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Kustanti CY, Chu H, Kang XL, Pien LC, Chen R, Tsai HT, Chou KR. Anticipatory grief prevalence among caregivers of persons with a life-threatening illness: A meta-analysis. BMJ Support Palliat Care 2024; 13:e1074-e1083. [PMID: 35149523 DOI: 10.1136/bmjspcare-2021-003338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/24/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Caring for a family member with a life-threatening illness may lead to increased levels of psychological morbidity. Given the lack of recognition of caregivers' grief, this study aimed to determine the prevalence of anticipatory grief disorders in caregivers of persons with a life-threatening illness for better intervention and management. METHODS CINAHL, Cochrane, Embase, Medline, PubMed, Scopus, PsycINFO and Web of Science were searched up to 21 March 2021 without language and time restrictions. The quality of the included studies was assessed with Hoy's criteria. A random-effects model was applied to calculate pooled prevalence rates, and multi-regression was performed to examine heterogeneity among studies. RESULTS A total of 3278 citations were retrieved, and 18 studies met the eligibility criteria involving 5470 caregivers. The pooled prevalence of anticipatory grief was 24.78% (95% CI 19.04% to 30.99%). The prevalence rates were significantly higher in female caregivers (16.64%; 95% CI 12.24% to 21.53%) compared with male caregivers (6.11%; 95% CI 4.55% to 7.87%). The married group also had a higher risk (14.66%; 95% CI 10.66% to 19.16%) than single group (5.47%; 95% CI 4.31% to 6.76%). CONCLUSIONS The overall pooled prevalence is substantially higher compared with after-loss grief in the general population and supported the presumptions that preloss grief has a greater magnitude compared with after-loss grief. Bereavement support, educational programmes and relevant resources should be delivered even before the actual loss to address the burden of caregivers.
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Affiliation(s)
- Christina Yeni Kustanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum, Yogyakarta, Indonesia
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, University of Pennsylvania, PA, Pennsylvania, USA
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Hsiu-Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Lai C, Aceto P, Pellicano GR, Servidei G, Gambardella A, Lombardo L. Will I or my loved one die? Concordant awareness between terminal cancer patients and their caregivers is associated with lower patient anxiety and caregiver burden. Eur J Cancer Care (Engl) 2021; 31:e13546. [PMID: 34931734 DOI: 10.1111/ecc.13546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aims of this study were to investigate the association between patients' awareness of their terminal illness and the levels of anxiety and depression, whether the concordance between the patients' and caregivers' belief about the patient's terminal illness was associated with patient's anxiety and depression, and with the caregiver burden. METHOD The study recruited 31 terminally ill patients with cancer along with their caregivers from a Palliative Care Unit. All data about patients and caregivers' awareness of the illness, patients' depression and anxiety, and caregiver burden were collected. RESULTS Patients aware of their short-term prognosis of death showed lower levels of anxiety than the unaware ones, especially women. Aware patients with concordant caregivers showed lower levels of anxiety but not of depression. Caregivers concordant with the patients' awareness presented lower levels of strain and burden. Finally, terminal patients who had an adult child caregiver were less likely to be aware of their terminal condition. CONCLUSIONS It appears that illness awareness and the caregiver's concordance with the patient's belief on the terminal condition are associated with lower anxiety, especially in women, and a reduced burden for caregivers.
