Course Of Bereavement Research Articles

Sadness and Loss: Toward a Neurobiopsychosocial Model

Sadness and Loss: Toward a Neurobiopsychosocial Model

INVITED ESSAY: Death-Specific Religious Beliefs and Bereavement: Belief in an Afterlife and Continued Attachment

This article integrates findings from a wide variety of research to describe the roles of death-specific religious beliefs in the course of stress and coping in bereavement. First, a meaning-making approach to the stress-coping process is presented and used to illustrate how death-specific beliefs provide meaning to the appraisal of a death and influence the process of coping with that death. Then, the constructs of belief in an afterlife and continued attachment are introduced as death-specific beliefs influential in the process of coping with bereavement. Finally, the meaning-making stress-coping framework is used to review and integrate available literature on these beliefs, their correlates, and their possible functions in the course of bereavement. We suggest that death-specific religious beliefs are vital determinants of adjustment to bereavement, and that these beliefs should be regarded as a legitimate focus of investigation. We conclude with suggestions for future research.

Evaluating the use of benzodiazepines following recent bereavement

There is no evidence to support current advice not to use benzodiazepines after bereavement. To determine the role of benzodiazepines in the management of bereavement. We conducted a randomised, double-blind, placebo-controlled evaluation of the use of diazepam after recent bereavement. Participants were randomised to either 2 mg diazepam or identically packaged placebo up to three times daily. The primary outcome measure was the Bereavement Phenomenology Questionnaire. Thirty subjects were randomised. No evidence was found of an effect of benzodiazepines on the course of the first 6 months of bereavement (estimated mean difference of combined follow-up assessments=0.3 in favour of placebo; 95% Cl - 6.2 to +6.7). We found no evidence of a positive or negative effect of benzodiazepines on the course of bereavement.

Toward an integrative perspective on bereavement.

For nearly a century, bereavement theorists have assumed that recovery from loss requires a period of grief work in which the ultimate goal is the severing of the attachment bond to the deceased. Reviews appearing in the 1980s noted a surprising absence of empirical support for this view, thus leaving the bereavement field without a guiding theoretical base. In this article, the authors consider alternative perspectives on bereavement that are based on cognitive stress theory, attachment theory, the social-functional account of emotion, and trauma theory. They then elaborate on the most promising features of each theory in an attempt to develop an integrative framework to guide future research. The authors elucidate 4 fundamental components of the grieving process--context, meaning, representations of the lost relationship, and coping and emotion-regulation processes--and suggest ways in which these components may interact over the course of bereavement.

Post-Homicide Reactions: Grief, Mourning and Post-Traumatic Stress Disorder following a Drunk Driving Fatality

This article examines the impact of gender, religious beliefs, subjective health status, individuals' past experience with death, social support, and time since the death on the extent of mourning, the extent of grieving, and Post-traumatic Stress Disorder (PTSD) symptomatology. It is proposed that the mode of death complicates the nature and course of bereavement after the death of a primary family member in a drunk driving collision. The unnecessary and violent nature of the death of drunk driving victims adds to the depth and extent of the psychological response to trauma. It is proposed that the models of grief utilized to conceptualize the grieving process are inadequate as a sole measure of the response of this type of death. Therefore, the inclusion of Post-traumatic Stress Disorder was provided for a more comprehensive understanding of this type of grief response. Survey data were collected on 171 primary family members of drunk driving victims (spouses, parents, siblings, or children) randomly selected from support groups and social service agencies throughout Texas. Results provide a greater understanding of the factor influencing the responses of the surviving family members after a drunk driving fatality and demonstrate that the grief and PTSD response share common predictors.

Facial expressions of emotion and the course of conjugal bereavement.

The common assumption that emotional expression mediates the course of bereavement is tested. Competing hypotheses about the direction of mediation were formulated from the grief work and social-functional accounts of emotional expression. Facial expressions of emotion in conjugally bereaved adults were coded at 6 months post-loss as they described their relationship with the deceased; grief and perceived health were measured at 6, 14, and 25 months. Facial expressions of negative emotion, in particular anger, predicted increased grief at 14 months and poorer perceived health through 25 months. Facial expressions of positive emotion predicted decreased grief through 25 months and a positive but nonsignificant relation to perceived health. Predictive relations between negative and positive emotional expression persisted when initial levels of self-reported emotion, grief, and health were statistically controlled, demonstrating the mediating role of facial expressions of emotion in adjustment to conjugal loss. Theoretical and clinical implications are discussed.

Tasks and mediators of mourning: A guideline for the mental health practitioner

Clinicians who work with bereaved individuals around grief issues need a way to understand the process of mourning. Generally, the mourning process can be conceptualized as involving either stages, phases, or tasks. In this article the author selects the task model and outlines the tasks of mourning as well as identifying 6 mediators of mourning that influence both the grief experience and duration of the bereavement course. This model is useful for working with both complicated and uncomplicated bereavement. © 1996 John Wiley & Sons, Inc.

Adult Child Loss and the Two-Track Model of Bereavement

The Two-track Model of Bereavement suggests that response to loss can be more effectively assessed when both the behavioral-psychological functioning and the internalized relationship to the deceased are considered [1–4]. Research based on this paradigm examined the experiences of 102 Israeli parents bereaved of sons four and thirteen earlier and a comparison group of seventy-three non-bereaved parents. All parents completed measures of functioning, anxiety, evaluation of self and son, written description of the son, and measures of the current life situation. Results indicated that the bereaved parents manifested difficulties in functioning and in their covert relationship to the deceased son. Differences between and within the bereaved groups by time and sex are considered. Regression documented an association between functioning and relationship to the deceased, and lent support to the assumptions underlying the Two-track Model of Bereavement. This discussion addresses the course of bereavement for adult sons with some implications for bereavement research and intervention.

