Levels Of Grief Research Articles

Acute mania following COVID-19 in a woman with no past psychiatric history case report

BackgroundThe COVID-19 pandemic that began in late 2019 is caused by infection with the severe acute respiratory syndrome coronavirus-2. Since that time, many neuropsychiatric sequelae including psychosis, neurocognitive disorders, and mood disorders have been observed. The mechanism underlying these effects are currently unknown, however several mechanisms have been proposed.Case presentationA 47-year-old woman with past medical history including hypertension and premenstrual syndrome but no psychiatric history presented to the psychiatric hospital with new onset mania. She had developed symptoms of COVID-19 and was later diagnosed with COVID pneumonia. During quarantine, she reported high levels of stress, grief, and anxiety. Seventeen days into her illness, she developed altered mental status, sleeplessness, elevated mood, talkativeness, and preoccupations. Her spouse was concerned for her safety and contacted emergency medical services who brought her to the psychiatric hospital. She had not slept for five days prior to her arrival and exhibited flight of ideas, talkativeness, and grandiose ideas. She reported a family history of bipolar disorder but no past manic or depressive episodes. She was diagnosed with acute mania and stabilized using antipsychotics, a mood stabilizer, and a short course of a benzodiazepine. Many of her symptoms improved, including her elevated mood, increased activity level, and flight of ideas though she continued to have decreased need for sleep as her benzodiazepine was tapered. She and her partner were agreeable to transitioning to outpatient care after her mood stabilized.ConclusionsThis report emphasizes the link between COVID-19 and neuropsychiatric symptoms. Acute mania has no recognized association with COVID-19, but similar presentations have been reported. The patient’s age and time to onset of psychiatric symptoms is consistent with previous reports. Given the growing body of evidence, this association warrants further investigation. Severe acute respiratory syndrome coronavirus-2 causes systemic inflammation and has been shown to be neurotropic. In addition, patients undergoing quarantine experience anxiety related to the disease in addition to social isolation. Psychiatric practitioners should be aware of these effects and advocate for psychiatric evaluation following COVID-19 infection. Understanding the sequelae of infectious disease is crucial for responding to future pandemics.

An Analysis of Factors Predicting Post-Traumatic Stress Disorder and Grief Following Comrade Loss.

This study explored how "inhibiting factors" associated with military-bereavement impact combatants' psychological sequelae following comrade loss. One hundred six eligible Israeli combat male-soldiers completed the Texas-Revised-Inventory of Grief, the post-traumatic-stress-disorder symptoms scale (PSS), the Male Role Norms Scale, the Social Acknowledgment Questionnaire, and a scale assessing Military Encouragement to Grieve (MEG-8). Time since loss had no impact on soldiers' levels of PSS or prolonged grief. Regression analysis indicated that higher masculinity-perception and disapproval from the family predicated higher PSS, above and beyond grief. Conversely, lower disapproval from the family, and higher disapproval from the general community, predicted higher grief, above and beyond PSS. Also, military encouragement significantly mediated the positive relationship between masculinity and sense of social-recognition. The results show how inhibiting factors contribute differently to the perpetuation of PSS and grief. This interplay sheds light on soldiers' "external" and "internal" loss processes of traumatic bereavement. The practical implications to treatment are also discussed.

Grief and functional impairment following COVID-19 loss in a treatment-seeking sample: the mediating role of meaning

ABSTRACT The COVID-19 pandemic has brought unprecedented levels of grief and psychological distress in community samples. We examined unique pandemic grief risk factors, dysfunctional grief, Post-traumatic Stress Disorder (PTSD) symptoms, general psychiatric distress, disrupted meaning, and functional impairment in a treatment-seeking sample of people bereaved from COVID-19 in the United Kingdom. A sample of 183 participants (91.80% female; M = 47.40 years) completed an online survey as part of an intake assessment for a grief support and referral service. Most reported clinically elevated PTSD symptoms (83.1%), psychiatric distress (64.0%), and functional impairment (56.8%). A smaller, but still concerning percentage (39.3%) reported clinically significant symptoms of dysfunctional grief. Disrupted meaning substantially mediated the relationship between risk factors and all four outcomes. Counsellors should address the breadth of psychological distress in those bereaved by COVID-19 and hone their skills in promoting meaning making in the wake of the trauma and loss generated by the pandemic.

