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Bottomley JS, Smigelsky MA. Bereavement in the Aftermath of Suicide, Overdose, and Sudden-Natural Death: Evaluating a New Measure of Needs. Assessment 2022; 30:1052-1064. [PMID: 35272500 PMCID: PMC9463411 DOI: 10.1177/10731911221081139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Bereavement has been associated with a number of adverse outcomes, including mortality, particularly among those who experience the sudden loss of a close other. With rising rates of sudden death in the United States, fueled by an alarming increase in fatal overdose deaths, identifying bereavement-related needs among the sudden-death bereaved is essential. The present study investigated the factor structure, internal reliability, and validity of the Sudden Bereavement Needs Inventory (SBNI) in a sample of sudden loss survivors (i.e., fatal overdose, suicide, and sudden-natural loss; N = 403). Confirmatory factor analysis supported a six-factor structure, with items reflecting pragmatic, informational, spiritual, relational, meaning, and emotional needs. SBNI factors showed adequate internal consistency, with significant associations between SBNI scores, loss characteristics, and mental health outcomes (e.g., prolonged grief symptoms, meaning-making, posttraumatic stress disorder [PTSD] symptoms, and anxiety), supporting the scale's validity and highlighting the potential applicability of the instrument in both research and clinical contexts. Future research should examine test-retest reliability of the SBNI, particularly through the lens of understanding whether and how bereavement needs change over time.
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Affiliation(s)
| | - Melissa A Smigelsky
- U.S. Department of Veterans Affairs, Integrative Mental Health, Durham, NC, USA
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Diolaiuti F, Marazziti D, Beatino MF, Mucci F, Pozza A. Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder. Psychiatry Res 2021; 300:113916. [PMID: 33836468 PMCID: PMC8479443 DOI: 10.1016/j.psychres.2021.113916] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/27/2021] [Indexed: 12/23/2022]
Abstract
Mourning is a coping-with-loss stage that prevents grief from becoming pathologic, i.e., complicated grief (CG) syndrome and persistent complex bereavement disorder (PCBD), recently included in international classification systems. During the COVID-19 pandemic, to contain virus spread, several countries adopted/adopt the prohibition of mourning rituals (funeral ceremonies/visiting to cemeteries), so that people were/are unable to give their hospitalized relatives the latest goodbye. Such measures can lead vulnerable individuals to develop CG and PCBD. We critically discuss literature-based risk factors for and protective resources against the onset of these conditions since the start of the pandemic and analyze prevention strategies to inform public health programs.
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Affiliation(s)
- Francesca Diolaiuti
- University of Pisa, Department Translational Research and New Technologies in Medicine and Surgery, Italy
| | - Donatella Marazziti
- University of Pisa, Department of Clinical and Experimental Medicine, Section of Psychiatry, Italy; Saint Camillus International University of Health and Medical Sciences, Rome, Italy; BRF Foundation Lucca, Italy.
