Meaning-Centred Coping Predicted Lower Depressive Symptoms among Caregivers with Complicated Grief

Background

Complicated grief is characterised by persistent low mood, intense distress and cognitive impairment. This study aimed to explore coping strategies (i.e. emotion-, problem- and meaning-centred) used by bereaved individuals facing complicated grief and how these strategies may predict psychological and cognitive outcomes.

Methods

In a cross-sectional study, 20 bereaved individuals (5 males, 15 females) that aged 27 years old-65 years old (mean = 42.25, standard deviation [SD] = 9.30) were recruited following the loss of a loved one due to physical illness. Participants were screened for complicated grief and subsequently completed self-report assessments of coping strategies and depressive symptoms using Brief Grief Questionnaire (BGQ), Brief Coping Orientation to Problems Experienced (COPE) Questionnaire, Meaning-Centered Coping Scale (MCCS) and Patient Health Questionnaire-9 Items (PHQ-9). Following that, participants underwent a neurocognitive assessment of working memory using the 2-Back task.

Results

Caregivers with complicated grief suffered from moderate severity of depressive symptoms (mean = 17.45, SD = 4.43) as they were coping with the losses. Furthermore, the findings showed that MCC significantly predicted lower levels of depressive symptoms (b = -0.50, t (16) = -2.25, P = 0.04). However, coping strategies did not significantly predict working memory performance.

Conclusion

These findings highlight the potential benefits of MCC in alleviating depressive symptoms in bereaved individuals and underscore its contribution to the development of grief interventions. Grief therapists can emphasise this coping strategy to promote healing and resilience in patients in the grief work.

Maladaptive Personality Characteristics, Coping and Situational Factors Predict Symptoms of Complicated Grief and Health Difficulties

Grief responses range from minimal changes in functioning to debilitating, prolonged, complicated grief. The objective of the current study was to clarify the relationship between maladaptive personality characteristics, coping and situational factors associated with symptoms of complicated grief and health difficulties among bereaved individuals who had lost a loved one within the past six months to two years (N = 304; 59% male; M age = 33.49, SD = 9.98, range 20-81). Situational risk factors, coping (self-distancing, denial, substance use, positive reframing, acceptance, religion, self-blame, behavioral disengagement, venting and humor) and maladaptive personality traits significantly predicted either symptoms of complicated grief or health difficulties. Coping strategies partially mediated the relationship between maladaptive personality traits and symptoms of complicated grief and health difficulties. Overall, these findings highlight the importance of maladaptive personality traits and coping strategies in the conceptualization of complicated grief and should be a greater focus of clinical intervention.

Why Does Grief Hurt?

Abstract. Grief is a major physical and psychological health concern for adults, as well as a key risk factor for depression. The direct and indirect costs of depression in adults place heavy burdens on societal resources. Indeed, bereavement is a stressful and profound life experience, with the grieving process combining reactions to a loss that may originate in complications for bereaved individuals. The goal of this systematic review is to synthesize the findings regarding depression and grief. Studies related to the topic were obtained from multiple databases through rigorous exclusion and inclusion criteria. Only empirical studies with quantitative methodologies were included. Objectives, sample (type of sample, % male, and age), instruments, and main conclusions were extracted from each study. Overall, there are personality and contextual factors that, in addition to affecting depressive reactions following a loss, may also interface with one’s ability to grieve. Furthermore, after the patient’s death, there was a decrease in depressive symptoms over time, indicating that these symptoms are dynamic. Individuals who experience prolonged grief exhibit depressive symptoms, and those who suffer a loss may have depressive symptoms, but in a natural and non-pathological way, that is, sadness and not depression. Depression tends to decrease over time, with the existence of more children and a focus on occupation.

Conflicted or close: Which relationships to the deceased are associated with loss-related psychopathology?

