Predictors Of Complicated Grief Research Articles

Predictors of Complicated Grief During the COVID-19 Pandemic: A Cross-Classified Analysis.

The COVID-19 pandemic left many people grieving multiple deaths and at risk for developing symptoms of complicated grief (CG). The present study is a prospective examination of the role of neuroticism and social support in the development of CG symptoms. Findings from cross-classified multilevel models pointed to neuroticism as a risk factor for subsequent CG symptoms. Social support had a stress-buffering effect, emerging as a protective factor following the loss of a first degree relative. More recent loss and younger age of the deceased were both independently associated with heightened CG symptoms. Results from the present study provide insight into heterogeneity in CG symptom development at the between-person level, and variability in CG symptoms within individuals in response to different deaths. Findings could therefore aid in the identification of those at risk for the development of CG symptoms.

Meaning reconstruction 70 years later: Processing older adults' unfinished business in a drama therapy group.

Unfinished business (UB), when individuals appraise their relationship with others or themselves as incomplete or unresolved, entails difficult emotions such as regret, remorse, and guilt. UB is often associated with bereavement and is considered to be a predictor of complicated grief. Here we report two case studies describing the processing of the sudden death of a significant other in the context of a randomized controlled study of 12-week drama therapy groups for older adults. The intervention followed the format of Playback Theater, an improvised form of theater based on personal stories, and a life review paradigm. A mixed-methods approach explored the course of individual therapy within the group and potential mechanisms of change. The participants completed mental health questionnaires in a pre-post-follow-up design. The qualitative data included video recordings and postintervention interviews. One participant reported a clinically significant (CS) change in depressive symptoms and psychological well-being on the post and follow-up measurement indices. The second reported a CS change in self-esteem and relationship satisfaction at the end of the intervention, but not at follow-up. The findings suggest that the drama therapy contributed to the resolution of UB through restorative work in the three domains defined in meaning reconstruction theory: the "event story" of the loss, the "back story" of the relationship with the deceased, and the "personal story" of self. The results point to the need for additional research on meaning reconstruction in the context of drama therapy and encourage the broader application of performative techniques to treat complicated bereavement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interpersonal facilitators of complicated grief and depression in the aftermath of suicide loss: The mediated roles of suicide-related shame and guilt.

Suicide-loss survivors (SLSs) are recognized as an at-risk population for several mental health complications, including complicated grief (CG) and depression. Recent studies have emphasized the contribution of interpersonal factors as well as suicide-related shame and guilt as facilitators of CG and depression among SLSs. In this 6 year longitudinal design study, we examined interpersonal variables as predictors of CG and depression, with suicide-related guilt and shame as mediators. Participants were 152 SLSs aged 18-70 who completed questionnaires assessing thwarted belongingness, self-disclosure, and social support at index measurement (T1); suicide-related shame and guilt and CG and depression were assessed 6 years later (T2). The integrated model revealed that the interpersonal factors of social support and self-disclosure at T1 significantly and negatively predict CG and depression (respectively) at T2. Thwarted belongingness was found to significantly and positively predict both CG and depression through the mediation of suicide-related shame levels. The findings highlight the critical role of interpersonal factors in facilitating CG and depression among SLSs. Theoretical implications relating to healing processes are discussed, as well as focused clinical recommendations, including psychoeducational interventions for addressing interpersonal difficulties and suicide-related shame in the aftermath of suicide loss.

Predictors of Complicated Grief in Caregivers of Palliative Care Patients.

Introduction: It is important to identify the factors s associated with complicated grief (CG) in order to prevent it. Objective: To determine the factors associated with CG in the end-of-life phase within the palliative care context. Method: The PRISMA model was followed for the review. We accessed the following databases: PUBMED, SCOPUS, and PsycoINFO, to review publications from 2006. Results: A total of 17 studies were obtained. A direct relationship between factors prior to bereavement and CG is established: intensity of anticipated grief, previous mental and physical health of the caregiver, social support; quality of patient care, communication at the end-of-life, preparation for death, spirituality, and sociodemographic factors. Conclusions: Previous mental health and level of anticipatory grief in the main caregiver are shown to be the most powerful predictors of CG. Patient age and quality of care are factors considered as strong predictors of CG in almost every study.