| | - Maria Francesca Beatino
- University of Pisa, Department Translational Research and New Technologies in Medicine and Surgery, Italy
| | - Federico Mucci
- University of Siena, Department of Biotechnology, Chemistry and Pharmacy, Italy
| | - Andrea Pozza
- University of Siena, Department of Medical Sciences, Surgery and Neurosciences, Italy
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3
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Kustanti CY, Fang H, Linda Kang X, Chiou J, Wu S, Yunitri N, Chu H, Chou K. The Effectiveness of Bereavement Support for Adult Family Caregivers in Palliative Care: A Meta‐Analysis of Randomized Controlled Trials. J Nurs Scholarsh 2021; 53:208-217. [DOI: 10.1111/jnu.12630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Christina Yeni Kustanti
- PhD Student of School of Nursing, College of Nursing Taipei Medical University, Taipei, Taiwan and Lecturer of Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum Yogyakarta Indonesia
| | - Hui‐Fen Fang
- Director of Nursing department, Taipei Cancer Center, Taipei Medical University, Deputy Director of Cancer Center, Taipei Medical University Hospital and Deputy Director of Nursing Service Taipei Medical University Hospital Taipei Taiwan
| | - Xiao Linda Kang
- Postdoctoral Researcher of School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan and School of Nursing University of Pennsylvania USA
| | - Jeng‐Fong Chiou
- Professor, Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University and Attending Physician, Department of Radiation Oncology Taipei Medical University Hospital Taipei Taiwan
| | - Shen‐Chi Wu
- Attending Physician of Department of Palliative Medicine Division Taipei Medical University Hospital, Taipei Medical University Taipei Taiwan
| | - Ninik Yunitri
- PhD Student of School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan and Lecturer of Mental Health and Psychiatric Nursing Department, Faculty of Nursing Universitas Muhammadiyah Jakarta Indonesia
| | - Hsin Chu
- Associate Professor of Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan and Attending Physician of Department of Neurology Tri‐Service General Hospital, National Defense Medical Center Taipei Taiwan
| | - Kuei‐Ru Chou
- Lambda Beta‐at‐Large Distinguished Professor of School of Nursing and Dean of College of Nursing, Taipei Medical University, Taipei, Taiwan and Vice Director of Department of Nursing, Taipei Medical University‐Shuang Ho Hospital, New Taipei City, Taiwan and Center for Nursing and Healthcare Research in Clinical Practice Application Wan Fang Hospital Taipei Medical University, Taipei, Taiwan and Psychiatric Research Center, Taipei Medical University Hospital Taipei Taiwan
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Acierno R, Kauffman B, Muzzy W, Tejada MH, Lejuez C. Behavioral Activation and Therapeutic Exposure vs. Cognitive Therapy for Grief Among Combat Veterans: A Randomized Clinical Trial of Bereavement Interventions. Am J Hosp Palliat Care 2021; 38:1470-1478. [DOI: 10.1177/1049909121989021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Approximately two-thirds of Operations Enduring Freedom, Iraqi Freedom, and New Veterans reported knowing someone who was killed or seriously injured, lost someone in their immediate unit, or personally saw dead or seriously injured Americans (Hoge et al., 2004; Thomas et al., 2010; Toblin et al., 2012). Thus, it is not surprising that prevalence of Persistent Complex Bereavement Disorder (PCBD) is high in these groups. Importantly, PCBD impact appears to be independent of both Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (Bonnano, 2007), 2 disorders that are also highly prevalent in these groups, thus tailored treatments for grief are indicated. The Department of Veterans Affairs suggests Cognitive Therapy for Grief as a first line psychotherapy, however treatments relatively more focused on behavior change and exposure to grief cues also may be useful for this population. To address this question, the present study used a randomized controlled trial to compare a 7-session program of Behavioral Activation and Therapeutic Exposure for Grief vs. Cognitive Therapy for Grief among 155 OIF/OEF/OND veterans. Both treatments produced significant treatment gains over baseline, and these improvements were maintained over 6-month followup; however no differences were observed between groups. Given equal efficacy, implications for matching treatment to patient characteristics are discussed.
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Affiliation(s)
- Ron Acierno
- Faillace Department of Psychiatry, University of Texas Health Sciences Center Houston, TX, USA
- Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Brooke Kauffman
- Faillace Department of Psychiatry, University of Texas Health Sciences Center Houston, TX, USA
- Department of Psychology, University of Houston, TX, USA
| | - Wendy Muzzy
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Melba Hernandez Tejada
- Faillace Department of Psychiatry, University of Texas Health Sciences Center Houston, TX, USA
| | - Carl Lejuez
- Office of the Provost, University of Connecticut, Storrs, CT, USA
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Zuniga-Villanueva G, Ramirez-GarciaLuna JL, Villafranca-Andino RI. A Compassionate Communities Approach in a Grief and Bereavement Support Program: Bridging the Gap in Palliative Care. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2021; 17:9-18. [PMID: 33722177 DOI: 10.1080/15524256.2021.1894309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Grief and bereavement support is a fundamental component of palliative care, yet there is a gap in practice as not all palliative care services offer it. The compassionate communities (CC) approach aims to build community capacity to address grief as grief support is considered everyone's responsibility. This study describes the characteristics, development, growth and attendees of a grief support program that uses a CC approach to bridge the gap of grief support in palliative care.
