Course Of Grief Research Articles

Longitudinal Effects of Coping on Outcome in a Randomized Controlled Trial of a Group Intervention for HIV-Positive Adults with AIDS-Related Bereavement

This study examined the longitudinal effects of coping on outcome one year following completion of a randomized, controlled trial of a group coping intervention for AIDS-related bereavement. Bereaved HIV-positive participants (N = 267) were administered measures of grief, psychiatric distress, quality of life, and coping at baseline, post-intervention, and at 4-, 8-, and 12-month follow-ups. Coping strategies directly impacted all outcome variables for both study conditions. Additionally, the coping intervention moderated the relationship between avoidant coping and the longitudinal course of grief and psychiatric distress, resulting in greater reductions in grief and distress for intervention participants after accounting for avoidant coping strategies.

The time course of grief reactions to spousal loss: Evidence from a national probability sample.

Most studies of widowhood have focused on reactions during the first few years postloss. The authors investigated whether widowhood had more enduring effects using a nationally representative U.S. sample. Participants were 768 individuals who had lost their spouse (from a few months to 64 years) prior to data collection. Results indicated that the widowed continued to talk, think, and feel emotions about their lost spouse decades later. Twenty years postloss, the widowed thought about their spouse once every week or 2 and had a conversation about their spouse once a month on average. About 12.6 years postloss, the widowed reported feeling upset between sometimes and rarely when they thought about their spouse. These findings add to an understanding of the time course of grief.

The Treasures of Grief

The author, a poet, novelist, and translator, is married to Janet Abrahm, MD, a faculty scholar of the Project on Death in America, Open Society Institute. Mr. Slavitt, whose mother was murdered in 1982, addressed a gathering of the Project’s faculty scholars, and offered these palliative care specialists an artist’s view of the experiences of loss and grief. The following is adapted from his remarks.

Verbal-autonomic dissociation and adaptation to midlife conjugal loss : A follow-up at 25 months

Individuals who fail to “workthrough” the emotional significance of a loss havetraditionally been assumed to suffer increased grief.Bonanno et al. (1995) tested this assumption byoperationally defining emotional avoidance as a verbal-autonomicresponse dissociation, or the reduced experience ofnegative emotion coupled with relatively high levels ofautonomic responsivity. In contrast to the traditional assumption, individuals who at 6 months hadshown verbal-autonomic dissociation had the mildestgrief course through 14 months. Verbal-autonomicdissociation was linked to initially high levels ofsomatic symptoms, but to low somatic symptoms at 14months. In the current investigation, we collectedfollow-up data on the same participants through 25months post loss and assessed additional health-related variables. Verbal-autonomic dissociation wasagain linked to the mildest grief course with noevidence of delayed grief. This predictive relationshipremained significant even when initial levels of grief were controlled. Further, no evidence was foundfor enduring or delayed health difficulties inassociation with verbal-autonomic dissociation.Implications for future bereavement research arediscussed.

Preparing Social Workers for the Inevitable

Despite the centrality of grief as a universal response to loss, and its prevalence in the social work domain, little empirical attention has been given to the impact of grief instruction in social work courses. This article presents results of a study examining the impact of a multimethod grief course on graduate social work students' level of death acceptance and sense of preparedness to respond to personal and professional losses. A quasi-experimental, nonequivalent control group design was used. Findings suggest that the grief course assisted students to perceive greater competence in their knowledge, skills, and sense of preparation for working with grieving clients, and that the course increased cognitive and affective dimensions of death acceptance in students. Implications for future research and for social work education are discussed in light of the study limitations.

Prediction and course of grief four years after perinatal loss due to congenital anomalies: a follow-up study.