Correlation of Alexithymia with Grief and Depression Symptom Severity in Persistent Complex Bereavement Disorder

This study aimed to compare the depression and grief levels between patients with persistent complex bereavement disorder who have alexithymia and those who do not have alexithymia. This study also aimed to examine the correlations between these variables. A total of 80 patients with persistent complex bereavement disorders were included and divided into two groups: alexithymia (n = 45) and nonalexithymia (n = 35). Each patient was evaluated using the Toronto Alexithymia Scale, the Inventory of Complicated Grief and the Beck Depression Inventory. Individuals with alexithymia who have symptoms of complicated grief may experience more severe depression and grief than patients without alexithymia. Among individuals with alexithymia, the difficulty identifying feelings dimension may be a predictor of complicated grief, and the externally oriented thinking dimension appears to be significant in terms of masking depressive symptoms.

Interpersonal predictors of suicide ideation and complicated-grief trajectories among suicide bereaved individuals: A four-year longitudinal study

BackgroundSurvivors of suicide loss (suicide survivors) are recognized as an at-risk population for several psychiatric complications, including complicated grief (CG) and suicide ideation (SI). Recent studies have emphasized the contribution of interpersonal factors, such as thwarted belongingness and perceived burdensomeness, on distress and suicidality. However, no longitudinal study has examined the predictive values of these interpersonal factors on CG and SI trajectories among suicide survivors to date. In this 42-month prospective design study, we examined interpersonal variables as predictors of CG and SI over time. MethodParticipants were 152 suicide survivors, aged 18-70, who completed questionnaires tapping thwarted belongingness, perceived burdensomeness, CG, and SI at index measurement (T1) and again after 18 months (T2) and 40 months (T3). ResultsThe integrated model showed that thwarted belongingness and perceived burdensomeness predicted SI and CG levels over time, both directly and indirectly. Thwarted belongingness was found to have a high predictive value on SI levels, whereas perceived burdensomeness was predictive of CG levels. LimitationsThe voluntary nature of the participants; self-report measures; lack of pre-suicide-loss assessment. ConclusionThe study's findings highlight the critical role of interpersonal factors in facilitating CG and SI among suicide survivors. Those with higher levels of thwarted belongingness and perceived burdensomeness presented increased prospects of both SI and CG. Theoretical implications relating to healing processes are discussed, as well as focused clinical recommendations, including psychoeducational interventions for addressing PB and TB among suicide survivors.

Developing and testing a nurse-led intervention to support bereavement in relatives in the intensive care (BRIC study): a protocol of a pre-post intervention study

BackgroundWhen a patient is approaching death in the intensive care unit (ICU), patients’ relatives must make a rapid transition from focusing on their beloved one’s recovery to preparation for their unavoidable death. Bereaved relatives may develop complicated grief as a consequence of this burdensome situation; however, little is known about appropriate options in quality care supporting bereaved relatives and the prevalence and predictors of complicated grief in bereaved relatives of deceased ICU patients in the Netherlands. The aim of this study is to develop and implement a multicomponent bereavement support intervention for relatives of deceased ICU patients and to evaluate the effectiveness of this intervention on complicated grief, anxiety, depression and posttraumatic stress in bereaved relatives.MethodsThe study will use a cross-sectional pre-post design in a 38-bed ICU in a university hospital in the Netherlands. Cohort 1 includes all reported first and second contact persons of patients who died in the ICU in 2018, which will serve as a pre-intervention baseline measurement. Based on existing policies, facilities and evidence-based practices, a nurse-led intervention will be developed and implemented during the study period. This intervention is expected to use 1) communication strategies, 2) materials to make a keepsake, and 3) a nurse-led follow-up service. Cohort 2, including all bereaved relatives in the ICU from October 2019 until March 2020, will serve as a post-intervention follow-up measurement. Both cohorts will be performed in study samples of 200 relatives per group, all participants will be invited to complete questionnaires measuring complicated grief, anxiety, depression and posttraumatic stress. Differences between the baseline and follow-up measurements will be calculated and adjusted using regression analyses. Exploratory subgroup analyses (e.g., gender, ethnicity, risk profiles, relationship with patient, length of stay) and exploratory dose response analyses will be conducted.DiscussionThe newly developed intervention has the potential to improve the bereavement process of the relatives of deceased ICU patients. Therefore, symptoms of grief and mental health problems such as depression, anxiety and posttraumatic stress, might decrease.Trial registrationNetherlands Trial Register Registered on 27/07/2019 as NL 7875, www.trialregister.nl

Predictors of Complicated Grief and Depression in Bereaved Caregivers: A Nationwide Prospective Cohort Study

