Course Of Bereavement Research Articles

Implementation of a hospital-based end-of-life and bereavement care program in a latin American middle-income country. A source of light and compassion in the midst of cloudy times

BackgroundThe death of a child is one of the most devastating events a family can face, resulting in significant physical and psychosocial morbidity. Bereavement support programs have been developed in high-income contexts to address this need. However, little is known about implementing bereavement programs in low-and middle-income countries (LMICs). Here, we describe the implementation of a bereavement program for parents whose children died due to cancer or other catastrophic illnesses.MethodsWe conducted a retrospective analysis to describe the implementation of a hospital-based End of Life (EoL) care and bereavement program. This program was developed in several stages, including an assessment of bereaved families, development program guidelines, staff training, piloting of the program, refinement, and standardization. The program was developed between 2019 and 2021 in a nonprofit, teaching hospital and referral center for southwestern Colombia.ResultsSeveral tools were developed as key components of the bereavement program: a virtual bereavement course; guidance for EoL and bereavement communication and care, memory making, and follow-up calls; a condolence letter template, and group support workshops. A total of 956 healthcare professionals were trained, 258 follow-up calls to bereaved parents were made, 150 individual psychological follow-ups to parents with complicated grief occurred, 79 condolence letters were sent, and 10 support group workshops were carried out. Challenges were identified and overcome, such as limited resources and staff, and cultural perceptions of death. In 2021, this program received an award by the hospital as the Best Strategy to Humanize Healthcare.ConclusionsThis study highlights the feasibility of developing and implementing EoL and bereavement care programs for parents and families within hospitals in LMICs. Lack of resources, staff, and training are some of the identified challenges to implementation. Utilizing methodological tools allows us to identify facilitator factors and deliverable outcomes of our EoL and bereavement program. This model provides a valuable framework for resource-limited settings.

Trajectories of depressive symptoms early in the course of bereavement: Patterns, psychosocial factors and risk of prolonged grief.

In the context of bereavement, little is known about the mechanisms that differentiate normative adjustment patterns from those that may indicate potential psychopathology. This study aimed to replicate and extend previous work by (1) characterizing the trajectories of depressive symptoms from 3 to 12months after the loss of a spouse, (2) examining whether (a) childhood maltreatment and attachment style predicted distinct depression trajectories, and (b) different depression trajectories were associated with the risk of prolonged grief at 12months post-loss. Recently bereaved individuals (N=175) completed self-report assessments at 3, 4, 6, and 12-months post-loss. Trajectories of depressive symptoms were estimated using group-based trajectory modelling. Four distinct trajectories of depressive symptoms were identified: (1) resilience (minimal/no depression across time points; 45%), (2) moderate depression-improved (alleviated to 'mild' by 12months; 31%), (3) severe depression-improved (alleviated to 'moderate' by 12months; 15%), and (4) chronic depression ('severe' symptoms across time points; 9%). Higher childhood maltreatment predicted a greater likelihood of belonging to the 'severe depression-improved' and 'chronic depression' groups than the 'resilient' and 'moderate depression-improved' groups. Widow(er)s with higher attachment anxiety were more likely to belong to the 'severe depression-improved' and 'chronic depression' groups than the 'resilient' group. The trajectory groups with persistent levels of depressive symptoms up until 6months were more likely to exhibit prolonged grief at 12months post-loss. Changes from pre-loss functioning cannot be estimated. Our findings provide insight into the early identification of post-loss prolonged grief.

Disruptions in self-regulatory processes predict depression and sleep disturbance in bereaved young adults.

