measure of yearning after bereavement.

Do Coping Strategies Differentially Mediate the Relationship Between Emotional Closeness and Complicated Grief and Depression?

Although complicated grief (CG) following the death of a loved one has traditionally been viewed as avoidance-driven, recent research implicates approach behavior. Researchers have investigated how coping styles predict CG; however, emotional closeness remains unexamined. This study investigated the differential relationship of approach- and avoidance-focused coping on CG and depressive symptoms. Bereaved adults (n = 340) completed questionnaires about their loss, coping styles, CG, and depression. Results suggest that approach-, but not avoidance-, focused coping mediates the relationship of emotional closeness on CG, while emotional closeness of the relationship had no direct impact on depressive symptoms. This suggests closeness of the relationship plays a unique role in CG.

Prolonged Grief, Posttraumatic Stress, and Depression Among Bereaved Parents: Prevalence and Response to an Intervention Program.

Bereaved parents may experience diverse psychological symptoms. Possible interventions are not yet well established. In this study, the psychological symptoms of 323 bereaved parents (mean age = 39.97, SD = 7.21, 52.0% female), referred to a 4-week family-oriented rehabilitation (FOR) program, were assessed. The baseline assessments indicated that 160 (49.5%) parents showed symptoms of prolonged grief disorder (PGD). Complicated grief was indicated in 272 (84.2%), depression in 191 (59.1%), and posttraumatic stress disorder in 242 (74.9%) parents. Mothers were at higher risk of complicated grief (p ≤ .001), depression (p = .029), and posttraumatic stress disorder (p = .004), compared to fathers. Significant remissions of symptoms between admission and discharge from the program are presented as symptoms of complicated grief, depression, and posttraumatic stress. The effect sizes ranged between d = 0.68 and 1.22. In addition, significantly fewer parents fulfilled PGD criteria on discharge from the FOR program (p ≤ .001). The special FOR program appears promising with regard to improving the bereaved parents' mental health.

Deepening the understanding of complicated grief among Chinese older adults: A network approach.

Instead of understanding symptoms in a way where a latent cause exists and symptoms serve as its indicators, the network approach enables an innovative comprehension on psychological disorders that focuses on causal interactions. There is need to update the knowledge in this direction in Chinese context. This study strives to apply network approach to deepening the understanding of complicated grief (CG) among older adults in rural China. A sample of older participants (N = 352) who experienced spousal bereavement living in Zhejiang Province of China were administrated with face-to-face interviews. Networks analysis was conducted to realize the object of this study. The 19-item ICG network revealed that symptoms were both positively and negatively connected within the network. The most three central symptoms were "feeling longing for the person who died" and "memories of the dead", and feeling lonely". Edge-weights accuracy and centrality stability were tested in order to remind carefulness when interpreting the results. This study demonstrates the utility of a network approach in deepening the understanding of the structure of CG symptoms among Chinese older people. Strengths and limitations, as well as implications for informing the assessment and treatment of this disorder, were discussed.

A qualitative study of bereaved family members with complicated grief following a death in the intensive care unit.

Grief is a normal reaction, and most family members (FMs) experience grief following a death. Typically, grief subsides without any major psychological or medical impairment. Nevertheless, some FMs may experience complicated grief (CG) reactions, with symptoms lasting months or years, and CG is particularly prominent among FMs of those who die in the intensive care unit (ICU). The purpose of this study was to examine how FMs experience grief, particularly CG, to inform future early screening and support programs in the ICU. This was a multicentre qualitative study focusing on semi-structured interviews with FMs who displayed symptoms of CG. Family members of patients who died in the ICU and who had a six-month inventory of CG score > 25 were included. Semi-structured interviews were conducted with FMs post-loss, with follow-up interviews three months after the initial interviews. Major themes identified following thematic analysis from eight participants with CG included 1) ante-mortem experience: the impact of the ICU experience prior to death of a loved on subsequent grief; 2) post-mortem experience: unpredictable post death reactions; 3) coping strategies: techniques used to reduce the severity of grief reactions; 4) sources of support: focusing on resources that the FM draws from for emotional support; and 5) perspectives on future ICU bereavement screening and support programs: advice that FM participants provided for future bereavement support. Bereaved FMs with CG described their experiences with grief, how ICU events influenced their bereavement, their coping strategies and sources of support, and their advice for future bereavement support programs for FMs of deceased ICU patients.

