Continuing bonds in bereaved Pakistani Muslims: effects of culture and religion

My child's home: Parental grief at a Chinese cemetery

This article explores how the parent-child bond is continued in an emergent deathscape in urban China where graves designated for deceased children are being created. This new child-centered deathscape stands in stark contrast to the dominant Chinese deathscape which is embedded in the longstanding practice of ancestor worship. Based on data collected through cemetery visits and interviews with bereaved parents, this article delves into the making of this new deathscape manifested at a cemetery in urban China to demonstrate the process of bereaved parents building and maintaining bonds with their deceased children. It reveals how bereaved parents regard their children's graves as the children's new homes in the afterlife. It also discusses how a deceased child's identity is presented and social presence continued at the grave, how parental love is expressed and practiced after the burial, and how the parent-child bond is expressed as continuing in the afterlife.

Cultural adaptation of an internet-based self-help app for grieving Syrian refugees in Switzerland

BACKGROUND

Loss and grief pose significant challenges for victims of armed conflicts, such as Syrian refugees. Internet-based interventions (IBIs) present a promising solution to address this treatment gap and provide adequate support. However, research on grief, grief support, and IBIs remain largely limited to Western cultural contexts, and culturally adapted IBIs for grief are needed. Following the Reporting Cultural Adaptation in Psychological Trials (RECAPT) framework, this study aimed to develop and further adapt a culturally sensitive IBI for bereaved Syrian refugees in Switzerland.

METHODS

The study employed qualitative methods. Initially, formative research was conducted to create a first version of the intervention, including semi-structured interviews with 10 experts to identify necessary cultural adaptations. The preliminary version of the intervention was then presented to six potential users and three experts to gather feedback on additional cultural adaptations through two iterative feedback rounds. The first round involved semi-structured interviews using a "paper version" of the intervention, followed by a second round with a walk-through think-aloud protocol with a beta version. Data were analyzed using framework analysis.

RESULTS

The input from various key informants at different stages of development provided valuable feedback on surface and deep structure adaptation, which may enhance treatment adherence, acceptance, and motivation.

CONCLUSIONS

These findings provide important insights and recommendations for the cultural adaptation of interventions and may help address the treatment gap for bereaved Syrian refugees.

Consequences of Unexplained Experiences in the Context of Bereavement - Qualitative Analysis

Unexplained experiences are common among bereaved people and are a natural part of grieving, but their consequences may affect their coping with grief. However, professionals lack awareness of these unexplained experiences, which may lead to an unnecessary pathologising of the experiences and a lack of opportunity for the bereaved to process their experiences in a safe environment. The study involved an inductive content analysis of 408 narratives of the consequences of unexplained experiences shared by 181 bereaved individuals. The consequences of the unexplained experiences were: (1) Experiencing after-effects which may alleviate or aggravate wellbeing, as well as be life-affecting; (2) consequences related to sharing or concealing the experiences, and the reactions of others to recounting the experience; (3) documenting the experience through videography, photography and keeping mementos. In conclusion, these experiences have consequences to bereaved which needs to be taken account in support interventions aimed at bereaved individuals.

Continuing bonds of bereaved Muslims mothers with their young dead child

Based on continuing bonds theory, this research examined the experience and manifestations of continuing bonds of bereaved Muslim mothers with their children who died in home accidents. This qualitative phenomenological study is based on interviews with 15 bereaved mothers (aged 28-46 years) whose children (aged 1-6 years) died 2-7 years before the interviews. Analysis revealed three themes: efforts to continue the physical bonds, challenges in the continuing bonds in cases of traumatic death, and belief in afterlife as the main element of the continuing bonds. The traumatic circumstances of the death challenged the ability to maintain the bond based on positive memories without it being overwhelmed by the traumatic memories of the last moments of the child's life. Religious beliefs played an important role in the characteristics of the bond. Maintaining the bond requires professionals to provide a therapeutic environment where bereaved mothers feel safe talking about it.

The impact of continuing bonds following bereavement: A systematic review

Following bereavement, continuing bonds (CBs) include engaging with memories, illusions, sensory and quasi-sensory perceptions, hallucinations, communication, actions, and belief that evoke an inner relationship with the deceased. To date, the literature has been unable to confirm whether retaining, rather than relinquishing, bonds is helpful. A mixed studies systematic literature search explored how CBs affect grief. Studies on the effect or experience of CBs on adjustment following bereavement were eligible for inclusion. Six computerized databases were searched. A total of 79 of 319 screened studies were included. Three themes were derived from the thematic analysis: (1) comfort and distress, (2) ongoing bonds and relational identity, and (3) uncertainty, conceptualizing, and spirituality. Themes describe the role of CBs for the accommodation of the death story, transformation of the relationship, meaning reconstruction, identity processes, and affirmation of spiritual belief. Results shed light on the adaptive potentials for CBs.