Losing a loved one is both common and profoundly stressful for young adults. Little research has examined the longitudinal course of post-loss cognitive processing, depression, and sleep difficulties. Further, little is known about the context of other stressors or the role of individual regulatory resources, such as attentional regulation, that might determine whether loss-related cognitive processing reduces distress. This prospective study examined changes in depression and sleep disturbance over 9weeks as a function of within- and between-person variation in stress exposure, loss-related cognitive processing, and attention regulation. Participants were 108 recently bereaved college students completing a lab-based assessment of attention regulation and four self-report surveys, spaced three weeks apart. Results revealed that most participants gradually reduced loss-related processing over the study period, with corresponding improvements in depression and sleep. Stress exposure was associated with increased processing, depression, and sleep disturbance. In exploratory analyses, high attentional alertness and slow re-orienting strengthened the association of within-person loss processing with sleep disturbance. Both within- and between-person variation in stress appear to engender risk for a prolonged course of bereavement. Future research should integrate objective attention measures with self-reported adjustment to stress to illuminate reciprocal links between depression, sleep, and loss-related cognitive processing.

Using the Kübler-Ross Model of Grief with Post-Traumatic Stress Disorder (PTSD): An Analysis of Manchester by the Sea

<p class="AbstractText">People may encounter different stages of grief during the course of bereavement, and not everyone can achieve a positive state of mind. This study intended to analyze how the characters in <em>Manchester by the Sea</em>, mainly Lee Chandler, Patrick Chandler, and Randi, manage their emotional responses when they are facing the loss of a loved one. The study used Elisabeth Kübler-Ross’s five-stage model of grief and post-traumatic stress disorder (PTSD) to analyze how these characters transition through their grief and whether they are likely to suffer from mental illness. Some people, like Randi and Patrick in the film, may recover from bereavement; however, some people, like Lee, may not, eventually becoming afflicted with mental illness or PTSD.</p>

The Burden of Bereavement: Early-Onset Depression and Impairment in Youths Bereaved by Sudden Parental Death in a 7-Year Prospective Study.

The authors sought to determine the long-term impact of sudden parental death on youths and pathways between youth bereavement and impairment. Youths (N=216) who lost a parent to suicide, accident, or sudden natural death and nonbereaved youths (N=172) were followed periodically for up to 7 years. The incidence and prevalence of disorder and of functional impairment, as well as pathways to impairment, were assessed using Cox and mixed-effects logistic regression and structural equation modeling. Prior to parental death, bereaved youths had higher rates of psychiatric disorder, parental psychiatric disorder, and maltreatment. Even after adjustment for predeath risk factors, bereavement was associated with an increased incidence of depression, posttraumatic stress disorder, and functional impairment. The peak incidence of depression was in the first 2 years postbereavement, with incident depression occurring mainly in those who lost a parent at age 12 or younger. Youths bereaved by all three causes of death showed higher rates of impairment at all time points. Structural equation modeling found that bereavement had a direct effect on impairment and was also linked to impairment via its effects on early and later depression and through negative life events. Child psychiatric disorder prior to parental loss also contributed to functional impairment. Parental death increased the incidence of depression in offspring early in the course of bereavement. Early identification and treatment of depression in bereaved youths and augmentation of family resilience may protect against later sequelae of functional impairment.

Punctive grace: reading religion in Barthes’ Mourning Diary

This discussion locates the doctrine of grace as one way of negotiating Barthes’ references to Christianity in his late writings. The dynamic influence of the divine experienced by the believer through faith, grace has the capacity to transform suffering into a meditative or ‘neutral’ thinking analogous to meditation or prayer. For the grieving Barthes, grace promises relief without negating the course of bereavement and so enables the act of writing. In recalling the maternal, grace also allows a focus on the mother Barthes develops in relation to the work of George Bernanos and Blaise Pascal, as well as Marcel Proust. After establishing Barthes’ interest in grace in Mourning Diary as well as A Lover’s Discourse, The Neutral and Camera Lucida, the essay discloses the working or movement of grace in three ideas current to these writings: ‘twinklings’, the ‘punctum’ and tears. These terms not only map the way to Barthes’ projected ‘new life’, or Vita Nova, but reveal an attentive engagement with Christianity and mysticism through which he discovers his neutral or non-egoic way of mediating grief. If ‘literature is like religion’, as Barthes claimed, then his writing is like grace, moving him and his reader towards an equanimity framed by, if not faithful to, Christian discourse.