Treating Complicated Grief among Orphaned Children in Kenya: Effectiveness of Complicated Grief Therapy

Complicated Grief (CG) also referred to as complicated bereavement is a clinically significant condition even though there is limited evidence on its prevalence and treatment in Kenya and Africa in general. The main aim of this 2019 study was to test the efficacy of a modified Complicated Grief Therapy (CGT) in treating complicated grief (CG) among orphaned children. A total of 426 orphaned children aged 10 - 15 years were screened using the Brief Grief Questionnaire to sample those with elevated grief scores. Of the 263 who met the criteria, only 241 participants fully participated in the six months study with 123 and 118 participants in the treatment and the control groups respectively. The treatment group was subjected to a shortened version of the CGT (12 weeks) while no treatment was offered to the control group. The prevalence of grief among orphaned children was 66% and using the Inventory for Complicated Grief, to determine the clinical levels, a mean grief score of 31.6 (SD = 9.52) was recorded. The reduced version of CGT was effective in the reduction of complicated grief symptoms t(122) = -15.79, p at a weekly reduction of 1.29 points. In the case of the control group, the paired sample test showed a statistically insignificant reduction of CG score, t(117) = -0.712, p = 0.478. Conclusions: Reducing CGT sessions 12 sessions to make it shorter and less stringent and using it as group therapy in a school setup did not interfere with its effect on the treatment of complicated grief among orphaned children.

Continuing bonds and dreams following violent loss among Cambodian survivors of the Pol Pot era

In non-Western societies, two-way communication between the bereaved and deceased is important in distinguishing adaptive versus maladaptive continuing bonds (CBs). We examined CBs expressed in dreams among Cambodian survivors during the Pol Pot era. Participants completed measures addressing dreams of the deceased, complicated grief (CG), and post-traumatic stress disorder (PTSD) symptoms. Participants who reported distressing dreams were more likely to have witnessed violent deaths of loved ones during the Pol Pot era and reported more severe CG and PTSD symptoms relative to those reporting other types of dreams. Distressing visitation dreams were shown to mediate the effect of violent loss on CG but not on PTSD.

Shame, guilt, and pride after loss: Exploring the relationship between moral emotions and psychopathology in bereaved adults

BackgroundSelf-blame following bereavement has been implicated in the development of post-loss psychopathology. However, prior studies have not distinguished between the emotions of shame versus guilt. This study examined the cross-sectional associations among bereavement-related shame, bereavement-related guilt, and two mental disorders that commonly arise after bereavement: complicated grief and depression. In addition, exploratory analyses examined the associations between bereavement-related pride and post-loss psychopathology. MethodsParticipants included 92 bereaved adults who experienced the death of a family member at least one year prior to the study. Participants completed self-report measures of complicated grief symptoms, depression symptoms, shame, guilt, and pride. ResultsShame and guilt were positively correlated with complicated grief and depression symptoms. When controlling for their shared variance, only shame remained a significant predictor of post-loss psychopathology. Follow-up analyses indicated that the effect of guilt on psychopathology depended on the level of shame, and vice versa. At low shame, guilt predicted psychopathology; however guilt did not predict psychopathology at moderate to high shame. At low to moderate guilt, shame predicted psychopathology; however shame did not predict psychopathology at high guilt. Pride negatively predicted depression symptoms, but not complicated grief symptoms, when we controlled for shame and guilt. LimitationsLimitations include the cross-sectional design and modest sample size. ConclusionsOur analyses identify shame as the more pathogenic moral emotion for bereaved adults. However, whereas guilt in the absence of shame is often considered adaptive, we found that guilt predicted greater psychological distress at low levels of shame in this sample.

Associations between self-compassion and complicated grief symptoms in bereaved individuals: An exploratory study

Grief is a normal and natural response to the loss of a loved one that is characterized by a broad range of emotional, behavioral, cognitive, and physiological symptoms. For most bereaved, these symptoms abate over time as the individual comes to terms with the loss. However, about 10% of the bereaved experience a persistent and debilitating grief reaction, a condition that has been termed complicated grief or prolonged grief. Self-compassion has been defined as a kind and caring attitude towards oneself when experiencing suffering. The present study explored the associations between self-compassion and complicated grief symptoms in a bereaved sample from the general population. Participants completed measures of complicated grief (Inventory of Complicated Grief), self-compassion (Self-Compassion Scale), and neuroticism (NEO FFI-3 neuroticism scale). In line with previous studies, bereavement by unexpected death and high neuroticism were related to grief symptom severity. The results further showed statistically significant relationships between low self-compassion and the severity of complicated grief symptoms. No associations between the cause of death (natural expected, natural sudden, or unnatural) and self-compassion were found. The self-kindness component of self-compassion did not moderate the relationships between established risk factors for complicated grief (cause of death and neuroticism) and complicated grief symptomatology. It is concluded that it is important for clinicians to be attentive to the role that low self-compassion may have in the grief response of bereaved individuals.

