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Athey A, Kilmer B, Cerel J. An Overlooked Emergency: More Than One in Eight US Adults Have Had Their Lives Disrupted by Drug Overdose Deaths. Am J Public Health 2024; 114:276-279. [PMID: 38382027 PMCID: PMC10882395 DOI: 10.2105/ajph.2023.307550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Alison Athey
- Alison Athey is with The RAND Corporation, Washington, DC. Beau Kilmer is with The RAND Corporation and the Pardee RAND Graduate School, Santa Monica, CA. Julie Cerel is with the College of Social Work, University of Kentucky, Lexington
| | - Beau Kilmer
- Alison Athey is with The RAND Corporation, Washington, DC. Beau Kilmer is with The RAND Corporation and the Pardee RAND Graduate School, Santa Monica, CA. Julie Cerel is with the College of Social Work, University of Kentucky, Lexington
| | - Julie Cerel
- Alison Athey is with The RAND Corporation, Washington, DC. Beau Kilmer is with The RAND Corporation and the Pardee RAND Graduate School, Santa Monica, CA. Julie Cerel is with the College of Social Work, University of Kentucky, Lexington
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Buur C, Zachariae R, Komischke-Konnerup KB, Marello MM, Schierff LH, O'Connor M. Risk factors for prolonged grief symptoms: A systematic review and meta-analysis. Clin Psychol Rev 2024; 107:102375. [PMID: 38181586 DOI: 10.1016/j.cpr.2023.102375] [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] [Received: 06/30/2023] [Revised: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND The diagnosis Prolonged Grief Disorder (PGD) has recently been included in ICD-11 and DSM-5-TR. To identify individuals who need help coping with grief, knowledge is needed about who is at risk of developing PGD. We, therefore, conducted a comprehensive systematic review and meta-analysis of the available literature on risk factors for prolonged grief symptoms (PGS). METHODS Based on a literature search in PsycInfo, PubMed, Web of Science, and CINAHL, we included the most frequently investigated risk factors in a meta-analysis. The effect size correlation was used as the standardized measure of the strength of the association between the risk factor and PGS. RESULTS Based on 120 studies of 61.580 participants published between 1989 and 2023, 19 risk factors were included in the meta-analysis. For the adjusted associations, the strongest associations with PGS were pre-loss grief symptoms (ESr = 0.39, 95%CI[0.24-0.53]) and depression (ESr = 0.30, 95%CI[0.13-0.44]). Small, but statistically significant associations were observed for unexpected death, violent/unnatural death, low educational level, low income, female gender, anxious attachment style, and death of a child or partner. CONCLUSIONS An updated overview of risk factors for PGS is presented, including their predictive strength. The results offer knowledge that can aid prevention and early identification of people at risk of PGD.
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Affiliation(s)
- C Buur
- Unit for Bereavement Research, Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
| | - R Zachariae
- Unit for Psycho-Oncology and Health Psychology, Dept. of Oncology, Aarhus University Hospital and Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - K B Komischke-Konnerup
- Unit for Bereavement Research, Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - M M Marello
- Unit for Bereavement Research, Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - L H Schierff
- Unit for Bereavement Research, Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - M O'Connor
- Unit for Bereavement Research, Dept. of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Lindeman SK, Selseng LB, Lorås L, Løberg AH. Living with sibling' drug use. Bereaved siblings' family stories. Int J Qual Stud Health Well-being 2023; 18:2240576. [PMID: 37506373 PMCID: PMC10392252 DOI: 10.1080/17482631.2023.2240576] [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] [Received: 12/18/2022] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Family members' problematic drug use is challenging for siblings affecting their well-being and their relationships within the family. Research about siblings living with brothers or sisters' problematic drug use and research on bereaved siblings' experiences indicates that life situations and support needs for both minor siblings and adult siblings can easily be overlooked, both in practice and in research. This article contributes to this knowledge gap by examining how siblings provide meaning to their sibling's drug use problem and how they position themselves and other family members accordingly. Qualitative semi-structured interviews were used for data collection, and fourteen bereaved siblings were interviewed. A narrative thematic analysis was chosen, and four themes were generated. These four themes, (1) Surviving difficult family life, (2) The relationships in continuous change, (3) It's worse for the parents, and (4) "We", as a synonym for the family, are presented in this article. Our findings demonstrated how complex and multifaceted siblings' stories about living with their brothers or sisters' ongoing drug use are. This study calls for more attention to siblings' situations. Siblings' lives are affected by their brothers or sisters' problems, and siblings should also be involved in routine support and treatment practices.