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Affiliation(s)
- Gregorio Zuniga-Villanueva
- Division of Pediatric Palliative Medicine, McMaster University, Hamilton, Canada
- Department of Pediatrics, Tecnologico de Monterrey, Monterrey, Mexico
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Abstract
Purpose of review a)The purpose of this systematic review was to characterize the studies published on grief interventions for bereaved older adults in the last 5 years. Grief intervention studies were included that exclusively focused on older adults as well as those that included older adults in their samples, in order to summarize the most up-to-date treatment options available for bereaved older adults. Recent findings b)Twenty-four articles that investigated grief interventions in older adults were identified. Generally, findings suggest viable treatment approaches for bereaved older adults are those incorporating behavioral activation and guidance on restoration-oriented coping. However, similar to studies of broader adult populations, grief interventions had small effects on grief-related symptoms in older adults. Few studies examined age as a moderator of treatment effects. Studies varied greatly by study design, sample size, and outcomes measured, which all likely impacted the efficacy of results. Summary c)This review suggests that, while there has been a growing focus on older adults, who have unique vulnerabilities in bereavement, the evidence-base of efficacious interventions for this population is limited. Given the need for specialized bereavement support for older adults will increase in the coming years, future research should prioritize rigorous investigations of grief treatment options leveraging technology to increase access and incorporate techniques that enhance engagement in life and connectedness for this vulnerable population.
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Johannsen M, Damholdt MF, Zachariae R, Lundorff M, Farver-Vestergaard I, O'Connor M. Psychological interventions for grief in adults: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2019; 253:69-86. [PMID: 31029856 DOI: 10.1016/j.jad.2019.04.065] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/30/2019] [Accepted: 04/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The present meta-analysis evaluates the efficacy of psychological interventions for grief in bereaved adults and explores the possible moderating influence of various study characteristics. METHODS A systematic literature search was conducted by two reviewers who independently searched electronic databases, reviewed and selected eligible studies, and evaluated their methodological quality. RESULTS A total of 31 randomized controlled trials (RCTs) were included in the meta-analysis. Statistically significant pooled effects of psychological intervention on grief symptoms were found for both post-intervention (Hedges's g = 0.41, p > .001, K = 31) and follow-up (g = 0.45, p > .001, K = 18). While generally robust, the effect was smaller at post-intervention when adjusting for possible publication bias (g = 0.31). Compared with the remaining studies, larger post-intervention effect sizes were found for studies with (1) individually delivered interventions (Beta = 0.49, p < .001), (2) the ICG-(R)/PG-13 questionnaire as the grief instrument (Beta = 0.46, p < .001), (3) participants who were ≥6 months post-loss (Beta = 0.58, p < .001), (4) participants included based on high baseline symptom levels (Beta = 0.40, p = .002) and (5) higher study quality (Beta = 0.06, p = .013). LIMITATIONS The included studies were methodologically heterogeneous and their methodological quality varied considerably. Moreover, there were some indications of publication bias. CONCLUSIONS Given the recent introduction of Prolonged Grief Disorder in the ICD-11, the results of the present meta-analysis are timely and of clinical relevance. Based on our results, psychological intervention appears efficacious for alleviating grief symptoms in bereaved adults, with several study characteristics as possible moderators of the effect. The interpretability of the results, however, is challenged by some limitations of the available research, including possible publication bias.
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Affiliation(s)
- M Johannsen
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark.