The Association of Grief with Mental Health and the Role of Loneliness During the COVID-19 Pandemic

Previous research found that bereavement is associated with several pathological responses affecting both physical and mental health. During the COVID-19 pandemic and the socially disruptive measures implemented, losses of close contacts have occurred under exceptional circumstances, and it is reasonable to expect that many bereaved people would be unable to overcome their loss adaptively, resulting in dysfunctional grief leading to mental health alterations. Loneliness, which has increased during the pandemic, has been identified as a significant risk factor for mental health that is common when people grieve. In this study, we aimed to gauge the effects of bereavement on mental health in the context of the COVID-19 pandemic and to explore the mediating role of loneliness on the relationship between grief and mental health alterations by surveying a representative sample of 2000 Spanish adults interviewed by phone during the pandemic (February-March 2021). Logistic regressions were performed to examine the effects of grief levels on depression, anxiety, panic attacks, post-traumatic stress disorder, substance abuse, and suicidal thoughts and behaviors. Our results confirmed that how the loss of a loved one is processed is associated with the development of mental health conditions. Dysfunctional grief was significantly associated with all mental health conditions, particularly depression (OR = 14.28) and anxiety (OR = 11.61). As predicted, loneliness accounted for a substantial percentage (8-30%) of the impact of grief on mental health outcomes.

The mediating role of state shame, guilt, and pride in the relationship between self-compassion and prolonged grief

IntroductionMost people experience grief-related symptoms after losing a loved one. Approximately 9.8% of bereaved individuals’ symptoms persist over the first year post-loss, emphasizing the importance of research in prolonged grief. The role of self-conscious emotions in prolonged grief, such as self-compassion, state shame, guilt and pride has been proposed in previous studies.ObjectivesOur aim was to examine the mediating role of state shame, guilt and pride in the relationship between self-compassion and prolonged grief.MethodsThis cross-sectional study collected data via online questionnaires based on self-reports (N=177, mean age: 42.26 years [SD=12.32], 97.2% women). Demographic and loss-related variables were measured, and further instruments assessed levels of self-compassion, state shame, guilt, and pride, and prolonged grief. Correlation and mediation analyses were used.ResultsTwo significant indirect effects were shown in the mediation model. First, lower levels of self-compassion predicted higher levels of state shame, which in turn predicted elevated levels of prolonged grief. Second, higher levels of self-compassion predicted higher levels of pride, which subsequently contributed to lower levels of prolonged grief. Guilt did not have a significant mediating role.ConclusionsThe results highlight the possible role of elevated levels of state shame and lower levels of self-compassion and state pride in the development of prolonged grief. It is important for researchers and clinicians to be attentive to the role of self-compassion, state shame and pride in grieving.DisclosureNo significant relationships.

Grief Symptoms Promote Inflammation During Acute Stress Among Bereaved Spouses

The death of a spouse is associated with maladaptive immune alterations; grief severity may exacerbate this link. We investigated whether high grief symptoms were associated with an amplified inflammatory response to subsequent stress among 111 recently bereaved older adults. Participants completed a standardized psychological stressor and underwent a blood draw before, 45 min after, and 2 hr after the stressor. Those experiencing high grief symptoms (i.e., scoring > 25 on the Inventory of Complicated Grief) experienced a 45% increase in interleukin-6 (IL-6; a proinflammatory cytokine) per hour, whereas those experiencing low grief symptoms demonstrated a 26% increase. In other words, high grief was related to a 19% increase in IL-6 per hour relative to low grief. The grief levels of recently bereaved people were associated with the rate of change in IL-6 following a subsequent stressor, above and beyond depressive symptoms. This is the first study to demonstrate that high grief symptoms promote inflammation following acute stress.

Grieving During the COVID-19 Pandemic: In-Person and Virtual "Goodbye".