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Affiliation(s)
- Sari Kaarina Lindeman
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Lillian Bruland Selseng
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Lennart Lorås
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Aina Helen Løberg
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Kalsås ØR, Titlestad KB, Dyregrov K, Fadnes LT. Needs for help and received help for those bereaved by a drug-related death: a cross-sectional study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:463-481. [PMID: 37969900 PMCID: PMC10634386 DOI: 10.1177/14550725221125378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2023] Open
Abstract
Background and aims: Individuals bereaved after sudden and unexpected deaths can benefit from professional help to cope after the loss, and the bereaved call for proactive, early and flexible help from professional services. Most drug-related deaths (DRDs) happen suddenly and unexpectedly. DRDs are a significant public health issue, yet few studies have examined DRD-bereaved people's needs and experiences with professional help. This article investigates the needs for help and received help reported by DRD-bereaved family members and friends, and suggests improvements in services based on the findings. Data and method: A heterogeneous convenience sample of DRD-bereaved family members and close friends (n = 255) were recruited for a survey from February to December 2018. Descriptive analyses were conducted for experiences with professional help, chi-square analyses to find predictors for help needs and received help, and logistic regression analysis to find predictors for satisfaction with the help provided. Results: Most DRD-bereaved individuals reported a need for professional help after the death regardless of family relation to the deceased, and about half of the participants received help. Nearly half of them were satisfied with the help. Our results indicated higher satisfaction with help among older bereaved, and the participants who received help from a crisis team or psychotherapist. The latter was particularly stated for younger participants. Few participants with children in the family reported that the children had received help, and less than one-third were satisfied with this help. Conclusion: The study shows that younger age groups and children need particular recognition, and a family perspective from services is essential. When assessing the help needs of the DRD-bereaved, relations of both psychological and biological closeness should be recognised. Help efforts should be tailored according to established knowledge of the provided help that bereaved populations deem effective.
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Affiliation(s)
- Øyvind Reehorst Kalsås
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Norway
| | - Kristine Berg Titlestad
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Norway
| | - Kari Dyregrov
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Norway
| | - Lars Thore Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Norway
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Stout JH, Fleury-Steiner B. Stigmatized Bereavement: A Qualitative Study on the Impacts of Stigma for Those Bereaved by a Drug-Related Death. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231203355. [PMID: 37725891 DOI: 10.1177/00302228231203355] [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: 09/21/2023]
Abstract
Research has given limited attention to family and friends bereaved by a drug-overdose death. To examine the ways in which stigma may uniquely impact the grieving processes of the bereaved, a thematic analysis of 35 semistructured in-depth interviews with family members and adult peers who lost a loved one to an overdose was conducted. Our findings demonstrate that the bereaved experience stigmatization after their loss. Specifically, respondents emphasized stigmatizing interactions with law enforcement, alienation from friends and family, a lack of social support, exchanges that enforced feeling rules, and being confronted by narratives of blame and individual choice as contributing to the degrees of stigmatization they experienced. Our findings highlight how bereavement becomes stigmatized to varying degrees through multiple interactions that have a compounding effect on mourners. We refer to this process as stigmatized bereavement, whereby the frequency of such interactions informs the degree of stigmatization the bereaved faces.
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Løseth HM, Selseng LB, Dyregrov K. Barriers and facilitative factors in the provision of first-responder services to persons bereaved following a drug-related death: A qualitative study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:371-390. [PMID: 37663058 PMCID: PMC10472927 DOI: 10.1177/14550725231165445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/08/2023] [Indexed: 09/05/2023] Open
Abstract
Aim: To broaden our knowledge from the perspective of municipality first-responder services of what prevents and what facilitates the provision of professional assistance to the bereaved after a drug-related death during the acute phase. Method: A reflexive thematic analysis was applied in six focus group interviews with 27 first-responder personnel in Norway. Results: The acute phase presented a challenging and complex support situation. We identified two main barriers: failure to initiate services and difficulties meeting with bereaved persons who use drugs. Facilitative factors were associated with competence and proactive cooperation. We discuss the findings in light of associated stigma, disenfranchised grief and an ecological approach to public services. Conclusion: First-responder professionals must understand drug-related death as a potentially traumatising event and initiate the procedures set out in the national guidelines. To achieve this, first-responder health and welfare services must become more knowledgeable about drug-related loss and bereavement, acute grief reactions and the need for psychosocial follow-up.
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Affiliation(s)
| | | | - Kari Dyregrov
- Western Norway University of Applied Sciences, Bergen, Norway
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Løseth HM, Dyregrov K, Selseng LB, Mellingen S. "How Do Municipal Managers Describe Improving the Services Provided to Drug Death-Bereaved Persons?" a Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231178870. [PMID: 37253588 DOI: 10.1177/00302228231178870] [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: 06/01/2023]
Abstract
Bereavement following drug-related losses is potentially traumatizing and may cause adverse health outcomes. These bereaved experiences are unacknowledged and omitted in municipal health and welfare service delivery. Reflexive thematic analysis was applied to six focus group interviews with 26 municipal managers. Knowledge about municipal managers' perspectives for improving psychosocial follow-up to drug-death-bereaved persons was perceived as vital for improving the quality of public services. The findings show how the services are perceived to be affected by macro-, meso, and micro-level processes. The participants suggested that service delivery should be based on an integrated organizational approach. Political, organizational, administrative, financial, and communicative processes are addressed and discussed in light of Osborne's theory of public service logic. The managers argue that a broad, contextual frame and infrastructure, enhancing managers' latitude of action regarding employees and facilitating collaborative service flexibility, would provide more sustainable, competent services.