OBJECTIVES

Prior studies have shown that pre-loss closeness and conflict with a deceased person are associated with the severity of symptoms of prolonged grief and/or depression. Nevertheless, mechanisms underlying these relationships are not well understood. We propose a theoretical model in which past closeness and conflict are related to prolonged grief and depression via concrete and symbolic continuing bonds (CB). The aim of our study was to test this model in a sample of bereaved family members.

METHODS

Individuals (N = 244) who had lost a family member from 0.5 to 8.0 years before the survey completed the Quality of Relationships Inventory-Bereavement Version, the Continuing Bonds Scale, the Prolonged Grief Disorder-13 scale, and the Patient Health Questionnaire-9.

RESULTS

The findings partially confirmed our model. Closeness was positively and moderately associated with symptoms of prolonged grief but not with symptoms of depression. Conflict was positively and weakly associated with symptoms of depression and prolonged grief. All of these relationships were only partially mediated by concrete/maladaptive and symbolic/adaptive CB.

CONCLUSIONS

The differences in the relationship of past closeness and conflict to prolonged grief and depression symptoms suggest that inter- and intrapersonal mechanisms of prolonged grief and depressive symptoms may be distinct. If future, especially longitudinal studies, confirm our model, CB would be a possible target for interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience loss-related psychopathology.

PRACTITIONER POINTS

Continuing bonds (CB) are a potential target of interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience symptoms of prolonged grief and/or depression. Internalization of the capacity to care for yourself and feel autonomous in a safe and stable therapeutic relationship may lead to increased self-confidence, promote working through past experiences in the relationship with the deceased, and gradual reduction of concrete forms of CB. Increasing awareness and acceptance of emotional experiences may contribute to the appreciation of past relationship with a deceased person and the growth of symbolic forms of CB. Future research should focus on verifying the effectiveness of the attachment-informed therapeutic approach to working with CB.

Associations between interpersonal dependency and severity of prolonged grief disorder symptoms in bereaved surviving family members

BACKGROUND

Several studies have shown that interpersonal dependency is a risk factor for prolonged grief disorder (PGD), a disorder that has been recently approved by the American Psychiatric Association Assembly for inclusion in the Diagnostic and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-TR). Nevertheless, it remains unclear whether this relationship is independent of depression, which may also be related to both loss and interpersonal dependency. Furthermore, anaclitic dependency (maladaptive and immature) compared to relatedness (more adaptive and mature) dependency, and the relationships between these types of dependency and PGD, have not been examined. The aim of the present study was to determine how anaclitic and relatedness dependency are associated with PGD symptom severity, controlling for depressive symptom severity, over and above potential sociodemographic and loss-related confounder variables.

METHODS

Participants (N = 241) bereaved after the death of a family member from 0.5 to 8 years before the survey (M = 3.36, SD = 2.02) completed the Depressive Experiences Questionnaire, the Patient Health Questionnaire-9, and the Prolonged Grief Disorder-13 scale (PG-13).

RESULTS

A hierarchical regression analysis confirmed that anaclitic dependency is positively associated with PGD symptom severity, even when controlling for depression severity and other potential confounder variables. There was no significant association between relatedness dependency and PGD.

CONCLUSIONS

To assess the risk of PGD in individuals bereaved after the death of a family member, it is important to assess anaclitic dependency.

Polish adaptation of the quality of relationships inventory-Bereavement version

We examined the psychometric properties of the Polish version of the Quality of Relationships Inventory-Bereavement Version (QRI-B) in a sample of 241 persons bereaved after the death of a family member from 0.5 to 8 years (M = 3.36, SD = 2.02) before the survey. A good fit of the original two-factor (Closeness and Conflict) model of the QRI-B was determined by confirmatory factor analysis. Cronbach's alpha was .91 for Closeness and .84 for Conflict. Closeness correlated negatively with attachment avoidance and Conflict correlated positively with attachment anxiety. The Polish version of the QRI-B is a valid and reliable measure of the quality of the pre-loss relationship with the deceased.