The Traumatic Grief Inventory–Self Report Plus (TGI-SR+) is a widely used and reliable tool assessing Prolonged Grief Disorder (PGD) symptoms. This study examined the factorial structure and psychometric properties of the Italian TGI-SR+. A community sample of 308 participants aged 18–65 (M = 37.9, SD = 14.5) with 78.2% women completed the TGI-SR+ and measures of psychological distress, post-traumatic symptoms, and quality of life. Confirmatory factor analysis supported a unidimensional model. Reliability was excellent. In total, 6.2% met criteria for DSM-5-TR and ICD-11 PGD (cutoff ≥71), and 3.9% for DSM-5 Persistent Complex Bereavement Disorder (PCBD; cutoff ≥75). PGD scores differed by gender and cause of death, with higher severity in women and sudden losses. The Italian TGI-SR+ showed good convergent and known-group validity, supporting its use in clinical assessment and research on psychological and social factors involved in the onset and course of PGD.

Abstract BackgroundThe Yaqui Intercultural Medicine Clinic was established in 2020 to provide accessible, culturally-attuned treatment for substance use and mental health disorders among an Indigenous Yaqui community in Mexico. The treatment program integrates ayahuasca ceremonies and psychotherapeutic support within a community-based outpatient treatment service. This observational pilot study was conducted to evaluate the safety, short-term symptom improvement, and cultural implications of the clinic's program.MethodsData from 37 patients who were diagnosed with depression, anxiety, complicated grief, or substance use disorder were included in the analysis. Patients were included in the study if they participated in at least one ayahuasca session with psychotherapeutic support. Data were collected using the Mini International Neuropsychiatric Interview (MINI), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Index for Complicated Grief (ICG), and the Post-Traumatic Stress Checklist for DSM-5 (PCL-5).ResultsPatients demonstrated marked reductions in scores of depression, anxiety, complicated grief, suicidality, and PTSD symptoms following ayahuasca ceremonies. After two ceremonies, mean BDI-II scores dropped from 15.7 to 5.1, mean BAI scores dropped from 16.6 to 6.3, and ICG scores reduced from 39.6 to 10.7. Among eight patients presenting suicide risk, seven cases resolved following a single ayahuasca ceremony. Safety assessment indicated that ayahuasca ceremonies were well-tolerated.ConclusionsPreliminary data suggest that ayahuasca ceremonies integrated within a culturally-attuned community-based mental health program show promise for rapidly reducing mental health symptoms among a small group of Yaqui patients. These findings support further research of community-based ayahuasca-assisted therapeutic programs for mental health treatment within Indigenous communities.

Men’s mourning experiences for the death of a loved one: An integrative review

ABSTRACT Background: Persistent Complex Bereavement Disorder (PCBD) comprises a set of grief symptoms that are often linked to other psychological conditions such as PTSD and depression, may be prevalent in Veterans with combat experience, and may also impact general health. Objective: This study investigated the association between grief and sleep, pain, PTSD, and depression, among Veterans participating in a clinical trial for PCBD treatment. Method: Data from 155 Veterans receiving treatments for PCBD were analysed to explore the association between PCBD and symptoms of sleep pain, PTSD, and depression. Veterans experiencing grief reported symptoms related to physical health, emotional problems, energy, and fatigue, emotional well-being, social functioning, presence of pain, and general health. PCBD appeared to have a specific association with pain and physical functioning, independent of other variables. Conclusions: This study examined the potential independent association of PCBD on physical and mental health in Veterans with PTSD. PCBD appeared to have a very specific and significant association with pain and physical functioning. In other words, the pain of grief was related to ratings of physical pain. Future research on PCBD should address the potentially bidirectional association with bodily pain, particularly chronic pain, in relation to loss, with specific attention to potential mechanisms underlying this relationship.

Grief is a normal response that occurs after the loss of a close one and is a process that takes time to heal. It can be defined as the normal process people go through to readjust their lives after a loss. To understand the psychology of grief, it is important to understand the theoretical and conceptual framework of grief and use effective treatment approaches to move beyond grief. In this chapter, a theoretical framework of grief, along with myths and cultural im- plications about the grieving process, and normal and pathological grief processes diagnosed as persistent complex bereavement disorder are mentioned. Also, it is mentioned about effective grief therapy methods such as grief coun- seling, family therapy approaches, expressive art therapy, cognitive-behavioral therapy, interpersonal psychother- apy, complicated grief therapy, and existential therapy. This literature review study examines the grief process and psychology in different aspects, understanding the theoretical framework of 21st century grief therapy approaches to provide a structure to recognize and realize grief multidimensionally and treat it integratively with using several techniques from various therapeutical schools.