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Affiliation(s)
- Carlo Lai
- Dynamic and Clinical Psychology, and Health Department, Sapienza University of Rome, Rome, Italy
| | - Paola Aceto
- Department of Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Anaesthesiology and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
| | - Gaia Romana Pellicano
- Dynamic and Clinical Psychology, and Health Department, Sapienza University of Rome, Rome, Italy
| | - Giulia Servidei
- Dynamic and Clinical Psychology, and Health Department, Sapienza University of Rome, Rome, Italy
| | - Aldo Gambardella
- Dynamic and Clinical Psychology, and Health Department, Sapienza University of Rome, Rome, Italy
| | - Luigi Lombardo
- Centro di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
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Calderon S, Samstag LW, Papouchis N, Saunders BA. The Effects of Early Parental Death and Grief on Interpersonal Functioning and Alexithymia in Adults. Psychopathology 2019; 52:198-204. [PMID: 31307047 DOI: 10.1159/000501156] [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: 10/26/2018] [Accepted: 05/24/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Empirical evidence suggests that individuals who have experienced the death of a parent early in life endorse interpersonal difficulties in adulthood. However, little is known about the underlying experiences that may lead to such distress. The current study examined whether individuals who experienced early parental death would endorse greater levels of alexithymia than individuals raised in intact families, and whether early parental death and interpersonal distress were linked through alexithymia and grief. METHODS A total of 160 participants in a parental death group and 183 in a comparison group completed self-report measures online. Statistical analyses were conducted using ANCOVA, mediation analysis, and regression. RESULTS We observed that the parental death group reported greater levels of alexithymia than the comparison group. Second, alexithymia mediated the relationship between early parent death and global interpersonal distress. Third, greater levels of complicated grief were related to greater levels of alexithymic traits in the parental death group. CONCLUSION Results suggest that early parental death results in higher levels of alexithymic traits. Furthermore, alexithymia indirectly leads to interpersonal distress in this population. Finally, the link discovered between grief and alexithymia has important clinical implications.
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Affiliation(s)
- Solara Calderon
- Department of Psychology, Long Island University, Brooklyn, New York, USA,
| | | | - Nicholas Papouchis
- Department of Psychology, Long Island University, Brooklyn, New York, USA
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Romero MM. Meaning Reconstruction in Bereaved Family Caregivers of Person's With Alzheimer's Disease: A Mixed-Methods Study. OMEGA-JOURNAL OF DEATH AND DYING 2018; 82:548-569. [PMID: 30590989 DOI: 10.1177/0030222818821024] [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: 11/15/2022]
Abstract
The purpose of this descriptive study was to identify whether meaning reconstruction was associated with indicators of bereavement adaptation in 66 spouses and adult child caregivers of person's with Alzheimer's disease. A cross-sectional mixed-methods design was used. Hierarchical regression models were used to examine whether meaning making predicted grief, depression, and positive and states of mind in the sample. Qualitative interviews were conducted to gain further knowledge about ways in which Alzheimer's disease caregivers construct meaning during bereavement. The majority of participants reported experiencing positive aspects of meaning reconstruction. Benefit-finding and identity change contributed to reductions in grief, and benefit-finding contributed to positive states of mind. Being a spouse and female gender contributed to increased grief and depression. Bereaved caregivers who are at risk for high levels of grief should be targeted for grief therapy interventions that foster meaning making.
