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Schneider S, Rerick PO, Cummings C, McLean E, Breen LJ, Singer J. Pandemic grief risk factors and prolonged grief disorder in bereaved young adults during COVID-19. Palliat Support Care 2023; 21:836-842. [PMID: 36994820 DOI: 10.1017/s1478951523000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVES This study evaluated whether COVID-19-specific risk factors (e.g., feeling guilty for not being present with the deceased at the time of the loss and feeling emotionally distant from the deceased prior to the loss) were associated with prolonged grief disorder (PGD) symptomatology or diagnosis among young adults bereaved due to any cause (e.g., illness and violent loss). METHODS We surveyed 196 young adults who had a family member/close friend die during the COVID-19 pandemic. Participants completed the PGD-12 Questionnaire and the 10-item Pandemic Grief Risk Factors (PGRF) Questionnaire. RESULTS More time spent with the deceased before the loss and greater endorsement of pandemic grief risk factors were associated with increased PGD symptoms and a greater likelihood of meeting the diagnostic criteria for PGD. SIGNIFICANCE OF RESULTS The COVID-19 pandemic created unique risk factors that affected the grieving process for bereaved individuals, regardless of whether the death was related to COVID-19 infection. These findings add to a growing body of literature examining grief and loss within the unique context of the COVID-19 pandemic and suggest that there may be detrimental long-term psychological outcomes for these bereaved individuals, regardless of the cause of death. Routine screening for these unique risk factors in medical and psychological clinics is warranted to help identify those individuals who could benefit from early intervention. Also, it will be important to understand and possibly modify evidence-based interventions and prevention programs to directly address the identified unique PGRF.
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Affiliation(s)
- Sydnie Schneider
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX79409-9819, USA
| | - Peter O Rerick
- Department of Psychology, Oklahoma City University, Oklahoma City, OK, USA
| | - Caroline Cummings
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX79409-9819, USA
| | - Elisabeth McLean
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX79409-9819, USA
| | - Lauren J Breen
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Jonathan Singer
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX79409-9819, USA
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Yıldırım YE. Prevalence of Prolonged Grief Disorder and Related Clinical Factors Among Turkish Psychiatric Outpatients During the COVID-19 Pandemic. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231187296. [PMID: 37386898 PMCID: PMC10315512 DOI: 10.1177/00302228231187296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Prolonged grief disorder (PGD), a new diagnosis in some classification systems, has gained prominence due to the high mortality rates observed during the Covid-19 pandemic. Herein, the prevalence of PGD (diagnosed with structured clinical interviews), death-related features, and associated clinical factors were investigated among outpatient psychiatric patients who lost a first-degree relative within the past 12-24 months. PGD was diagnosed in 30/68 patients (44.1%). PGD development did not differ based on cause of death (Covid-19-related vs. other causes) but was associated with higher age of the bereaved, younger age of the deceased, and degree of kinship. Higher rates of depression, insomnia, and anxious attachment were also observed in PGD patients. Finally, the unexpectedness of death predicted the development of PGD. Due to the high prevalence of PGD among psychiatric patients, clinicians should be aware of the disorder, monitor grief processes in high-risk patients, and consider PGD in treatment planning.
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Singer J, Daum C, Evans A, Schneider S, Vugrin M, Loggers E. An examination and proposed theoretical model of risk and protective factors for bereavement outcomes for family members of individuals who engaged in medical aid in dying: A systematic review. Palliat Med 2023:2692163231172242. [PMID: 37129287 DOI: 10.1177/02692163231172242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Medical Aid in Dying is an end-of-life option that allows a physician to provide a patient with a prescription to end their life. Though Medical Aid in Dying intends to reduce suffering for a patient, opponents argue Medical Aid in Dying may increase suffering for the family members during bereavement. To better understand the bereavement outcomes for family members/friends following Medical Aid in Dying, an exhaustive review of the risk and protective factors for bereavement outcomes is warranted. AIM This systemic review aimed to identify studies that examined bereavement outcomes of family members of individuals who engage in Medial Aid in Dying, identify risk and protective factors for bereavement outcomes, and propose a theoretical model to enhance conceptual clarity. DESIGN A mixed-method systematic review. DATA SOURCES Ten databases were searched on June 16, 2021 and later conducted two updates (latest April 25, 2022). RESULTS Thirteen articles met inclusion criteria. Risk and protective factors were identified pre-Medical Aid in Dying and risk factors post-Medical Aid in Dying. Few studies compared bereavement outcomes for family members of individuals utilizing Medical Aid in Dying to family members who lost someone to natural loss. CONCLUSIONS This study provides equivocal results about the effects of Medical Aid in Dying on family members following the loss. The theoretical model outlines potential risk and protective factors. This model provides a greater understanding of possible universal risk and protective factors for family members of individuals who engaged in Medical Aid in Dying.