Abstract Within the next 10 years there will be at least 9 million NEWLY Bereaved Dementia Caregivers, disproportionately affecting African American families due, in part, to dementia prevalence that is twice that of White counterparts. Up to 26% of Bereaved Dementia Caregivers experience pathologically prolonged or exacerbated grief, often referred to as complicated grief or prolonged grief disorder: 2.5x the rate of other chronic disease care contexts, like cancer. The present project used an asset-based approach to assess the needs and resources of African American Bereaved Dementia Caregivers. This project was conducted with community members and university members serving as Co-Principal Investigators. Community PIs lead a grassroots organization that has served Bereaved Dementia Caregivers since 2016. The University PI leads a research team devoted to understanding and improving the experience of Bereaved Dementia Caregivers. The present symposium will discuss the challenges and opportunities offered by this unique collaboration and insights gleaned by a project designed to serve doubly underrepresented groups: African American Bereaved Dementia Caregivers (who sometimes call themselves the “ultra-invisible”). Because this was a project funded through grant dollars, we will also discuss actionable insights that we hope may help others develop fruitful academic-community partnerships. Finally, we will share recruitment strategies for speaking with minoritized populations and insights from engaging gleaned through conversations with African American Bereaved Dementia Caregivers.

The Traumatic Grief Inventory Self-Report (TGI-SR) as a Clinical Measure to Identify Brazilians with Prolonged Grief Disorder and Persistent Complex Bereavement Disorder

To determine whether male adolescents incarcerated in a juvenile justice facility would participate in and benefit from a grief-focused, evidence-based group treatment program. Few studies have examined the effectiveness of evidence-based, grief focused treatments for incarcerated adolescents, although these youths are reported to experience higher rates of bereavement than those in the general population. Between 2015 and 2020, 63 male adolescents incarcerated at a secure correctional facility in the midwestern United States received group treatment for symptoms of maladaptive grief using an evidenced-based intervention called Trauma and Grief Component Therapy for Adolescents (TGCTA; Saltzman et al., 2017). Data collection before and after treatment included a brief screening measure, demographic information on each youth, and the Persistent Complex Bereavement Disorder (PCBD) Checklist, scored according to multidimensional grief theory (Layne et al., 2017). Mean PCBD grief domain scores decreased significantly for separation distress and circumstance-related distress from baseline to after TGCTA (Layne et al., 2014) group participation. After group completion, the association between PCBD grief symptoms and functional impairment was unchanged in the family domain, decreased in the school domain, and increased in the peers/friends domain. In the 5- to 15-week period after the group versus the 5- to 15-week period before the group, there was a 50% reduction in the number of behavioral incident reports involving TGCTA group participants, while 63 matched control participants had no change in behavioral incident reports. Study findings demonstrate the feasibility of treating maladaptive grief with youths in the juvenile justice system and provide preliminary evidence that grief-focused treatment may reduce maladaptive grief symptoms and improve behavioral functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

ObjectiveThis randomized-waitlist controlled trial is the first study examining short-term effects of a self-guided online grief-specific cognitive behavioral therapy (CBT) in reducing early persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression symptoms in adults bereaved during the COVID-19 pandemic. MethodSixty-five Dutch adults, bereaved at least three months earlier during the pandemic, with clinically-relevant PCBD, PTSD, and/or depression symptoms, were allocated to a treatment (n = 32) or waitlist condition (n = 33). Telephone interviews were conducted to assess PCBD, PTSD, and depression symptoms (using validated instruments) at baseline, post-treatment, and post-waiting period. Participants received an eight-week self-guided online grief-specific CBT including exposure, cognitive restructuring, and behavioral activation assignments. Analyses of covariance were performed. ResultsIntention-to-treat analyses indicated that people in the intervention condition showed significantly lower PCBD (d = 0.90), PTSD (d = 0.71), and depression (d = 0.57) symptom-levels post-treatment relative to waitlist controls post-waiting, while taking baseline symptom-levels and use of professional psychological co-intervention into account. ConclusionsThe online CBT proved to be an effective intervention, reducing PCBD, PTSD, and depression symptoms. Pending replication of these findings, early online interventions may be widely implemented in practice to improve treatments for distressed bereaved people.