Who leaves suicide notes? A six-year population-based study.

Popular culture insists on the significance of suicide notes, but research has yielded conflicting results about who leaves notes. Utilizing 6 years of suicides from a comprehensive statewide data surveillance system, differences were examined between cases with suicide notes and those without in terms of demographics, circumstances of the suicide, and precipitating circumstances. Of the 2,936 suicides, 18.25% included a note. Demographics and circumstances did not differ for cases with a note compared to cases with no note. Results have implications for working with people bereaved by suicide in helping understand that the notes are uncommon and not systematic. However, it is also possible that for some individuals, the content of a note is meaningful and can help or hinder their course of bereavement.

Course of bereavement over 8-10 years in first degree relatives and spouses of people who committed suicide: longitudinal community based cohort study

Objective To identify factors predicting the long term course of complicated grief, depression, and suicide ideation in a community based sample of relatives bereaved through suicide.Design Longitudinal cohort study. Included...

Are individual differences of attachment predicting bereavement outcome after perinatal loss? A prospective cohort study

ObjectiveThe purpose of this study was to examine the influence of attachment, social support and the quality of the current partnership on the outcome of bereavement after perinatal loss. MethodsIn a prospective cohort design 33 women after perinatal loss were approached on admission to hospital and reassessed four weeks, four months and nine months later. The initial assessment included the Adult Attachment Interview and self-report questionnaires for social support and quality of the current partnership. Bereavement outcome was assessed using measures of grief (MTS), depression and anxiety (HADS), psychological distress (BSI), somatisation (BSI-SOM) and symptoms of PTSD (PDS). ResultsAll measures of outcome showed a significant improvement over time. Standardized effect sizes between the initial assessment and nine month follow-up ranged between .36 for anxiety (HADS) and 1.02 for grief (MTS). Social support, quality of the partnership and secure attachment correlated inversely, and insecure preoccupied attachment correlated positively with the outcome measures. Preoccupied attachment was included as a predictor in two multivariate statistical models of non-linear regression analysis, one with somatisation (adjusted R2=.698, P=.016), the other with posttraumatic stress symptoms at nine month follow-up (adjusted R2=.416, P=.002) as target variable. Initial assessment scores of psychological distress predicted the course of the respective measure during follow-up (adjusted R2=.432, P=.014). ConclusionAttachment, social support and the quality of the current partnership have an impact on the course of bereavement after perinatal loss. Secondary prevention after the event may focus on these factors in order to offer specific counselling and support.

Physiological correlates of bereavement and the impact of bereavement interventions

The death of a loved one is recognized as one of life's greatest stresses, with reports of increased mortality and morbidity for the surviving spouse or parent, especially in the early months of bereavement. The aim of this paper is to review the evidence to date to identify physiological changes in the early bereaved period, and evaluate the impact of bereavement interventions on such physiological responses, where they exist. Research to date suggests that bereavement is associated with neuroendocrine activation (cortisol response), altered sleep (electroencephalography changes), immune imbalance (reduced T-lymphocyte proliferation), inflammatory cell mobilization (neutrophils), and prothrombotic response (platelet activation and increased vWF-ag) as well as hemodynamic changes (heart rate and blood pressure), especially in the early months following loss. Additional evidence suggests that bereavement interventions have the potential to be of value in instances where sleep disturbance becomes a prolonged feature of complicated grief, but have limited efficacy in maintaining immune function in the normal course of bereavement.