Bereavement and Heightened Existential Awareness

"Ask not for whom the bells toll; they toll for thee." John Donne's admonition, though written 350 years ago, endures with astonishing freshness; it speaks to something self-evident, to a truth that is well known to many who have experienced bereavement--that the death of a significant other has the potential to hurl the survivor into a confrontation with his/her own death. A confrontation with death--should we seek it? There is evidence in the clinical literature that in terminally ill patients such a confrontation may lead to pronounced positive psychological changes. Research (Yalom 1980) has documented that terminally ill patients may undergo a series of positive personal changes; they communicate more openly with family and close friends, they experience fewer fears, they rearrange their life priorities, they are less preoccupied with the trivialities of life, they live life more immediately rather than postpone experience and pleasure into the future. Does spousal bereavement in our culture confront individuals with their own personal death? Does it cause some widow/widowers to regard their existence in a different manner? If so, might it be possible that those bereaved individuals who examine their life deeply may have a different course of bereavement than those who do not look within? Might it even be possible that bereavement, for some individuals, results in psychological shifts analogous to the positive changes reported by terminally ill patients? These are the basic questions of our research inquiry. We designed a project which would allow us to determine, in a nonclinical sample of bereaved spouses, differences in the degree of existential awareness and the consequences of such awareness on the course of bereavement. We also attempted to determine which subjects were more likely to develop heightened existential awareness. The participants studied were part of an intervention project on bereavement in which we studied a sample of widows and widowers in the first few months of bereavement and then offered them an opportunity to participate in an eight-meeting support group. Reports of the clinical issues emerging in our short-term bereavement groups and of the efficacy of these groups were published elsewhere (Yalom and Vinogradov 1988; Lieberman and Yalom 1991).

Retrospective assessment of marital adjustment and depression during the first 2 years of spousal bereavement.

Two hundred twelve bereaved elders rated marital adjustment using items drawn from the Locke and Wallace (1959) Marital Adjustment Test and completed the Beck Depression Inventory 2 months, 12 months, and 30 months after the loss of their spouses. Their responses were compared with those of 162 nonbereaved individuals of comparable age who were tested at the same times. More positive ratings of marital adjustment were made by bereaved subjects than by nonbereaved subjects. Among nonbereaved elders, more severe ratings of depression were associated with lower ratings of marital adjustment. In the bereaved sample, however, the opposite was found: More severe ratings of depression were associated with higher ratings of marital adjustment. This pattern of results changed only slightly over the 2.5-year course of bereavement and was not influenced by gender. These results are discussed in terms of cognitive processes (e.g., idealization) that influence retrospective assessments of marital adjustment during bereavement.

Retrospective assessment of marital adjustment and depression during the first 2 years of spousal bereavement.

Two hundred twelve bereaved elders rated marital adjustment using items drawn from the Locke and Wallace (1959) Marital Adjustment Test and completed the Beck Depression Inventory 2 months, 12 months, and 30 months after the loss of their spouses. Their responses were compared with those of 162 nonbereaved individuals of comparable age who were tested at the same times. More positive ratings of marital adjustment were made by bereaved subjects than by nonbereaved subjects. Among nonbereaved elders, more severe ratings of depression were associated with lower ratings of marital adjustment. In the bereaved sample, however, the opposite was found: More severe ratings of depression were associated with higher ratings of marital adjustment. This pattern of results changed only slightly over the 2.5-year course of bereavement and was not influenced by gender. These results are discussed in terms of cognitive processes (e.g., idealization) that influence retrospective assessments of marital adjustment during bereavement.

The Role of Social Support in Bereavement

Spousal bereavement involves a social network crisis. The individual's response is influenced by prebereavement personality factors and preexisting social network characteristics. The impact of the loss on the individual and other network members, and the presence or absence of concurrent stressors, will determine the “goodness of fit” between the support offered and the needs of the bereaved and perception of the environment as helpful or unhelpful. An inadequate social network is associated with high distress over the course of bereavement. Intervention aimed at increasing social support can decrease the distress of bereavement.

Bereavement and its complications in medical patients: a guide for consultation-liaison psychiatrists.

Bereaved individuals consult their physicians, including psychiatrists, at an increased frequency for the many symptoms of normal or pathological grief as well as related medical and psychiatric disorders. As many as 25 percent of patients seen by a consultation-liaison service may be suffering from recent unresolved grief. The consultation-liaison psychiatrist needs to be sensitive to the manifestations and course of bereavement in both its uncomplicated and pathological forms. This report provides an overview of these issues as a guide for the accurate assessment and treatment of this often unconsidered condition.

Treating Depressions of Bereavement with Antidepressants: A Pilot Study

Seven of 10 bereaved, depressed spouses had moderate to marked improvement of depressive symptoms during a 4-week open trial of tricyclic antidepressants. Several considerations suggested that this was a response in large part to the pharmacologic intervention and not simply to a therapeutic relationship. The application of antidepressants to treatment of the persistent major depressive syndromes observed late in the course of bereavement should be studied in systematic, controlled studies with larger samples. This is an important clinical issue given the high risk of prolonged depressive syndromes in acutely bereaved spouses.

Urinary free cortisol and separation anxiety early in the course of bereavement and threatened loss

Among 56 persons who were acutely bereaved or threatened with a loss, a group with worsening separation anxiety over a period of a month early after the event had higher urinary free cortisol output than a group experiencing improvement in grief. Although not tested in this study, both these psychological and physiological measures may have potential for serving as early predictors of poor outcome in bereavement for the 15%–20% of exposed persons who are at risk for unresolved grief or persistent depressive syndromes.