| | - M F Damholdt
- Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - R Zachariae
- Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
| | - M Lundorff
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
| | - I Farver-Vestergaard
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
| | - M O'Connor
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
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Matching response to need: What makes social networks fit for providing bereavement support? PLoS One 2019; 14:e0213367. [PMID: 30845193 PMCID: PMC6405096 DOI: 10.1371/journal.pone.0213367] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 02/19/2019] [Indexed: 11/29/2022] Open
Abstract
The objectives of this study were to explore the goodness of fit between the bereaved peoples’ needs and the support offered by their social networks; to ascertain whether this support was experienced as helpful or unhelpful by bereaved people; and to explore both the types of social networks that offer effective support and the characteristics of the communities that encourage and nurture such networks. This study was based on qualitative interviews from twenty bereaved people, in Western Australia, interviewed in 2013. A framework analysis of these interviews was undertaken using a deductive approach based on the goodness of fit framework. Much of this support is provided informally in community settings by a range of people already involved in the everyday lives of those recently bereaved; and that support can be helpful or unhelpful depending on its amount, timing, function and structure. Improving the fit between the bereaved person’s needs and the support offered may thus involve identifying and enhancing the caring capacity of existing networks. An important strategy for achieving this is to train community members in mapping and developing these naturally occurring networks. Some such networks will include relationships of long standing, others may be circles of care formed during a period of caring. Peer support bereavement networks develop from these existing networks and may also recruit new members who were not part of the caring circle. The findings endorse social models of bereavement care that fit within a public health approach rather than relying solely on professional care. As exemplified by Compassionate Communities policies and practices, establishing collaboration between community networks and professional services is vital for effective and sustainable bereavement care.
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Impaired mental health and low-grade inflammation among fatigued bereaved individuals. J Psychosom Res 2018; 112:40-46. [PMID: 30097134 DOI: 10.1016/j.jpsychores.2018.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Fatigue is a common symptom in stressed individuals. Bereavement is a major life event that has been associated with impaired mental health. Little research has investigated the prevalence of fatigue and its inflammatory correlates in bereaved individuals. OBJECTIVES To assess fatigue prevalence and its relationship with mental health outcomes and markers of inflammation, as indexed by C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) in bereaved individuals. METHODS Seventy-eight-bereaved adults were examined for fatigue (SF-36 energy/vitality scale), perceived stress (PSS), depression (CES-D), sleep quality (PSQI), pain (SF-36 pain scale), and general health (SF-36 general), and their serum levels of CRP, IL-6 and TNF-α were measured. Group differences between fatigued versus non-fatigued individuals were estimated using analysis of covariance (ANCOVA), with adjustment for body mass index (BMI). RESULTS Fatigued bereaved individuals (33%; SF-36 energy/vitality score 0-45) had significantly higher CRP levels (p < .05) as compared to non-fatigued bereaved individuals and reported higher levels of pain (p < .001), greater stress (p < .001), depression (p < .001), and sleeping problems (p < .001), as well as poorer social functioning (p < .001) and general health (p < .001) than those in the non-fatigued group. No group differences were found for IL-6 and TNF-α. CONCLUSIONS Fatigued bereaved individuals showed elevated systemic inflammation as measured by CRP in comparison to non-fatigued bereaved individuals. They were also more likely to report mental health problems that co-occur with fatigue in the context of immune activation. Continued research is needed to help clarify the involvement of inflammatory markers in the development of fatigue in a larger sample of bereaved adults.
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Abstract
PURPOSE OF REVIEW There is increasing recognition that a minority of bereaved persons experiences persistent and disabling grief symptoms, also termed complicated grief. We review currently proposed criteria for complicated grief in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) and the International Statistical Classification of Diseases and Related Health Problems (ICD-11), highlight controversies with regard to establishing complicated grief as a psychiatric disorder, summarize recent complicated grief treatment research within a cognitive behavioral treatment framework, and establish a novel and systematic research agenda for complicated grief treatment. RECENT FINDINGS Clinicians should be wary of overdiagnosis and misdiagnosis of complicated grief. Recent changes to definitions of complicated grief may threaten generalizability and clinical application of research findings. Universal treatment, treatment for at-risk groups and preventive complicated grief treatment appear ineffective. Although medication is often prescribed to bereaved persons, evidence for its effectiveness is equivocal. Face-to-face and internet-based cognitive behavioral therapy techniques appear most effective in targeting complicated grief. However, little is known about what, how, and for whom treatment works best. SUMMARY In light of these findings, we recommend systematic investigation of: what works best in complicated grief treatment, by conducting well designed, stepped effectiveness trials and treatment component dismantling studies; how it works, by conducting investigations on therapeutic theories and examining mediators of therapeutic change; and for whom it works, by examining potential moderators of treatment effects.
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