The COVID-19 pandemic resulted in physical and emotional tolls on healthcare workers and caregivers, which have caused prolonged grief disorder and persistent complex bereavement disorder. Highlighting key learnings from healthcare workers' experiences during the pandemic, this article outlines self-care strategies to help nurses better prepare for future healthcare emergencies.

Loss of companion animals can result in various psychological reactions, including complicated grief, depression, anxiety, and insomnia. However, research on the prevalence of patients requiring clinical intervention is limited. Moreover, research examining the relationship between childhood trauma and psychological symptoms after pet loss is lacking. Therefore, this study aimed to investigate the rates of clinically significant psychological distress after pet loss and the impact of childhood trauma on adults who have experienced pet loss. An online survey was conducted with non-clinical adult participants who had experienced the loss of a companion animal. Psychiatric characteristics were evaluated using standardized assessments, including the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the Insomnia Severity Index (ISI). Childhood trauma was evaluated using the Childhood Trauma Questionnaire (CTQ). In a sample of 137 individuals who had experienced pet loss, the percentages of those who exceeded the cutoff points were 55% for the ICG, 52% for the PHQ-9, 40% for the GAD-7, and 32% for the ISI. The group that reported childhood trauma exhibited significantly higher scores on the ICG (t = 2.16, P = 0.032), PHQ-9 (t = 3.05, P = 0.003), GAD-7 (t = 2.61, P = 0.010), and ISI (t = 2.11, P = 0.037) than in the group without childhood trauma. For participants who experienced pet loss for less than one year, there was no significant difference in the ICG between the trauma and non-trauma groups, as both had extremely high scores. However, the trauma group had a significantly higher PHQ-9 (t = 2.58, P = 0.012) than the non-trauma group. In contrast, for participants who experienced pet loss for more than one year, the trauma group had a significantly higher ICG (t = 2.22, P = 0.03) than the non-trauma group, while there was no significant difference in the PHQ-9. Additionally, the emotional abuse scores on the CTQ were most significantly correlated with the ICG scores even after controlling for depressive symptoms. People who experienced pet loss had significant psychological symptoms, ranging from 32% to 55%. Childhood trauma experiences affect complicated grief, depressive symptoms, anxiety symptoms, insomnia and prolonged grief disorder after pet loss. After pet loss, people with childhood trauma may require more psychological help than those without trauma.

The loss or death of a beloved pet creates a grief reaction comparable to that of the loss of a family member and may lead to the development of symptoms consistent with a diagnosis of persistent complicated grief disorder. Nevertheless, society does not always recognize it as a significant loss, which may contribute to bereaved owners feeling isolated and ashamed when coping with it, as well as not resorting to mental health professionals when necessary. The development of instruments to assess these reactions may contribute to improving the understanding of this suffering. This study aimed to adapt the Pet Bereavement Questionnaire for European Portuguese speakers. A non-probabilistic convenience sample of 169 adults who had a pet that died answered a battery of questionnaires, which included the Portuguese version of the Pet Bereavement Questionnaire. This version resulted from a consensus translation prepared by two translators and subsequently subjected to a cognitive debriefing. The Portuguese version of the instrument demonstrated good reliability (good internal consistency for the total questionnaire and for its subscales) and good external validity (negative correlation with well-being measures and positive correlation with psychopathology measures), as well as reasonable internal validity and sensitivity.

Grief researchers are concerned that the COVID-19 pandemic will precipitate increases in severe, persistent, and disabling grief, termed prolonged grief disorder or persistent complex bereavement disorder (Boelen, et al., 2020). This study demonstrated that individuals who were not allowed to visit their loved one during the dying process experienced more intense grief and higher depression levels compared to those who chose not to visit or were allowed to visit their loved one. This study also demonstrated that individuals who experienced the death of an unvaccinated loved one experienced more intense grief and higher depression levels compared to the death of one who had been vaccinated. A total of 169 adults, age 18 and older completed an online survey that included questions on sociodemographic and loss-related variables, the Pandemic Grief Scale, and the Beck Depression Inventory.