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Lai C, Luciani M, Di Mario C, Galli F, Morelli E, Ginobbi P, Aceto P, Lombardo L. Psychological impairments burden and spirituality in caregivers of terminally ill cancer patients. Eur J Cancer Care (Engl) 2018; 27:e12674. [DOI: 10.1111/ecc.12674] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- C. Lai
- Dynamic and Clinical Psychology; Sapienza University of Rome; Rome Italy
| | - M. Luciani
- Psychiatry and Psychology Institute; Catholic University of Sacred Heart; Rome Italy
| | - C. Di Mario
- Dynamic and Clinical Psychology; Sapienza University of Rome; Rome Italy
| | - F. Galli
- Dynamic and Clinical Psychology; Sapienza University of Rome; Rome Italy
| | - E. Morelli
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca; Rome Italy
| | - P. Ginobbi
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca; Rome Italy
| | - P. Aceto
- Department of Anaesthesiology and Intensive Care; Catholic University of Sacred Heart; Rome Italy
| | - L. Lombardo
- U.O. di Cure Palliative, Fondazione Sanità e Ricerca; Rome Italy
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Lai C, Borrelli B, Ciurluini P, Aceto P. Sharing information about cancer with one's family is associated with improved quality of life. Psychooncology 2016; 26:1569-1575. [PMID: 27935142 DOI: 10.1002/pon.4334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 11/23/2016] [Accepted: 11/25/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between cancer patients' ability to share information about their illness with their social network and attachment style dimensions, alexithymia, and quality of life. We hypothesised that ability to share information about one's cancer with family, friends, and medical teams would be positively associated with quality of life and secure attachment and negatively associated with alexithymia. METHODS Forty-five cancer patients were recruited from the Psycho-oncology Unit of the San Camillo-Forlanini Hospital in Rome. We collected anamnestic data and self-report data on social sharing ability, quality of life, alexithymia, and attachment. RESULTS Sharing with family (B = 4.66; SE = 1.82; β = .52; SE = 0.20; t(41) = 2.6; P = .0143) was the only predictor of global health status, and attachment security was the only predictor of mean social sharing (B = 0.25; SE = 0.06; β = .63; SE = 0.14; t(41) = 4.4; P < .0001). CONCLUSIONS Encouraging patients to share information about their experience of cancer may help to improve their quality of life. Attachment security seems to promote social sharing. Psychological assessments of cancer patients should cover both ability to share information about one's cancer with family and attachment security.
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Affiliation(s)
- Carlo Lai
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Beatrice Borrelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Paola Aceto
- Department of Anesthesiology and Intensive Care, Catholic University of Sacred Heart of Rome, Italy
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Lai C, Luciani M, Galli F, Morelli E, Moriconi F, Penco I, Aceto P, Lombardo L. Persistent complex bereavement disorder in caregivers of terminally ill patients undergoing supportive-expressive treatment: a pilot study. J Ment Health 2016; 26:111-118. [DOI: 10.3109/09638237.2016.1167855] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Carlo Lai
- Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy,
| | - Massimiliano Luciani
- Psychiatry and Psychology Institute, Catholic University of Sacred Heart, Rome, Italy,
| | | | | | - Federica Moriconi
- Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy,
| | | | - Paola Aceto
- Department of Anaesthesiology and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
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Lai C, Luciani M, Galli F, Morelli E, Cappelluti R, Penco I, Aceto P, Lombardo L. Attachment Style Dimensions Can Affect Prolonged Grief Risk in Caregivers of Terminally Ill Patients With Cancer. Am J Hosp Palliat Care 2015; 32:855-860. [DOI: 10.1177/1049909114547945] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Objective: The aim of the present study was to evaluate the predictive role of attachment dimensions on the risk of prolonged grief. Sixty caregivers of 51 terminally ill patients with cancer who had been admitted in a hospice were selected. Methods: Caregivers were interviewed using Attachment Scale Questionnaire, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Prolonged Grief Disorder 12 (PG-12). Results: The consort caregivers showed higher PG-12 level compared to the sibling caregivers. Anxiety, depression, need for approval, and preoccupation with relationships levels were significantly correlated with PG-12 scores. Conclusion: Female gender, high levels of depression, and preoccupation with relationships significantly predicted higher levels of prolonged grief risk.
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Affiliation(s)
- Carlo Lai
- Dynamic and Clinical Psychology, Sapienza University, Rome, Italy
| | - Massimiliano Luciani
- Psychiatry and Psychology Institute, Catholic University of Sacred Heart, Rome, Italy
| | | | | | | | - Italo Penco
- Fondazione Roma, Hospice-SLA-Alzheimer, Rome, Italy
| | - Paola Aceto
- Department of Anaesthesiology and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
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Ando M, Ninosaka Y, Okamura K, Ishi Y. Difficulties in caring for a patient with cancer at the end of life at home and complicated grief. Am J Hosp Palliat Care 2013; 32:173-7. [PMID: 24301084 DOI: 10.1177/1049909113514626] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to investigate difficulties in caring for a patient with cancer at the end of life at home and to examine relationships between difficulties with care and complicated grief. The 45 bereaved family members completed the Family Difficulty Scale (FDS) and the Inventory of Complicated Grief (ICG). The FDS score for "Patient's pain and condition" was the highest, followed by "Caregivers did not want home care" and "No support from others." There was a significant relationship between FDS and ICG scores. These results suggest that the condition of the patient, the view of the caregiver on home care, and the absence of other support are important factors contributing to difficulties of family caregivers, and that these difficulties may lead to complicated grief.