The emotional reactions of women (N = 29) after perinatal loss were evaluated over a four-year period by means of standardized questionnaires and a semi-structured interview. Eleven women (38 per cent) displayed a level of general psychological distress which is clinically significant. Grief reactions declined significantly during this period, except for difficulties with coping and despair concerning the loss, and a quarter of the women still showed a clinically significant high level of distress for intrusive images. The disposition for feelings of inadequacy (i.e. feeling anxious, insufficient, depressed and having low self-esteem) was strongly and positively related to the intensity of stress, grief and general psychological distress after four years. Our findings emphasize the importance of psychosocial screening of those women identified as showing signs of inadequacy in the face of (threatened) pregnancy loss with the objective to offer them additional psychological support.

Cognitive behavioral grief therapy

From a REBT perspective, loss through death is viewed as an intense negative and traumatic Activating event which effects the Belief system and related emotional and behavioral Consequences. Grief, then, is seen as a normal reaction and the process that follows is a necessary one characterized by the bereaved attempting to reorganize a shattered belief system. In the present paper a distinction between functional and dysfunctional grief is made. Based on Ellis' differentiation between iB's and RB's, typical irrational grief-related beliefs are identified (with specific focus on pain related ones). Various REBT interventions aimed at facilitating a more functional, healthier course of grief are suggested.

Pregnancy following miscarriage: course of grief and some determining factors.

This prospective study aimed to investigate the impact of both (the speediness of) a subsequent pregnancy and the birth of a viable child on grief arising from a previous pregnancy loss. Data were collected from a series of written questionnaires. Of the 2140 pregnant women who participated in the study, 227 lost a baby by miscarriage (85%) or perinatal death (15%). In 221 women, the loss concerned a singleton. At each of four post-loss assessments, these women completed the Perinatal Grief Scale. They also indicated whether they had conceived again and, if they had, related how they felt about that. Data were analyzed by means of hierarchical multiple regression. Both conceiving again and the birth of a living child lessened grief. A speedy new pregnancy was only rarely found to be detrimental. It is suggested that parents, at least following miscarriage, no longer be advised to wait a specific time before conceiving again. Preferably their individual situation should be discussed with them in order to help them make their own informed decision concerning the subsequent pregnancy.

Depression in recently bereaved prepubertal children

The purpose of this study was to ascertain depressive symptoms in recently bereaved prepubertal children and compare these symptoms with those of depressed prepubertal children. The subjects were 38 children who had recently experienced the death of one but not both of their parents. They had to meet strict inclusion criteria so that the effects of bereavement per se, rather than other significant stressors, could be assessed. The comparison group consisted of 38 hospitalized, depressed children individually matched to each bereaved subject for age, sex, and socioeconomic status. All of the children underwent systematic and comprehensive evaluation. They and their parents were independently evaluated by trained interviewers using the parent and child versions of the Diagnostic Interview for Children and Adolescents. Family histories and basic demographic information were also obtained. The recently bereaved children endorsed many depressive symptoms. Thirty-seven percent of them met the DSM-III-R criteria for a major depressive episode. The depressed children, however, had more depressive symptoms on average than the bereaved children. The factors associated with increased depressive symptoms in the bereaved children were 1) the mother as the surviving parent, 2) preexisting untreated psychiatric disorder in the child, 3) family history of depression, and 4) high socioeconomic status. A considerable number of the bereaved children developed the clinical symptoms of a major depressive episode immediately after the death of a parent. The relation of these symptoms to the subsequent course of grief and to major depressive disorder remains unknown and should be studied further.

Time course of spousal bereavement

This article reports the results of a survey on 300 widows and widowers who experienced spousal bereavement weeks to years prior to the study, and discusses the symptoms, syndromes, and behaviors seen at various time intervals. Although the reactions to widowhood were highly variable and individual, it was clear that for many widows and widowers, the time course of grief was much more prolonged than generally expected. Dysphoric feelings, symptoms, and behaviors were most frequent during the first year of bereavement, but often remained prevent even four or more years after the death. In particular, anger, guilt, depresssion, and anxiety tended to diminish over time, but not to statistically significant degrees. Many widows and widowers never fully accepted the fact of their spouses' deaths and maintained a continuing relationship with their deceased spouses, in their own ways, indefinitely. The implications of these findings and directions for future research are discussed.