This study examined the relationship between having an opportunity to say goodbye to a dying family member or friend in personal or virtually, as well as attending their funeral services in person or virtually, and the bereaved individuals’ psychological distress and complicated grief during the COVID-19 pandemic. Five hundred and nineteen US adults who had lost a family member or a friend between January 2020 and June 2021 completed an online survey for this study. Only a small proportion of participants were able to say goodbye to their dying family member or friend in person, and saying goodbye virtually was associated with higher levels of complicated grief and psychological distress. Those who physically attended a formal, in-person funeral or memorial service reported lower levels of psychological distress. The findings suggest a complicated process of saying goodbye in different formats during the pandemic.

Minding environment, minding workers: environmental workers' mental health and wellbeing.

Climate change and environmental degradation caused by human activities are having an irrefutable impact on human health, particularly mental health. People working in the environment sector are confronted with these impacts daily. This exploratory study was conducted as a response to concern in the sector about rising levels of worry and distress, and a need for organizational knowledge about effective workplace mental health strategies. Using evidenced-based frameworks for workplace mental health and wellbeing, the study focused on the relationship between climate change, environmental degradation and mental health issues for this sector. This Australian-based exploratory qualitative study was guided by participatory research approaches. Maximum variation and criterion sampling strategies were applied to engage environmental sector senior managers (n = 8) in individual/paired interviews, followed by online focus group sessions with frontline employees (n = 9). Qualitative thematic analysis techniques were used in an iterative process, combining inductive and deductive strategies. Data was triangulated and interpretation was finalized with reference to literature and a workplace mental health promotion framework. Interview data provided new perspectives on the interconnectivity between risk and protective factors for mental health. Workers were motivated by commitment and values to continue their work despite experiencing increasing levels of trauma, ecological grief, and stress due to overwork and ecological and climate change crises. The findings highlight the need for integrated health promotion approaches that acknowledge the complex interactions between risk and supportive factors that influence mental health in this sector.

Are Sensory Experiences of One's Deceased Spouse Associated with Bereavement-Related Distress?

Following late-life spousal bereavement, sensory and quasi-sensory experiences of the deceased (SED) are commonly reported. This longitudinal study examined SED among 310 older widowed adults 6-10 (T1) and 18-20 (T2) months post loss. Reports of SED in the first 6-10months after loss were associated with higher symptom levels of prolonged grief, post-traumatic stress, and loneliness at T1. Experiencers of SED were more likely to experience symptoms of prolonged grief and post-traumatic stress above cut-off scores at T1. Importantly, only a minority of the experiencers of SED displayed these elevated levels of bereavement-related distress. In addition, employing multi-level-modeling, a similar trajectory of decreasing bereavement-related distress over time was found for both experiencers and non-experiencers of SED. We argue that SED may be one of several potential reactions to bereavement, which should not be seen as an indicator of grief complications per se.

Bereavement in Pakistan during the COVID-19 pandemic: Psychometric analysis of the Pandemic Grief Scale-Urdu Version (PGS-UV)

With nearly 4 million deaths worldwide, COVID-19 has resulted in a great loss of life. For many of the bereaved, the grieving process has been especially difficult due to COVID-19 spatial distancing procedures and the traumatic circumstances of this particular form of loss. Consequently, a large number of the world’s bereaved are experiencing dysfunctional levels of grief. To assess such grief, the Pandemic Grief Scale (PGS) was created to identify those affected who may benefit from professional support. This study aimed to psychometrically analyze the properties of the Urdu version of the scale, among a sample of 272 Pakistanis who lost a loved one to COVID-19 from March to June 2021. Results revealed that the scale was found to be a reliable and valid tool for assessing dysfunctional pandemic grief for both men and women. However, unique gender differences were found. Additional research should further confirm the psychometric properties of the PGS on other culturally diverse samples.