Long-term efficacy of brief psychotherapies for refugees in low-resource settings is insufficiently understood. Integrative adapt therapy (IAT) is a scalable treatment addressing refugee-specific psychosocial challenges. We report 12-month post-treatment data from a single-blind, active-controlled trial (October 2017-August 2019) where 327 Myanmar refugees in Malaysia were assigned to either six sessions of IAT (n = 164) or cognitive behavioral treatment (CBT) (n = 163). Primary outcomes were posttraumatic stress disorder (PTSD), depression, anxiety, and persistent complex bereavement disorder (PCBD) symptom scores at treatment end and 12-month post-treatment. Secondary outcome was functional impairment. 282 (86.2%) participants were retained at 12-month follow-up. For both groups, large treatment effects for common mental disorders (CMD) symptoms were maintained at 12-month post-treatment compared to baseline (d = 0.75-1.13). Although participants in IAT had greater symptom reductions and larger effect sizes than CBT participants for all CMDs at treatment end, there were no significant differences between treatment arms at 12-month post-treatment for PTSD [mean difference: -0.9, 95% CI (-2.5 to 0.6), p = 0.25], depression [mean difference: 0.1, 95% CI (-0.6 to 0.7), p = 0.89), anxiety [mean difference: -0.4, 95% CI (-1.4 to 0.6), p = 0.46], and PCBD [mean difference: -0.6, 95% CI (-3.1 to 1.9), p = 0.65]. CBT participants showed greater improvement in functioning than IAT participants at 12-month post-treatment [mean difference: -2.5, 95% CI (-4.7 to -0.3], p = 0.03]. No adverse effects were recorded for either therapy. Both IAT and CBT showed sustained treatment gains for CMD symptoms amongst refugees over the 12-month period.

Though grief and loss have been normalized in mental health discourse, a particular class of bereavement remains as diagnosis-Persistent Complex Bereavement Disorder.Discussion of this more complex and enduring condition is undertaken in what follows.The dynamics of grief and loss are discussed through this diagnostic category in light of the cultural and psychological concept of the fetish.Fetish serves substitution, evocation, and symbolization in many domains but is particularly relevant in the inertia associated with pathological grief.The complex phenomenon of significant loss and the concept of the fetish as substitution for/defense against complexity is provided.

Victims of crimes have been granted increasing procedural rights to participate in the juridical process since the mid 1990s. However, knowledge about the (anti)-therapeutic effect of participation is limited. We examined the associations between symptom levels of persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression and the intention to participate in a criminal trial. Furthermore, we investigated the mediating role of state anger in these associations. People who lost loved ones after a plane disaster with flight MH17 (N = 203) completed questionnaires within three weeks before the start of the criminal trial. Mediation analyses indicated that people, who did not intend to actively participate in the trial by delivering a written or oral victim statement, were less likely to experience anger, which is, in turn, associated with attenuated psychopathology levels. State anger explains 68% of the effect of the intention to exercise the right to speak on PCBD levels. An important limitation is the cross-sectional study design, which precludes conclusions about temporal associations. More research is needed to improve preparation and support of bereaved people when they intend to exercise their victim rights during a criminal trial.

ABSTRACT Background and Objectives Bereavement is a serious public health concern. Some people suffer prolonged and debilitating functional impairment after the death of a loved one. Evidence suggests that flexibility in coping approaches predicts resilience after stressful life events, but its long-term effects after the unique experience of bereavement are unknown. Which strategies of coping flexibility predict better—or worse—adjustment over time for bereaved people and at what times? Design and Methods The present study used path analyses to investigate longitudinal effects of forward-focus and loss-focus coping strategies on symptoms of persistent complex bereavement disorder (PCBD), depression, and posttraumatic stress disorder in a spousally bereaved adult sample (N = 248) at three time-points after the loss (∼3 months, ∼14 months, and ∼25 months). Results Forward-focus coping demonstrated adaptive utility overall, with sooner effects on PCBD than on depression. By contrast, loss-focus coping demonstrated a delayed-onset, maladaptive pattern. Conclusions The findings contribute to the coping flexibility literature by suggesting that the adaptiveness or maladaptiveness of different coping strategies may depend on the context that requires coping. In particular, forward-focus coping may be substantially more advantageous than loss-focus coping in the context of bereavement. Implications, limitations, and future research directions are discussed.