Polish version of the Inventory of Complicated Grief - preliminary validation.

The purpose of the following study was to verify the psychometric properties of the Polish version of the Inventory of Complicated Grief. 278 people who experienced loss of a close relative or a friend participated in the research on adaptation of the tool. The following research methods were applied: ICG (Inventory of Complicated Grief), BDI (Beck Depression Inventory), STAI (State-Trait Anxiety Inventory), IES-R (Impact of Events Scale-Revised), AHS (Adult Hope Scale), LOT-R (Life Orientation Test-Revised), GSES (General Self-Efficacy Scale), MSTAT-2 (Multiple Stimulus Types Ambiguity Tolerance). The statistical analyses conducted as part of the research prove the Polish version of the ICG to be a reliable and valid tool (Cronbach's alpha = 0.941). Amoderate positive correlation was noted between the overall ICG score and depression (r = 0.50; p < 0.001), post-traumatic stress disorder (r = 0.67; p < 0.001) and trait anxiety (r = 0.59; p < 0.001). The general ICG results also display negative correlation between variables related to positive expectations of the future: optimism (r = -0.37; p < 0.001), hope for success (r =-0.19; p =0.001), general self-efficacy (r = - 0.27; p < 0.001), and ambiguity tolerance (r = - 0.27; p < 0.001). The conducted confirmatory factor analysis (CFA) revealed that the one-factor model of the Polish version of the Inventory of Complicated Grief can be considered wellfitted to the data (correlation of measurement errors was allowed). Preliminary studies on the adaptation of the Polish version of the ICG prove, therefore, that it is a valid and reliable tool. However, further research is needed to help better understand the structure of complicated grief symptoms.

Investigating the Hypothesis That Coping and Nonattachment Mediate Complicated Grief Onto Hoarding

One hundred and four participants across Australia (M age = 58.28, SD = 12.84; 52.9% male; 1% did not indicate) completed online questionnaires to investigate complicated grief (CG) symptoms, coping, and nonattachment onto hoarding behavior. Generally speaking, expected correlations were found. The hypothesis that coping and nonattachment would mediate grief onto hoarding was partially supported. Only mental disengagement reported to partially mediate the relationship between CG and hoarding. Hoarding can be explained in part by attempts to distract oneself from negative emotions of loss, perhaps at best viewed as a risk factor maintaining hoarding, when considering the methodology.

Can a single question about family members\u2019 sense of security during palliative care predict their well-being during bereavement? A longitudinal study during ongoing care and one year after the patient\u2019s death

BackgroundIt has been recognised that more evidence about important aspects of family members’ sense of security during palliative care is needed. The objectives of the study was: i) to discover what variables are associated with family members feeling secure during palliative care; ii) to develop a model of family members’ sense of security during palliative care, and iii) to evaluate if family members’ sense of security during ongoing palliative care predicts well-being during bereavement.MethodsBetween September 2009 and October 2010, 227 family members (of patients admitted to six Swedish palliative home care units) participated in the study (participation rate 75%) during ongoing care and 158 participated also 1 year after the patient’s death (70%). They answered a single question regarding the family members’ sense of security during the palliative care period. The question was constructed and validated by the researchers. Data were also collected using other questions and validated instruments and analysed stepwise with Generalized Linear Models (ordinal multinomial distribution and logit link).ResultsSixteen variables were positively related to family members’ sense of security during ongoing palliative care. The five variables with the highest importance were selected into the model (listed in decreasing importance): Family members’ mastery; nervousness and stress; self-efficacy; patient having gynaecological cancer; family members’ perceived quality of life. Moreover, the family members’ sense of security during ongoing palliative care predicted ten variables indicating their well-being 1 year after the patient’s death, e.g. psychological well-being, complicated grief symptoms, health related quality of life.ConclusionsThe findings reveal possibilities to identify family members at risk of negative adjustment to bereavement in clinical practice and may help to develop interventions to support family members during ongoing palliative care.

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.

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.

Changing Suicide Bereavement Narrative Through Integral Breath Therapy

ABSTRACT The purpose of this study was to examine the efficacy of Integral Breath Therapy (IBT) as an appropriate intervention for facilitating meaning-making out of a traumatic loss and reducing symptoms of complicated grief, specifically for those bereaved by suicide. The narrative mixed methods design included pre- and post- measures of the Inventory of Complicated Grief with eight participants selected from a South Texas bereavement facility. The following themes emerged from the pre-interviews: Isolation/Avoidance, Disbelief/Shock, Shattered Sense of Self, Holding On, Guilt/Blame, and Rupture with Spirituality, while themes from the post-interview were Connection, Purpose, Hope, Acceptance, Sense of Self, and Catharsis/Letting Go.