The Effects of Mindfulness-Based Stress Reduction on Trauma in Victims of Gun Violence: a Pilot Study

ObjectivesGun violence is a significant problem in the United States of America. Gun violence produces lifelong psychological adversity, trauma, and grief. In the face of this epidemic, efficacious therapies that assuage gun violence-based trauma and negative health are lacking.MethodsThe proposed, longitudinal pilot experiment examined the effects of an 8-week mindfulness-based stress reduction (MBSR) program on traumatized individuals as a direct consequence of gun violence. Twenty-four victims of gun violence (median age = 53 years; 21 female) completed measures of the primary outcome: trauma. Secondary outcomes were characterized as grief, depression, sleep quality, life satisfaction, and mindfulness. All assessments were administered before, after 5, and 8 weeks of MBSR training. It was hypothesized that trauma and other comorbidities would improve following MBSR. It was also predicted that outcomes would be significantly stronger from baseline to 5 weeks of MBSR training than from 5 to 8 weeks of training.ResultsBefore MBSR, volunteers exhibited high levels of trauma, depression, sleep difficulty, and grief. Participation in MBSR was associated with improved trauma, depression, sleep difficulty, and life satisfaction. The most pronounced improvements in psychological disposition were exhibited within the first 5 weeks of MBSR. However, these benefits were largely preserved after completion of the course. Importantly, increases in dispositional mindfulness predicted lower trauma, complicated grief, and sleep difficulties.ConclusionsThe present findings should be interpreted with caution because they were derived from an uncontrolled, non-randomized trial. However, said findings suggest that MBSR may reduce trauma and improve overall well-being in gun violence victims.

The relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer: a cross-sectional study

BackgroundAnticipatory grief has been shown to be highly prevalent among family caregivers of patients with advanced illness. Qualitative study suggests that illness uncertainty may be one of the core characteristics of anticipatory grief, but it has not been confirmed in quantitative studies. Therefore, the purpose of this study was to explore the relationship between anticipatory grief and illness uncertainty among Chinese family caregivers of patients with advanced lung cancer and to determine the factors influencing anticipatory grief.MethodsThis descriptive cross-sectional study used a convenience sampling method and recruited 254 inpatient family caregivers from the thoracic medicine ward of Liaoning Cancer Hospital & Institute in Shenyang, mainland China. Anticipatory grief (Anticipatory Grief Scale (AGS), illness uncertainty (Uncertainty in Illness Scale Family Caregiver Version) and sociodemographic information (Self-compiled general information questionnaire) were measured using validated self-report measures.ResultsChinese family caregivers of patients with advanced lung cancer had high levels of anticipatory grief (73.5 ± 16.1). The results of the correlation analysis showed a positive association between anticipatory grief and illness uncertainty (r = 0.580, P < 0.001). The final linear regression model with anticipatory grief as the dependent variable included four variables: illness uncertainty (β = 0.674, P < 0.001), lack of informativeness (β = − 0.168, P = 0.08), monthly income (β = 0.139, P = 0.006), and caregiving burden (β = − 0.196, P < 0.001).ConclusionsIllness uncertainty is probably an important factor affecting anticipatory grief. Excessive caregiving burden is associated with high levels of anticipatory grief. Improving illness uncertainty and caregiving burden may effectively reduce anticipatory grief among Chinese family caregivers.

Predictors of prolonged grief in an internet-based grief therapy for people bereaved by suicide

Internet-based cognitive-behavioural grief therapy (ICBGT) has proven to be effective for people bereaved by suicide, however the extent to which patients can benefit from therapy seems to differ. This study investigates predictors of initial grief as well as change in grief severity following treatment in an ICBGT for people bereaved by suicide. Data was gathered from a randomized control trial including 57 people participating in a 5-week intervention. Change in grief symptoms was calculated using absolute change scores of grief. In order to examine best overall combination of independent variables, best subset regressions were conducted. Higher levels of pre-test grief were associated with worse sleep quality (β = 0.32, p = .002), lower self-esteem (β = −0.37, p = .002), lower support seeking (β = −0.38, p = .006), and a higher need for social support (β = 0.28, p = .028). A greater reduction in grief severity was associated with higher self-efficacy (β = −0.49, p = .001), higher attachment anxiety (β = −0.31, p = .017) and higher pre-test grief symptoms (β = −0.39, p = .006). Attention should be paid to the intensity of grief, the attachment style and a positive self-image, as these variables seem to influence the extent, to which patients’ symptoms of PGD subside following ICBGT. To specifically target factors of patients that require improvement, further studies are needed.