Exploring Young Millennials’ Motivations for Grieving Death Through Social Media

Past research has explored social media grief; however, the motivations for using a range of social media sites, specifically by young millennials, to grieve death fail to be explored expansively in existing thanatology research. Fourteen young millennials participated in individual semi-structured interviews, specifically questioning their motivations for using social media sites to grieve. The interviews were analysed using the thematic analysis framework identified by Braun and Clarke (2013). Four themes were generated: online influence, to announce the death, personal benefit and the hypocrisy of online mourning. The online influence theme suggests that individuals are motivated to grieve due to online influence and pressure. The personal benefit theme suggested social media present many benefits for the bereaved, including continuing bonds, which motivated them to use these platforms. The analysis also indicated that within the motivations there was hypocrisy regarding how young millennials perceive their grief posting activity when compared to others.

The Effects of Bereavement Time on the Relationship Between Coping Strategies and Psychological Distress

The purpose of this study was to investigate the relationship between bereaved individuals' coping patterns, mental health, and time post-loss. A questionnaire using the Coping with Bereavement Scale (CBS) and the Kessler Psychological Distress Scale (K6) was completed by 173 family members of individuals who died from cancer between August 2013 and March 2016. Confirmatory factor analysis revealed a three-factor solution for the CBS comprised of "life orientation," "avoidance," and "retaining ties" with the deceased. Scores on retaining ties were significantly but weakly correlated with K6 scores; however, the intensity of this relationship increased with more time post-bereavement, and individuals who retained strong ties with the deceased for two years or more demonstrated poorer mental health. Although retaining ties with the deceased might be an adaptive psychological process following bereavement, in this study, long-term persistence with that coping strategy was associated with greater overall psychological distress. Further research is needed to identify optimal coping methods to address evolving needs during the bereavement process.

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.

How we continue bonds with deceased persons: The proximity-seeking behavior scale

Continuing bonds is a multifaceted process, encompassing perceptions, beliefs, illusions and hallucinations, and overt behaviors. We developed the Proximity-Seeking Behavior Scale (PSBS) to assess overt behavior to continue bonds with the deceased person. We had 694 bereaved adults complete an online survey. Exploratory and confirmatory factor analyses yielded a one-factor model for PSBS items. PSBS reliability was good. PSBS scores correlated positively with rumination and yearning, feeling connected to the deceased person, and prolonged grief and depression symptoms. The PSBS appears a reliable and valid instrument to assess proximity-seeking behaviors.

Investigation of the relationship between continuing bonds and adjustment after the death of a first-degree family member by using the Multidimensional Continuing Bonds Scale

OBJECTIVES

The study aims to develop a continuing bonds scale, investigate the relationship between continuing bonds and adjustment after loss, and test the moderating role of meaning reconstruction in this relationship.

METHODS

Data were collected from two different samples of 306 (Study 1) and 271 (Study 2) bereaved adults.

RESULTS

The four factors structure of the Multidimensional Continuing Bonds Scale (MCBS) was explored and confirmed. Hierarchical regression analysis revealed that continuing bonds showed a significant relationship with prolonged grief symptoms after controlling the risk factors such as gender, age of the deceased, time since loss, and cause of death. Meaning reconstruction moderated the relationship between continuing bonds and prolonged grief symptoms.

CONCLUSION

The results revealed that the MCBS can be used as a valid and reliable scale to assess the continuing bonds construct. The relationship between continuing bonds and prolonged grief symptoms varies according to the levels of meaning reconstruction.

Dying, Death and Mourning amid COVID-19 Pandemic in Kashmir: A Qualitative Study

Using a qualitative approach, this study aimed to examine the changing nature of death, dying and mourning among Muslims of Kashmir due to the COVID-19 pandemic. Telephonic Interviews were conducted with 17 participants, whose loved ones died after the outbreak of the COVID-19 in Kashmir. The findings of the study revealed that the deceased mostly died in isolation with no one around. Mourning the loss was also highly challenging with participants receiving less in-person support thus leading to mourning in isolation. The inability to perform last rites added yet another layer of grief which resulted in prolonged grief among the bereaved and impacted their overall wellbeing.

Mapping Mourning Among Muslims of Kashmir: Analysis of Religious Principles and Current Practices

From the instance a person passes away, the funeral, mourning, and memorial ceremonies follow sets of religious principles and procedures in every society. However, at the same time, these ceremonies and practices are influenced by the cultural patterns that people endorse. Mourning practices among Muslims of Kashmir also derive from such a religious-cultural amalgamation. This study aims to highlight mourning practices from two standpoints: (a) the prerequisites of the Islamic tradition and (b) the way mourning is actually practiced in Kashmir. To compare the general mourning practices with the actual Kashmiri Muslim mourning practices, different secondary sources were used and in-depth interviews were conducted with 11 participants (6 women, 4 men, and 1 Islamic scholar). The study revealed that mourning practices followed by Muslims of Kashmir are influenced by traditions outside the religion of Islam.