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Affiliation(s)
- Hilde-Margit Løseth
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Kari Dyregrov
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Lillian Bruland Selseng
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Sonja Mellingen
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Kalsås ØR, Dyregrov K, Fadnes LT, Titlestad KB. The social health domain of people bereaved by a drug-related death and associations with professional help: A cross-sectional study. DEATH STUDIES 2022; 47:926-937. [PMID: 36347016 DOI: 10.1080/07481187.2022.2142329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
People bereaved by traumatic deaths are vulnerable to long-lasting impairments in social health, including the quality of social relationships and the capacity to manage their social lives. In this Norwegian study involving 255 participants bereaved by a drug-related death, we aimed to investigate their social health and associations with professional help. The results of a cross-sectional survey showed that participants on average rated their social health as poor, though with large variations within the group. Participants who reported high satisfaction with professional help reported significantly higher scores on most social health-related variables. More research is needed on professional help focusing on the social health of traumatically bereaved people.
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Affiliation(s)
- Øyvind R Kalsås
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Bergen, Vestland, Norway
| | - Kari Dyregrov
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Bergen, Vestland, Norway
| | - Lars Thore Fadnes
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kristine B Titlestad
- Department of Welfare and Participation, Western Norway University of Applied Sciences, Bergen, Vestland, Norway
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Dyregrov K, Titlestad KB, Selseng LB. Why Informal Support Fails for Siblings Bereaved by a Drug-Related Death: A Qualitative and Interactional Perspective. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221129372. [PMID: 36154325 DOI: 10.1177/00302228221129372] [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: 11/16/2022]
Abstract
Drug-related deaths constitute a significant challenge that strongly impacts the lives of the bereaved and the risks of mental and social problems are well-documented. This paper is the first one to explore how bereaved siblings experience informal support after drug-related deaths. Reflexive thematic analysis is used to analyze ten semi-structured interviews with bereaved siblings. Three main themes were identified: (1) valued support elaborates on the range of desired support and content of the support received; (2) barriers to support were connected to complex family relations, different grief reactions, and stigma, shame, and devaluation; (3) ways to promote support focus on openness and mutual closeness. The discussion revolves around the 'strong' sibling role, complex family relations, stigma, protective silence, and disenfranchised grief. Interactional aspects involved in social support and the importance of addressing this in clinical practice, to utilize the vital support potential for the bereaved experiencing drug-related death, are discussed.
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Affiliation(s)
- Kari Dyregrov
- Western Norway University of Applied Sciences, Bergen, Norway
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Titlestad KB, Kristensen P, O'Connor M, Hystad S, Dyregrov K. Paths to positive growth in parents bereaved by drug-related death: A mixed-method study. Front Psychol 2022; 13:982667. [PMID: 36092064 PMCID: PMC9453645 DOI: 10.3389/fpsyg.2022.982667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Drug-related deaths (DRDs) are a major public health challenge. Losing a child to a DRD can be a very stressful life event, which places parents at risk of mental and physical health problems. However, traumatic experiences like losing a child to DRD can paradoxically also lead to positive psychological changes. A mixed-method approach was used to understand the complexity of the phenomenon of post-traumatic growth experienced by parents following a DRD. Method By combining data from a survey (n = 89) and interviews (n = 14), we explored positive growth experiences among Norwegian parents. We conducted descriptive analyses of the sample’s demographic characteristics and mean scores for Post-traumatic Growth Inventory (PTGI-SF) items. Hierarchical multiple regression was used to examine the influence of the ability to perform daily activities (WSAS), self-efficacy (GSE-SF), social support (CSS), and symptoms of prolonged grief (PG-13) on the outcome variable of post-traumatic growth (PTGI-SF). Reflexive thematic analysis was applied to analyze the qualitative data. Finally, we integrated the results of the survey and the interviews. Results For items measuring post-traumatic growth, parents scored highest on the item “I discovered that I’m stronger than I thought I was” and lowest on the item “I am able to do better things with my life.” Self-efficacy and social support had a statistically significant relation with post-traumatic growth. Two themes were generated from the interviews: (I) new perspectives on life and (II) new paths in life. Even though the “New Possibilities” subscale had the lowest mean score for the PTGI-SF, new paths in life were important for many of the interviewed parents. Discussion Parents described traumatic stressors associated with having a child who uses narcotics and hence experienced positive changes even before losing their child. We argue that on an individual level, the consequences of spillover stigma, low self-efficacy, and intrusive rumination can hinder potential post-traumatic growth. On a group level, enhancing network support may increase post-traumatic growth experiences. Hence, parents who have experienced a DRD can benefit from help to activate their social networks and strengthen their self-efficacy.
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Affiliation(s)
- Kristine Berg Titlestad
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- *Correspondence: Kristine Berg Titlestad,
| | - Pål Kristensen
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Maja O'Connor
- Unit for Bereavement Research, Department of Psychology and Behavioral Science, Aarhus University, Aarhus, Denmark
| | - Sigurd Hystad
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Kari Dyregrov
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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