Caught in a Loop with Advance Care Planning and Advance Directives: How to Move Forward?

Completion of an advance care planning (ACP) process and/or an advance directive should result in patients receiving the care they desire at the end of life. However, three decades of research have shown that is just not the case. ACP has been a front runner in developing the science within palliative care. Some positive outcomes such as lowering levels of surrogate grief may be associated with ACP. Yet, it does not appear that further ACP research will ensure that seriously ill patients will get goal-concordant care. An unfortunate consequence of palliative care research and advocacy so far is the misguided notion of many hospital systems trying to solve their palliative care problems by only implementing an ACP initiative. At best, ACP is but one tool in the collective palliative care toolbox. New tools are needed. Given that we have finite resources, future research should focus more on tools to improve symptom management, better models of care, and systems that will ensure goal-concordant care that meet the needs of the population that the health care system is designed to meet.

Grief and ruminative thought after perinatal loss among Turkish women: one-year cohort study.

Among women who have suffered loss of pregnancy, the level of grief decreases gradually. Age, mental health status and childlessness are the factors known to mostly affect women's levels of grief. To assess the levels of grief among women who experienced perinatal loss and the changes in their ruminative thought styles over the first year after their loss. One-year follow-up study carried out in a university hospital in Turkey. The study population included 70 women who experienced loss of pregnancy in the hospital. The sample size was calculated using G*Power V3.1. Data were collected at 48 hours, at the third month, at the sixth month and at one year after pregnancy loss, between June 2018 and June 2019. A personal information form, the Perinatal Grief Scale and the Ruminative Thought Style Questionnaire were used for data collection. The women's highest levels of grief and ruminative thought style were in the first 48 hours. Their tendency towards grief and ruminative thought styles decreased over the repeated measurements during the follow-up. Women aged 20-29 years had the highest levels of grief at the third month after perinatal loss. Nursing assessments regarding grief and ruminative thought style over the first 48 hours after perinatal loss should be integrated into nursing care for these women. Grief follow-up programs for these women can be developed through nursing research.

Healing the Collective Grief: A Story of a Marshallese Pastor from Okinawa

World War II and the Cold War never ended in the Marshall Islands. A seamless continuum of colonialism, wars and nuclear testing destroyed their ancestral islands, traditions, as well as the physical and spiritual wellbeing of the people; it caused them profound personal and collective grief. This article considers the grieving of the Marshallese people, through the lens of a life story of a migrant to the Marshall Islands from Okinawa, Chutaro Gushi (1911–1977). The examination uses the concepts provided by grief studies, such as personal grief and collective grief, and applies the theoretical and conceptual framework presented by the social constructionists, such as meaning making, social validation, and moral injury, to frame the understanding of their grieving, coping and healing processes. The life story of pastor Chutaro revealed an intricate reflexive interface between his personal grief and collective grief in the Marshall Islands. His personal grieving and healing process was also closely linked with the healing of the collective grief that was also an element of his personal grief. In this process, Christian churches played crucial roles to bridge the two levels of grief. They facilitated the transformation of Chutaro’s profound personal grief and moral injury into a powerful public mission to give voices to the victims of the nuclear tests in the Marshall Islands.

Grief as a mediator of the relationship between empathy and compassion fatigue.