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Affiliation(s)
- Jonathan Singer
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Courtney Daum
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Amelia Evans
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Sydnie Schneider
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Margaret Vugrin
- Libraries of the Health Sciences, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Elizabeth Loggers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Oncology, University of Washington, Seattle, WA, USA
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McLean E, Livingston TN, Mitchell SM, Singer J. Perceptions of grief reactions in family members of incarcerated individuals: A vignette-based experiment. DEATH STUDIES 2023; 47:1167-1179. [PMID: 36772949 PMCID: PMC10363178 DOI: 10.1080/07481187.2023.2175391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
We examined perceptions of individuals grieving the loss of a family member to incarceration. Participants (N = 1095) were randomized to a vignette that varied by race-ethnicity, crime type, and grief trajectory to assess their perceptions. Results indicated: (1) participants perceived prolonged grief as less appropriate than resilience; (2) Black family members grieving someone who committed a violent crime as more appropriate compared to White family members; and (3) women endorsed both grief trajectories as more appropriate and indicated greater comfort supporting the family member. Lastly, participants indicated prolonged, White and Latinx grievers should seek therapy more than resilient or Black individuals.
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Affiliation(s)
- Elisabeth McLean
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | | | - Sean M. Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Jonathan Singer
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
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Cherblanc J, Gagnon C, Côté I, Bergeron-Leclerc C, Cadell S, Gauthier G, Boelen PA. French-Canadian validation of the Traumatic Grief Inventory-Self Report (TGI-SR). DEATH STUDIES 2022; 47:430-439. [PMID: 35686539 DOI: 10.1080/07481187.2022.2085347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Jacques Cherblanc
- Humanities and Social Sciences, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Cynthia Gagnon
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires, Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Saguenay, Canada
| | - Isabelle Côté
- Humanities and Social Sciences, Université du Québec à Chicoutimi, Chicoutimi, Canada
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires, Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Saguenay, Canada
| | | | - Susan Cadell
- School of Social Work, University of Waterloo, Waterloo, Canada
| | - Geneviève Gauthier
- Humanities and Social Sciences, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
- ARQ National Psychotrauma Centre, Diemen, Netherlands
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Doering BK, Barke A, Vogel A, Comtesse H, Rosner R. Predictors of Prolonged Grief Disorder in a German Representative Population Sample: Unexpectedness of Bereavement Contributes to Grief Severity and Prolonged Grief Disorder. Front Psychiatry 2022; 13:853698. [PMID: 35558417 PMCID: PMC9090313 DOI: 10.3389/fpsyt.2022.853698] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/01/2022] [Indexed: 12/13/2022] Open
Abstract
Most people adapt to bereavement over time. For a minority, the grief persists and may lead to a prolonged grief disorder (PGD). Identifying grievers at risk of PGD may enable specific prevention measures. The present study examined the extent to which the subjective unexpectedness of the death predicted grief outcomes above and beyond known sociodemographic and objective loss-related variables in a sample drawn from a population-representative investigation. In our sample (n = 2,531), 811 participants (M age 55.1 ± 17.8 years, 59.2% women) had experienced the loss of a significant person six or more months ago. Participants provided demographic and loss-related information, perceptions of the unexpectedness of the death and completed the Prolonged Grief Disorder-13 + 9 (PG-13 + 9). The PG-13 + 9 was used to determine PGD caseness. A binary logistic regression investigated predictors of PGD caseness, and a linear regression predictors of grief severity. ANCOVAs compared PGD symptoms between the groups who had experienced an "expected" vs. "unexpected" loss, while controlling for