ContextComplicated grief and depressive symptoms in bereaved caregivers have been associated with female gender, spousal relation, and preloss psychological distress, but population-based, prospective studies are scarce. ObjectivesWe aimed to investigate whether severe preloss grief and depressive symptoms, caregiver burden, preparedness for death, communication about dying, and socioeconomic factors predicted complicated grief and postloss depressive symptoms. MethodsWe conducted a population-based, prospective Danish survey of caregivers. Questionnaires for their closest caregiver were mailed to patients registered with drug reimbursement for terminal illness. Of the 3635 (38%) responding caregivers, 2420 were bereaved within six months. Of these, 2215 (88%) completed a postloss follow-up questionnaire. Associations between complicated grief (Prolonged Grief-13), postloss depressive symptoms (Beck Depression Inventory-II), and predictive factors were analyzed with mutually adjusted multivariable logistic regression models. ResultsAt six-month follow-up, 7.6% reported complicated grief and 12.1% reported postloss depressive symptoms, whereas the levels of grief and depressive symptoms were higher preloss. Complicated grief and postloss depressive symptoms were predicted by severe preloss grief symptoms (adjusted odds ratio [OR] = 3.8, 95% CI: 2.4–6.1), preloss depressive symptoms (adjusted OR = 5.6, 95% CI: 3.5–9.0), being a partner (adjusted OR = 2.2, 95% CI: 1.2–3.7), and low educational level (adjusted OR = 2.0, 95% CI: 1.2–3.7). Complicated grief was not predicted by age and gender, whereas postloss depressive symptoms were predicted by young age, female gender, and low preparedness for death. ConclusionSevere preloss grief and depressive symptoms were key predictors of postloss complicated grief and depressive symptoms. Systematic assessment may identify caregivers with a high risk profile who need targeted support.

PC-FACS

PC-FACS

PÉRDIDA, DEPRESIÓN Y DUELO COMPLICADO EN UNA MUESTRA MEXICANA

The purpose of this research is to explore traces of losses considered as not overcome within a Mexican sample of bereaved people, also to contribute with significant data for the comprehension of complicated grief (CG). In a community sample of 321 participants from central Mexico who had lived at least one bereavement experience, the history of losses inventory (HLI) was administered and the presence of complicated grief and depressive symptoms were assessed. 12.46% of the sample reached CG punctuation range and 35.2% considered not having overcome at least one of their bereavement experiences. Results point out the relationship to the deceased and other variables included in the HLI as possible predictors of CG.

Traumatic and Complicated Grief Among Children: One or Two Constructs?

The purpose of this study was to examine the concepts of traumatic and complicated grief among children. Some authors seemingly use the concepts interchangeably, whereas others make a distinction between the two. A sample of 240 mainly parentally bereaved children were administered the Extended Grief Inventory (EGI). Two confirmatory factor analyses were run to examine the EGI factor structure and to determine whether traumatic and complicated grief are one or two concepts. Goodness-of-fit tests for the two models was considered acceptable for both models, however, the two-factor model was a better fit. Multiple regression analyses found that children's age, gender, and ethnicity were important predictors of traumatic grief but only gender was a predictor of complicated grief. Violent death was a predictor of complicated grief in an unadjusted regression analysis.

Predictors of Complicated Grief: A Systematic Review of Empirical Studies

A systematic review of the literature on predictors of complicated grief (CG) was undertaken with the aim of clarifying the current knowledge and to inform future planning and work in CG following bereavement. Predictors of CG prior to the death include previous loss, exposure to trauma, a previous psychiatric history, attachment style, and the relationship to the deceased. Factors associated with the death include violent death, the quality of the caregiving or dying experience, close kinship relationship to the deceased, marital closeness and dependency, and lack of preparation for the death. Perceived social support played a key role after death, along with cognitive appraisals and high distress at the time of the death. Inconsistent definitions of CG and measurement tools were noted in the earlier studies reviewed. Limitations identified in the studies included use of cross-sectional designs, heterogeneous samples, high attrition, demographic differences between cases and controls, differences in length of time since death, and differences in types of death experienced. Notwithstanding these limitations, some consistent findings have emerged. Further research into conceptualizations of CG in terms of attachment theory and constructivist and cognitive-behavioral concepts of finding purpose and meaning after bereavement is warranted.

Predictors of complicated grief

This study examined whether process variables predict an outcome of complicated grief. A turbulent and prolonged grief was predicted to occur after the death of a spouse in subjects who had self-blame, used the deceased for an extension of self, had ambivalence toward the deceased, or overcontrolled emotional responses. Ninety subjects were examined at 6, 14, and 25 months after the loss via a self-report battery of process variables and a structured clinical interview designed to assess symptoms. Subjects with complicated grief were compared with those with normative grief. Predictions were supported only in tertiary data analyses; they were not supported well in the primary and secondary statistical analyses. The authors concluded that either self-reports of process variables are inadequate measures or the theory that led to these measures and predictions is in need of revision.