The Traumatic Grief Inventory Self-Report (TGI-SR), which aims to assess both Persistent Complex Bereavement Disorder and Prolonged Grief Disorder, has been validated in several languages. This study sought to validate the French-Canadian version. We conducted an online survey exploring the impact of the COVID-19 pandemic on grief. With data from 728 participants, the scale demonstrated high internal consistency, correlated significantly with three other scales known to measure similar concepts, and distinguished between groups known to be different. This study supports the use of the TGI-SR French-Canadian version by clinicians and researchers to assess complications of grief.

Introduction: The death of a spouse is one of the most stressful events in life. A better understanding of the factors leading to difficulties in adaptation to the situation of loss in widowed people seems to be important. The main goal of the presented study is to verify the role of the circumstances of the loss of a spouse (a sudden and unexpected death) with respect to severity of the symptoms of complicated grief and post-traumatic stress disorders.
 Method: Fifty five widowed people participated in the study (27 of them indicated that their spouse's death occurred suddenly and unexpectedly, in the case of 28 people the loss had been anticipated). The time elapsed since death ranged from six months to 2.5 years. To measure the severity of complicated grief, the Complicated Grief Inventory by Prigerson et al. (in the Polish adaptation by Ludwikowska-Świeboda and Lachowska) was used. In order to assess the severity of symptoms of post-traumatic stress disorder (intrusion, avoidance and hyperarousal), the Impact of Event Scale — Revised by Weiss and Marmar (in the Polish adaptation by Juczyński and Ogińska-Bulik) was used. To determine the circumstances of the spouse's death, a self-authored demographic data questionnaire was used.
 Results: As expected, the experience of a sudden and unexpected death is a significant predictor of the severity of complicated grief. Detailed analyses revealed that widowed people who experienced a sudden and unexpected death of their spouse are significantly more likely to be preoccupied with thinking about the deceased, experience shock and disbelief, and feel distanced from those who are important to them (compared to people who experienced an anticipated loss). They may also have a greater tendency to avoid stimuli reminding them of the deceased, experience more discomfort when recalling the deceased, and have difficulty trusting other people since their loss. A sudden and unexpected death is also a significant predictor of the severity of hyperarousal symptoms.
 Conclusions: Widowed people who view their spouse's death as sudden and unexpected are at a greater risk of a disruption of the grief process.

IntroductionWhen grief reactions after bereavement are so intense that they impair daily functioning, a diagnosis of disturbed grief may apply. Slightly differing criteria-sets for disturbed grief are included in the ICD-11, the DSM-5, and its forthcoming text revision, DSM-5-TR. We examined psychometric properties of a new self-report measure, the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+), that assesses these criteria sets for Persistent Complex Bereavement Disorder (PCBD) as per DSM-5, and Prolonged Grief Disorder (PGD) as defined in ICD-11 and DSM-5-TR. Material and methodsWe examined the: i) factor structure, ii) internal consistency, iii) temporal stability, iv) convergent validity, v) known-groups validity, vi) probable caseness, and vii) optimal clinical cut-off scores in two Dutch bereaved samples. Sample 1 consisted of 278 adults, bereaved by various causes. Sample 2 included 270 adults who lost loved ones in a traffic accident. ResultsWe found support for a 3-factor PCBD model, 1-factor DSM-5-TR model, and 1-factor ICD-11 PGD model. The DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD items demonstrated good internal consistency and temporal stability. Associations between disturbed grief symptoms and posttraumatic stress and depression levels supported convergent validity. Associations between demographic/loss-related variables and disturbed grief symptoms supported known-groups validity. Optimal clinical cut-offs for the TGI-SR+ total score were ≥ 75, ≥71, and ≥ 75 for probable caseness of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD, respectively. DiscussionWhile replication of our findings in diverse bereaved samples is needed, we conclude that the TGI-SR+ is a reliable and valid measure to assess symptoms of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD.