Anxiety sensitivity in bereaved adults with and without complicated grief

Differential correlates of prolonged grief and depression after bereavement in a population-based sample

Bereavement can lead to prolonged grief disorder (PGD) as well as episodes of major depression. Studies on the prevalence of PGD and its differences from postbereavement depression have not been conclusive. This study compared the correlates of depression and prolonged grief (PG) symptoms in a population-based random sample (N = 535) using the Beck Depression Inventory, Inventory of Complicated Grief-Revised, Anxiety Sensitivity Index (ASI), and Adult Separation Anxiety Questionnaire (ASAQ). Correlates of PG and depressive symptoms were examined using linear regression in 328 bereaved respondents. The prevalence of probable PGD based on PGD-2009 criteria was 3.0% among bereaved respondents and 1.9% in the total sample. PG was related to bereavement-related features including sex of the deceased, β = - .110, p = .026; time since loss, β = - .179, p = .001; the number of lifetime losses experienced, β = .157, p = .016; and perceived closeness with the deceased, β = .214, p < .001. Only lower income of the bereaved predicted depression, β = - .139, p = .018. In women, but not in men, the loss of a male family member (i.e., brother or son) was a significant predictor of PG symptoms, β = - .180, p = .006. The results confirm the qualitative distinction between depression and PG in a nonclinical sample and show that PG is mainly related to the intrinsic and extrinsic characteristics of the deceased or of death, whereas depression relates only to the characteristics of the bereaved person.

Music therapy for supporting informal carers of adults with life-threatening illness pre- and post-bereavement; a mixed-methods systematic review

BACKGROUND

Music therapy interventions with informal carers of individuals with life-threatening illness at pre- and post-bereavement is an increasingly important clinical area. This systematic review is the first to synthesise and critically evaluate the international evidence associated with music therapy with adult informal carers pre- and post-bereavement. Specifically, the objectives were: i) to describe the characteristics and effectiveness of music therapy interventions which aim to improve health-related outcomes for adult informal carers of adults with life-threatening illness (pre- and post-bereavement), and ii) to describe the experience of music therapy for adult informal carers of adults with life-threatening illness (pre- and post-bereavement).

METHODS

Eligibility: adult informal carers of adults at end of life or bereaved; music therapy interventions for improving health-related outcomes; qualitative; mixed-method; and quantitative studies including comparators of any other intervention; published in English from 1998 onwards. Six databases were searched up to July 2022. A JBI mixed-methods systematic review approach was followed throughout, including quality appraisal, data extraction and a convergent segregated approach to synthesis and integration.

RESULTS

A total of 34 studies were included, published between 2003 and 2022. Most were conducted in North America (n = 13), Australia (n = 10), or Europe (n = 8). No studies were conducted in low- and middle-income countries or in the UK. The majority were qualitative (n = 17), followed by quasi-experimental (n = 8), mixed-methods (n = 7) and two RCTs. The majority focused on carers of individuals with dementia (n = 21) or advanced cancer (n = 7). Seventeen studies were purely quantitative or included a quantitative component. During meta-synthesis, findings were aligned to core outcomes for evaluating bereavement interventions in palliative care and previously identified risk factors for complicated grief. Commonly targeted outcomes in quantitative studies included quality of life and mental wellbeing, showing equivocal effectiveness of music therapy with significant and non-significant results. Twenty-two studies either purely qualitative or with a qualitative component underwent meta synthesis and suggested a diverse range of improved pre- and post-bereavement outcomes for informal carers across all core outcomes, and across all risk and protective factors, including psychological, spiritual, emotional, and social outcomes.

CONCLUSIONS

Qualitative studies provide moderate to strong evidence for improved health-related outcomes for adult informal carers of adults with life-threatening illness pre-bereavement. Limited studies including those bereaved negates conclusions for the bereavement phase. Comparisons and explanations for effectiveness across quantitative and qualitative studies are equivocal, with a high risk of bias and small samples in the limited number of quantitative studies, demonstrating a need for high-quality RCTs.

SYSTEMATIC REVIEW PRE-REGISTRATION

PROSPERO [CRD42021244859].

Personality and Grief-Related Panic Attacks: Analysis of Neuroticism, Worry, and Anxiety Sensitivity

Grief-related panic attacks (GRPAs) are a relatively common yet debilitating psychological reaction to loss, the mechanisms of which remain poorly understood among scholars. The purpose of this study was to identify the personality traits that underlie GRPAs in a sample of 314 bereaved adults. The results indicate that GRPAs were relatively common (55.4%) and that anxiety sensitivity uniquely predicted both frequency and impairment associated with these kinds of attacks, while taking into account the effects of neuroticism, trait worry, grief, and gender. Findings suggest that anxiety sensitivity may be a risk factor for GRPAs and magnified grief for some mourners. Clinical implications and future directions are discussed.

Anxiety Sensitivity Moderates the Association Between Peritraumatic Distress and Bereavement Outcomes Among Sudden Loss Survivors

Peritraumatic distress and anxiety sensitivity are associated with complications in bereavement, including posttraumatic stress and prolonged grief reactions. The extent to which these factors interact to contribute to bereavement-related distress, however, remains unclear. This study investigates whether anxiety sensitivity moderates the association between peritraumatic reactions and posttraumatic stress and prolonged grief symptoms in a sample of young adults with a history of bereavement due to sudden, unexpected deaths. Participants were 606 undergraduate students recruited from two US universities. Results suggest that peritraumatic emotional and physical distress and anxiety sensitivity are all independently associated with both posttraumatic stress and prolonged grief reactions. Furthermore, the association between peritraumatic distress and prolonged grief, but not posttraumatic stress, is moderated by anxiety sensitivity. These findings point to several potentially important, clinically modifiable factors associated with a variety of bereavement-related mental health problems among a vulnerable group of grievers.

Complicated Grief: Risk Factors, Protective Factors, and Interventions

Complicated grief (CG) poses significant physical, psychological, and economic risks to bereaved family caregivers. An integrative review of the literature published 2009-2018 on CG associated with caregiving was performed using PubMed, PsychINFO, and Web of Science. The search returned 1428 articles, of which 32 were included in the review. Sixteen studies described risk and protective factors and 16 described interventions for CG. Caregiver-related risk factors included fewer years of education, depression, anxiety, poor physical health, and maladaptive dependency and attachment traits. Additional risk factors included lower perceived social support, family conflict at end-of-life, and family having difficulty accepting death. Care recipient-related risk factors are younger age, fear of death, and place of death. Protective factors included hospice utilization in reducing fear of death, high pre-bereavement spiritualty, and satisfaction with palliative care. Complicated grief treatment was the most widely-studied intervention. Social Workers and other clinicians can use this information to identify family caregivers at increased risk for CG and refer or implement an early intervention to lessen its impact.

The Influence of Anxiety Sensitivity on a Wish to Die in Complicated Grief

Individuals with complicated grief are at elevated risk of suicidal thoughts. Anxiety sensitivity has recently emerged as a risk factor of suicide. This study aimed to investigate a possible association between anxiety sensitivity and a wish to die in individuals with complicated grief. Participants were evaluated for participation in a treatment study and completed an ancillary questionnaire-based study. Participants were 51 bereaved adults evaluated (age: mean, 54 [SD, 13.6] years; 78% [n = 40] women). Logistic regression was used to examine the relationship between anxiety sensitivity and a wish to die. Overall, anxiety sensitivity was associated with a wish to die at the level of a medium effect size, although it did not reach statistical significance. The anxiety sensitivity social concerns subscale was significantly associated with a wish to die. These findings add to a growing literature implicating anxiety sensitivity in reporting a wish to die.

Grief-related panic symptoms in Complicated Grief

BACKGROUND

Although Complicated Grief (CG) has been associated with comorbid Panic Disorder (PD), little is known about panic attacks in CG, and whether panic symptoms may be grief-related. The present study examines the presence and impact of grief-related panic symptoms in CG.

METHODS

Individuals with CG (n=146, 78% women, mean (SD) age=52.4(15.0)) were assessed for CG, DSM-IV diagnoses, work and social impairment, and with the Panic Disorder Severity Scale modified to assess symptoms "related to or triggered by reminders of your loss" and anticipatory worry.

RESULTS

Overall, 39.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and 32.2% reported some level of anticipatory worry about grief-related panic. Of interest, 17% met DSM criteria for PD. Among those without PD, 34.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and this was associated with higher CG symptom severity (t=-2.23, p<0.05), and functional impairment (t=-3.31, p<0.01). Among the full sample, controlling for CG symptom severity and current PD, the presence of at least one full or limited-symptom grief-related panic attack was independently associated with increased functional impairment (B(SE)=4.86(1.7), p<0.01).

LIMITATIONS

Limitations include a lack of assessment of non-grief-related panic symptoms and examination of a sample of individuals seeking treatment for CG.

CONCLUSIONS

Grief-related panic symptoms may be prevalent among individuals with CG and independently contribute to distress and functional impairment.

Duelo prolongado y factores asociados

Objetivo: Describir factores asociados a la presencia de Duelo Prolongado (DP) medido con el cuestionario Prolonged Grief Disorder-13 (PG-13) en pacientes que han perdido a un ser querido entre 6 y 18 meses.Método: Estudio transversal. Dolientes mayores de edad procedentes de atención primaria, hospitales de cuidados paliativos y un equipo de soporte a la atención domiciliaria paliativa en Madrid. Se recogieron variables del fallecido y del doliente: sociodemográficas, socioeconómicas, antecedentes psiquiátricos, utilización de recursos sanitarios, Trastorno por Ansiedad Generalizada (TAG), apoyo social, percibido y duelo prolongado con PG-13 y el Inventario Texas Revisado de Duelo (ITRD). Se calcularon medidas de tendencia central y distribución de frecuencias, se calculo asociación entre variables con c2 y t-student, se ajustó modelo multivariante.Resultados: La prevalencia de DP fue de 7,023%. La presencia de DP se asoció significativamente con ser mujer, no tener trabajo, ingresos familiares bajos, fallecido más joven, enfermedad no susceptible de recibir cuidados paliativos, historia de ansiedad y/o depresión antes y después de la pérdida, haber consultado a un psiquiatra, haber tomado psicofármacos, una mayor frecuentación de los servicios de urgencias, medicina y enfermería de atención primaria, con TAG, EDM, apoyo social percibido bajo y DP según los criterios del ITRD. En el análisis multivariante se asoció con haber visitado al psiquiatra, EDM y con ingresos mensuales inferiores a 2.000 euros.Conclusiones: Podemos modificar pocos de estos factores, pero conocerlos e identificar con prontitud a estos pacientes nos permitirá derivarlos a tratamientos apropiados como terapia específica de duelo.