Role of technology in restructuring the traditional practices around death and mourning in Kashmir

Using a grounded theory approach, this qualitative study aimed to highlight the evolving technological dimensions of death and mourning practices and its transfer from a set physical setting to virtual and open space. The study was carried on 30 participants from Kashmir. Data was collected using in-depth face-to-face interviews and field notes were also used to capture non-verbal communication. The results of the study revealed that a considerable shift is being witnessed so far as death and mourning practices in Kashmir are concerned. The physical space is shrinking and giving way for virtual spaces to play their role in practices related to death and mourning.

Grief reactions and coping strategies of Muslim nurses dealing with death

BACKGROUND

An intensive care unit (ICU) features high mortality rates. Witnessing subsequent deaths may affect nurses psychologically and spiritually. Islam has an influence on Muslims' life and death. Nevertheless, little is known about Muslim intensive care nurses' experiences of grief in dealing with the deaths of patients.

AIM AND OBJECTIVES

This study aimed to describe the grief reactions and coping strategies of Muslim nurses in dealing with the death of patients.

DESIGN

This is a qualitative study with a phenomenological approach.

METHODS

Semi-structured individual interviews were conducted. Fourteen participants from an ICU in an Indonesian tertiary public hospital participated in this study. Data were analysed by thematic analysis. Trustworthiness was established by Lincoln and Guba's criteria.

RESULTS

The findings identified four reactions of grief, four factors influencing reactions of grief, and three coping strategies used in dealing with death in an ICU. The reactions of nurse's grief were crying, being sad, feeling disappointed, and feeling guilty. These reactions were related to several factors including the circumstances of the patient's death, nurse's expectation of patient's recovery, relationships with the patient, and the reactions of family. Coping management strategies used by nurses in dealing with their grief comprised: sharing with colleagues, avoiding dying and death situations, and engaging in spirituality.

CONCLUSIONS

The Muslim ICU nurse participants experienced their grieving through a variety of psychological reactions influenced by several factors. Personal coping strategies were revealed in dealing with their grief. However, avoiding dying and death situations affected their duty.

RELEVANCE TO CLINICAL PRACTICE

Attention to nurses' grief should be paid to maintain their psychological well-being and quality of end-of-life care. Providing formal support to enhance grief management is recommended.

Submitting to God's will: Attitudes and beliefs of Moroccan Muslim women regarding mourning and remembrance

This study aimed to elicit the attitudes and beliefs of middle-aged and elderly Moroccan Muslim women regarding mourning and remembrance, to identify whether differences are observable between middle-aged and elderly participants, to explore the role of religion and to document how the actual attitudes of our participants relate to normative Islamic literature. Interviews were conducted with middle-aged and elderly Moroccan women living in Belgium (n = 30) and with experts in the field (n = 15). This study reveals that the religious beliefs have a great impact on the views of Muslim women. We found striking similarities between our participants' views and normative Islamic literature.

"Every soul shall taste death." Attitudes and beliefs of Moroccan muslim women living in Antwerp (Belgium) toward dying, death, and the afterlife

This study aims to elicit the beliefs and attitudes of middle-aged and elderly Moroccan Muslim women toward dying, death, and the afterlife; to identify whether differences are observable between middle-aged and elderly participants and to document how the actual attitudes of our participants relate to normative Islamic literature. Interviews were conducted with middle-aged and elderly Moroccan women living in Belgium (n = 30) and with experts in the field (n = 15). This study reveals that the belief in an omnipotent and omniscient God and in an afterlife strongly marks the attitudes of first- and second-generation Muslims in Belgium toward life and death.

The meaning of rituals after a stillbirth: A qualitative study of mothers with a stillborn baby

AIMS AND OBJECTIVES

To explore the meaning of rituals that women and their families perform after a stillbirth.

BACKGROUND

A cultural taboo in Taiwan prohibits discussing death; thus, parents of stillborn babies have no established public mourning or burial ceremonies to perform for their stillborn children. Stillbirths are often treated as if they had never happened.

DESIGN

Qualitative descriptive study.

METHODS

In-depth interviews, which were transcribed and content analysed, were conducted with a purposive sample of 16 women discharged from two teaching hospitals in Taiwan after they had a stillbirth.