The Phenomenology and Course of Depression in Parentally Bereaved and Non-Bereaved Youth

To compare the phenomenology and course of bereavement-related depression to depression that occurred later in the course of bereavement and to depression in non-bereaved youth. This sample is drawn from a cohort of parentally bereaved youth and non-bereaved controls followed for approximately 5 years. Three groups of depressed youth were compared with respect to symptoms, severity, duration, risk for recurrence, and correlates and risk factors: (1) a group with bereavement-related depression (BRD, n = 42), with the onset of a depressive episode within the first 2 months after parental loss; a group with later bereavement depression (LBD, n = 30), with onset at least 12 months after parental loss; and a non-bereaved control group with depression (CD, n = 30). BRD episodes were similar to LBD and CD with respect to number of symptoms, severity, functional impairment, duration, risk for recurrence, and most risk factors and correlates. BRD, compared with both CD and LBD, were younger, exposed to fewer life events, and less likely to have experienced feelings of worthlessness. Also, caregivers of BRD showed higher rates of depression and post-traumatic stress disorder at the time of the depression compared with each of the other two groups. BRD is similar to both LBD and CD in phenomenology, course, and risk factors, supporting a diagnostic and therapeutic approach to BRD similar to that for non-bereavement-related depressions. In the bereaved child who presents with depression shortly after parental death, the clinician should also be alert to caregiver depression and post-traumatic stress disorder.

Paediatric trainees learn how to approach child bereavement with the help of bereaved parents

BackgroundCurriculum mapping exercises highlighted child bereavement as an area where competencies were difficult for trainees to achieve.MethodsIn co-operation with the Child Bereavement Charity, a team of experienced professionals and educators...

What makes grief difficult? Perspectives from bereaved family caregivers and healthcare providers of advanced cancer patients

Family members who take on the role of caregiving for someone who is dying begin bereavement after being emotionally and physically taxed by the caregiving experience. The course of bereavement is influenced by a number of factors, including health problems, financial concerns, social support, and family relationships. This paper reports on findings from a secondary analysis of qualitative data from a study examining family caregiver coping in end-of-life cancer care, to describe, from the perspectives of bereaved family caregivers, their perspectives on what made their grief difficult. Qualitative data from three focus groups with family caregivers (n = 19) and two focus groups with health professionals (n = 14) were subjected to interpretive thematic analysis. Our finding suggest three broad areas that make family caregivers' grief difficult: (1) dealing with occurrences in everyday life; (2) dealing with challenges specific to the caregiving situation; and (3) dealing with the healthcare system. The findings provide an important beginning point in understanding the types of issues that seem to make grief difficult for family caregivers of cancer patients at the end of life and can help professional groups to understand what is needed by family caregivers in terms of support and delivery of services.

Post-traumatic growth and bereavement

There is no uniform response to death, and the range of initial responses may run from delighted, satisfied and relieved, through to distraught, depressed and traumatised. This variability in initial response means that the subsequent course of bereavement is likely to be equally varied – with final outcomes often dependent upon what has preceded them. Where some subset of final outcomes is of research interest, it is essential that the antecedents of, or preconditions for, the final outcome are of at least equal interest. This appears in some cases to have become less of a focus in the bereavement research on post-traumatic growth (PTG). Without at least attempting to distinguish normal mourning from depression, and traumatic from other pathological responses to bereavement, it is unlikely that PTG will be consistently associated with adjustment or distress. In this review, we outline some of the conceptual distinctions that may be important in increasing our understanding of responses to death and conclude that making such distinctions, where possible, can enhance our treatment approaches in terms of ensuring they are tailored to accommodate particular psychiatric syndrome(s) that can follow bereavement, but are also aimed at facilitating PTG in certain individuals.

Grief and Depression: Treatment Decisions for Bereaved Children and Adults

Grief and Depression: Treatment Decisions for Bereaved Children and Adults

How They Died, Time since Loss, and Bereavement Outcomes

This analysis explores associations between differing death circumstances and the course of bereavement among a sample of 540 bereaved parents. Comparisons were made between parents whose children died by suicide (n = 462), those losing children from other traumatic death circumstances (n = 54), and others whose children died from natural causes (n = 24). Results were mixed, showing suicide survivors with more grief difficulties and other mental health problems on some criteria, though most findings showed no substantive differences between these subgroups. Results also showed, in the first years after loss, repeated suicide attempts and prior negative relationships with the decedent were associated with greater grief difficulties. However, as more time passed, all death circumstance differences were overshadowed by the importance of the time span since loss. This data also suggested that between 3 and 5 years usually marks the turning point, when acute grief difficulties accompanying a suicide loss begin to subside.