the relationship to the deceased and time since loss. The loss of a child (OR = 23.66; 95%CI, 6.03-68.28), or a partner (OR = 5.32; 95%CI, 1.79-15.83), the time since loss (OR = 0.99; 95%CI, 0.99-1.00) and the unexpectedness of the death (OR = 3.58; 95%CI, 1.70-7.69) were significant predictors of PGD caseness (Nagelkerke's R2 = 0.25) and grief severity. Participants who had experienced the loss as unexpected (vs. expected) reported higher scores on all PGD symptoms. Unexpectedness of the death emerged as significant risk factor for PGD, even after controlling for demographic and other loss-related variables. While our findings replicate previous research on the importance of the relationship to the deceased as a risk factor for PGD, they also highlight the importance of assessing the subjective unexpectedness of a death and may help to identify risk groups who can profit from preventive interventions.
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Affiliation(s)
- Bettina K Doering
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.,Clinical Psychology and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Antonia Barke
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Anna Vogel
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Hannah Comtesse
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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Specht F, Vöhringer M, Knaevelsrud C, Wagner B, Stammel N, Böttche M. Prolonged grief disorder in Arabic-speaking treatment-seeking populations: Relationship with socio-demographic aspects, loss- and trauma-related characteristics, and mental health support. Front Psychiatry 2022; 13:933848. [PMID: 36186889 PMCID: PMC9520198 DOI: 10.3389/fpsyt.2022.933848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Prolonged grief disorder (PGD) has been included as a new diagnosis in the ICD-11 and is set to be included in the DSM-5-TR. To better identify vulnerable individuals, different factors associated with PGD have to be taken into account, but results regarding these factors remain equivocal. Moreover, few studies on PGD are available from Arabic-speaking populations and from different countries dealing with conflicts and wars. The objective was thus to examine PGD prevalence and associated characteristics in these populations. MATERIALS AND METHODS A total of N = 1,051 bereaved participants from Arabic-speaking populations completed the PG-13 as part of a screening procedure for an online mental health intervention. Multiple linear regression was conducted to examine associated factors for PGD symptom severity, and multiple logistic regression was applied to investigate associated factors for PGD according to PG-13 diagnostic criteria. RESULTS Of the participants, 18.8% (n = 198) met the PGD diagnostic criteria, at an average of about 6 years post-loss. The multiple linear regression yielded eight associated factors for PGD symptom severity (age, gender, number of losses, number of traumatic event types, relationship with the deceased, age at loss, impairment during first year post-loss, perceived social support), which explained 40.2% of the variance [F (17, N=1,033) = 40.82, p < 0.001, R 2 = 0.402]. The multiple logistic regression yielded five significant associations with PGD (gender, relationship with the deceased, number of lost persons, impairment during first year post-loss, perceived social support), which explained 33.0% (Nagelkerke R 2) of the variance in PGD according to PG-13 diagnostic criteria. DISCUSSION A substantial proportion of the participants met the PG-13 criteria for PGD, emphasizing that therapeutic services are indispensable in this population. The associated factors for PGD found in our Arab-speaking sample are largely consistent with those found in studies from other regions. The slightly differing numbers of associated factors between the linear and logistic regression underline that a continuous score reflects the continuum between normal and dysfunctional grieving, and therefore also a range of factors associated with PGD.
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Affiliation(s)
- Freya Specht
- Research Department, Center ÜBERLEBEN, Berlin, Germany
| | - Max Vöhringer
- Research Department, Center ÜBERLEBEN, Berlin, Germany
| | | | - Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Nadine Stammel
- Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Research Department, Center ÜBERLEBEN, Berlin, Germany.,Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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