RESULTS

Families engaged in rituals for two underlying reasons: to benefit the deceased child and the immediate family. The meanings of the rituals for the child are presented through three themes: (i) sending the baby's spirit to a safe place, (ii) protecting it from suffering and (iii) preparing it for a better reincarnation. The meanings of rituals for the families are presented through four themes: (i) releasing parental guilt by doing their best for the deceased child, (ii) cutting bonds with the child, (iii) avoiding additional misfortune should they mishandle the funeral and (iv) praying for a successful subsequent pregnancy.

CONCLUSIONS

Death-related rituals are highly culturally diverse. This study fills a gap about Asian cultures. Participating in rituals permits a mother to do something for her deceased child, helps relieve her guilt and lets her cope with the stillbirth. Rituals after a stillbirth can help a woman recover from grieving and allow her to hope for a successful subsequent pregnancy.

RELEVANCE TO CLINICAL PRACTICE

Health professionals should discuss with bereaved parents what rituals they would like to perform and then respect their decisions. A continuum of care and support that exists from the prenatal diagnosis through the stillbirth and beyond is recommended for parents and families during this difficult time.

Continuing Bonds and Bereavement Adjustment Among Bereaved Mainland Chinese

Given the important role of continuing bonds (CBs) in bereavement adjustment, the aim of this study was to examine the relationship between CBs and bereavement adjustment and identify influences on CB among bereaved mainland Chinese. The Continuing Bonds Scale, Prolonged Grief Questionnaire 13, and Posttraumatic Growth Inventory were administered to 273 bereaved participants. Findings in the current study suggest psychometric validity of the Continuing Bonds Scale in a mainland Chinese sample and confirm that externalized CB is positively associated with severity of grief symptoms, and internalized CB is positively associated with the respondent degree of posttraumatic growth and identifies influences on externalized CB and internalized CB. These findings clarify the complex influence of CB in grieving process and highlight the need of incorporating CB into grief counseling.

Experiencing Loss: A Muslim Widow's Bereavement Narrative

In this article, we explore how Islam, minority status and refugee experiences intersect in shaping meaning-making processes following bereavement. We do this through a phenomenological analysis of a biographical account of personal loss told by Aisha, a Muslim Palestinian refugee living in Denmark, who narrates her experience of losing her husband to lung cancer. By drawing on a religious framework, Aisha creates meaning from her loss, which enables her to incorporate this loss into her life history and sustain agency. Her narrative invites wider audiences to witness her tale of overcoming loss, thus highlighting the complex way in which religious beliefs, minority status and migration history come together in shaping meaning-making processes, and the importance of reciprocity in narrative studies.

Parental relationships beyond the grave: Adolescents' descriptions of continued bonds

OBJECTIVE

Many people experience an ongoing relationship with a deceased loved one. This is called a "continued bond." However, little is known about the adolescent experience with continued bonds once a parent has died. This study describes three ways that adolescents continue their relationship with a parent after that parent's death.

METHOD

Individual semistructured interviews were conducted with nine adolescent children of deceased hospice patients from a large hospice in northeastern Ohio as part of a larger grounded-theory study. The interviews were audiotaped, transcribed verbatim, and analyzed using a conventional content analysis approach.

RESULTS

Adolescents continued their bonds with deceased parents in one of three ways: experiencing encounters with the deceased parent, listening to the inner guide of the parent, and keeping mementos to remind them of the parent.

SIGNIFICANCE OF RESULTS

The ways that the adolescents continued their bond with a deceased parent assisted them in creating meaning out of their loss and adjusting to life without that parent. Our results can be used by health professionals and parents to help adolescents after a parent has died.

Let me hear of your mercy in the mourning: forgiveness, grief, and continuing bonds

Clarity about the utility of continuing bonds (CB) continues to be evasive in the research. In 2 different correlational studies, the authors explored the relationship between CB and 2 other variables: 1 representing mental health (forgiveness of the deceased) and the other representing psychological distress (prolonged grief). Although researchers have addressed the latter relationship in the literature, assessing the relationship between CB and forgiveness has not been undertaken. Results suggest that forgiveness in general, and affective aspects of forgiveness in particular, predict psychological forms of CB. Results related to grief depended on how CB was assessed. These findings provide evidence of the relative health of certain types of relationship with deceased persons and also suggest that forgiveness interventions may be a way of promoting such healthy bonds.

The role of continuing bonds in coping with grief: overview and future directions

The existing empirical literature depicts a complex picture of the role that continuing bonds play in coping with bereavement, with contradictory findings emerging across studies. This article presents an overview of continuing bonds research and highlights several areas ripe for exploration. First, definitional issues are identified. Second, three paths for clarification are presented: the bereaved's perception of the bond as positive or negative, the quality of the predeath relationship, and the bereaved's afterlife beliefs. Through refining the definition and exploring these potential avenues of research, we hope to clarify the roles that continuing bonds may play in coping with bereavement.