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Affiliation(s)
- Michiyo Ando
- Faculty of Nursing, St Mary's College, Kurume City, Fukuoka, Japan
| | | | | | - Yoko Ishi
- Nasu Red Cross Hospital, Otawara, Tochigi, Japan
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Abstract
Bereavement is a common experience in adults aged 60 and older. Loss of a loved one usually leads to acute grief characterized by yearning and longing, decreased interest in ongoing activities, and frequent thoughts of the deceased. For most, acute grief naturally evolves into a state of integrated grief, where the bereaved is able to reengage with everyday activities and find interest or pleasure. About 7 % of bereaved older adults, however, will develop the mental health condition of Complicated Grief (CG). In CG, the movement from acute to integrated grief is derailed, and grief symptoms remain severe and impairing. This article reviews recent publications on the diagnosis of CG, risk factors for the condition and evidenced-based treatments for CG. Greater attention to CG detection and treatment in older adults is needed.
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Fasse L, Sultan S, Flahault C, MacKinnon CJ, Dolbeault S, Brédart A. How do researchers conceive of spousal grief after cancer? A systematic review of models used by researchers to study spousal grief in the cancer context. Psychooncology 2013; 23:131-42. [DOI: 10.1002/pon.3412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Léonor Fasse
- Institut Curie; Paris F-75006 France
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
| | - Serge Sultan
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
| | - Cécile Flahault
- Institut Curie; Paris F-75006 France
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
| | - Christopher J. MacKinnon
- Department of Educational and Counseling Psychology; McGill University; Montréal Québec Canada
- Palliative Care Research; SMBD Jewish General Hospital; Montréal Québec Canada
- Psychosocial Oncology Program; Montreal General Hospital; Montréal Québec Canada
| | - Sylvie Dolbeault
- Institut Curie; Paris F-75006 France
- Inserm, U 669; Paris France
- Université Paris-Sud and Université Paris Descartes; UMR-S0669; Paris France
| | - Anne Brédart
- Institut Curie; Paris F-75006 France
- Université Paris Descartes; LPPS EA 4057, IUPDP; Paris France
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Lai C, Luciani M, Morelli E, Galli F, Cappelluti R, Penco I, Aceto P, Lombardo L. Predictive role of different dimensions of burden for risk of complicated grief in caregivers of terminally ill patients. Am J Hosp Palliat Care 2013; 31:189-93. [PMID: 23689368 DOI: 10.1177/1049909113490227] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to test whether high levels of caregiver burden, as other confirmed predictors, are associated with the risk of prolonged grief disorder in caregivers of terminally ill patients. A predictive study was carried out in order to test the hypothesis. A demographic schedule, the Prolonged Grief 12 (PG-12), the Toronto Alexithymia Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Caregiver Burden Inventory were administered to 60 caregivers of 51 patients who were admitted in Hospice. In the regression analysis, difficulty in recognizing emotions, total burden, depression, and developmental burden dimension were significant predictors of PG-12 levels. Findings showed that feeling of deprivation of existential expectations represents the greater risk factor for the prolonged grief disorder, among the burden dimensions.
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Affiliation(s)
- Carlo Lai
- 1Dynamic and Clinical Psychology Department, Sapienza University of Rome, Rome, Italy
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