Oncology nurses are at high risk of developing compassion fatigue (CF) because of the persistent exposure to patients' suffering and death. Empathy is a prerequisite cognitive reaction for CF. Nurses with greater empathy levels are more prone to develop an emotional connection with patients. However, it is this kind of close bonds that led nurses to experience a deep sense of grief. Cumulative grief may eventually develop into CF. This study examined the levels of grief, empathy and CF, evaluated the correlation among empathy, grief and CF, and verified the role grief as a mediator of the relationship between empathy and CF. Participants were 794 Chinese oncology nurses in a cross-sectional study. We measures consisted a demographic questionnaire, the Interpersonal Reactivity Index, the Texas Revised Inventory of Grief-Present, and the Professional Quality of Life Scale. Oncology nurses showed moderate levels of empathy and grief, moderate to high levels of CF. Perspective taking was negatively related to grief and secondary traumatic stress (STS). Empathic concern was negatively related to burnout (BO). Personal distress was positively related to grief, STS and BO. Grief was positively related to STS and BO. Grief played a partial mediating role between empathy and STS. Oncology nurses commonly experience CF. There is a need to provide interventions and effective supports for oncology nurses to improve their empathy ability, and help them cope with grief and CF.

Grief as a predictor of long-term risk for suicidal ideation and attempts of parentally bereaved children and adolescents.

Although children who experience the death of a parent have a heightened risk of suicidality, the long-term associations between grief and suicidality among bereaved youth have yet to be examined. Research is needed to test the specific aspects of grief associated with suicidality, after controlling for other risk factors, in this population. Grief and covariates, including age, gender, parental cause of death, time since parental death, depression, anxiety, internalizing problems, posttraumatic stress symptoms, and child treatment involvement, were assessed at baseline, 6-year, and 15-year follow-ups in a sample of 244 parentally bereaved youth aged 8-16 years. Utilizing multiple grief measures, a bifactor approach was used to identify a general factor and two uncorrelated specific factors: Intrusive Grief Thoughts and Social Detachment/Insecurity. Suicidal thoughts and attempts were assessed at both follow-ups. The Intrusive Grief Thoughts specific factor had a prospective nonlinear association with suicidality at both follow-ups after controlling for all baseline covariates. The nonlinear relation consisted of a large effect, OR > 73 (using the rescaled scores), on the increased risk of suicidality from low to moderate levels of intrusive grief, with no association from moderate to high levels. At 6-year follow-up, the specific Social Detachment/Insecurity factor was significantly associated with suicidality after controlling for covariates. Specific grief factors assessed at different points were associated with suicidal thoughts or attempts among parentally bereaved youth. These findings highlight the significance of specific aspects of child and adolescent grief that have implications for the development of upstream suicide prevention services.

The Loss of a Service Dog Through Death or Retirement: Experiences and Impact on Partners

This study was designed to better understand how service dog partners experience the loss of their service dog. An anonymous survey was distributed to service dog partners who had lost a dog within the last five years. One-way ANOVAs were used to assess loss differences (retirement vs. death) on scores for Centrality of Events Scale, Warwick-Edinburgh Mental Well-Being Scale, Social Constraints Measure, and Self-Compassion Scale. Linear regression was conducted on the total bereavement score to determine the impact of the above assessment measures. We found higher grief scores for those whose service dog died compared to those whose dog retired. Perceptions of social constraints and feelings related to the centrality of the event were predictors of overall grief for those who lost a dog due to retirement; centrality of event feelings predicted grief level for those experiencing a death. Findings suggest a need for grief support for service dog partners.

Examining bereavement-related needs and outcomes among survivors of sudden loss: A latent profile analysis.

Recognizing important bereavement-related needs among sudden loss survivors (e.g., suicide, overdose)-a population that is burgeoning and at risk for deleterious outcomes-is a critical task as needs may reflect modifiable grief-related variables that can assist with post-loss adjustment. Latent profile analysis was used among 347 sudden loss survivors to (a) identify distinct patterns of needs among survivors of sudden loss, (b) assess predictors of such profiles, and (c) investigate differences in profiles in terms of bereavement outcomes. Four classes of bereavement-related needs were identified: a low needsclass, a moderate needs-spiritualclass, a moderate needs-relationalclass, and a high needs(HN) class. Clear differences emerged between need classes with the HN class evidencing the greatest level of grief and mental health sequelae. Tending to bereavement-related needs is critical, as they indicate the degree of distress and reflect modifiable therapeutic variables.