Humor, Laughter, and Happiness in the Daily Lives of Recently Bereaved Spouses

The positive psychology movement has created more interest in examining the potential value of experiencing positive emotions (e.g., humor, laughter, and happiness) during the course of bereavement. This study of 292 recently widowed (5-24 weeks) men (39%) and women (61%) age 50 and over examined both the perceived importance of and actual experience of having positive emotions in their daily lives and how they might impact bereavement adjustments. We found that most of the bereaved spouses rated humor and happiness as being very important in their daily lives and that they were also experiencing these emotions at higher levels than expected. Experiencing humor, laughter, and happiness was strongly associated with favorable bereavement adjustments (lower grief and depression) regardless of the extent to which the bereaved person valued having these positive emotions.

Bereavement-related Depression

<p>This issue of <cite>Psychiatric Annals</cite> examines bereavement-related depression. Articles discuss the signs, symptoms and course of bereavement, the relationship between bereavement and depression, complicated grief, and sleep disturbance in bereavement.</P>

Bereavement: Signs, Symptoms, and Course

<p>In his paper “Mourning and Melancholia,” Freud described five features of melancholia, “ … a profoundly painful dejection, cessation of interest in the outside world, loss of the capacity to love, inhibition of all activity, and a lowering of the self-regarding feelings to a degree that finds utterance in self-reproaches and self-revilings, and culminates in a delusional expectation of punishment. He felt that mourning includes these same symptoms, except for the last. Freud believed that mourning is not a pathological condition and that it subsides with time; interfering with it was useless and potentially harmful. Indeed, the loss of a loved one is a universal experience that may be one of the most significant and traumatic life events that people face. Nevertheless, most people cope with loss with minimal morbidity. For a minority, the death of a loved one may lead to increased use of substances (alcohol, benzodiazepines, and other hypnotics), the development of a psychiatric illness like chronic depression, or even greater mortality. </p> <h4>ABOUT THE AUTHORS</h4> <p>Paula L. Hensley, MD, is with the Department of Psychiatry, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM. Paula J. Clayton, MD, is with the American Foundation for Suicide Prevention, New York, NY.</p> <p>Address correspondence to: Paula L. Hensley, MD, 2118 Central Ave. SE Suite 37, Albuquerque, NM 87106; or e-mail: <a href="mailto:phensley@salud.unm.edu">phensley@salud.unm.edu</a>.</p> <p>Dr. Hensley and Dr. Clayton have disclosed no relevant financial relationships.</p> <h4>EDUCATIONAL OBJECTIVES</h4> <ol><li>Describe the symptoms of bereavement in adults and children.</li> <li>Recognize the signs that an individual is experiencing difficulty with the course of bereavement.</li> <li>Discuss the morbidity and mortality of bereavement in adults. </li> </ol>

Using Students' Journals about Death Experiences as a Pedagological Tool

ABSTRACT The purpose of this article is to evaluate a pedagological tool for student's study of death and bereavement. Previous research suggests that students may be more willing to discuss issues associated with death through written correspondence rather than through oral communication. However, despite these efforts there are still students who experience great difficulty in expressing themselves fully in class—by no fault of the teacher—but merely due to the student's own disposition. Based on the data, it appears as if journal writing may offer a way around this difficulty. Data were collected from two sites: a private college in New England and a Midwestern state university. Common themes that students stated effected their experiences with death included reactions of significant others to the death in question, the funeral services provided, and the familial events postfuneral. The limitations and benefits of using journaling as a pedagological tool for a bereavement course are discussed. Using projects such as this one may help students to accurately display their learning to the professor while still bringing in their own perceptions of death.