THE LONG-TERM LONELINESS OF WIDOWHOOD: A SYSTEMATIC REVIEW OF MARITAL STATUS DIFFERENCES

Loneliness can be prominent in bereavement, possibly leading to compromised mental and physical health. We systematically reviewed the extent of loneliness across marital status groups, examining the prevalence, intensity, risk factors, and correlates of loneliness in widowhood, compared to other marital statuses. Studies that met predefined criteria as well as investigated marital status (comparisons) were included in the review. For reporting, we followed the PRISMA statement. Thirty-eight studies were included. Widowhood was associated with a greater likelihood and intensity of loneliness when compared to other marital statuses, and especially the divorced. Widowers were on average lonelier than widows. Findings suggest that , widowed persons are uniquely vulnerable to loneliness, and that, in the long-term, loneliness may be more pronounced among the widowed than the divorced. However, methodological shortcomings (e.g., heterogenous samples, different measures of loneliness) of available studies must be considered, and future research should aim to overcome these limitations.

The ICD-11 and DSM-5-TR prolonged grief criteria: Validation of the Traumatic Grief Inventory-Self Report Plus using exploratory factor analysis and item response theory

More recently, the prolonged grief disorder (PGD) has been recognized as a mental health disorder following bereavement, which is distinct from depression and PTSD. However, the number and proposed symptom items vary across the ICD-11 and the DSM-5-TR criteria for PG. The Traumatic Grief Inventory-Self Report Plus (TGI-SR+), which is an updated version of the TGI-SR, is currently the only robust instrument that assesses PG according to the ICD-11 and DSM-5-TR criteria. For research and clinical use among French-speaking countries, the forward-backward procedure was applied to translate the TGI-SR+ into French language. Exploratory factor analysis and parallel analysis converged towards a two-dimensional structure for the TGI-SR+, representing adaptation difficulties and traumatic separation distress. However, items mapping onto ICD-11 and DSM-5-TR criteria for PG represented a one-dimensional structure. Findings based on item response theory method provided strong evidence for discriminative characteristics of the items The internal reliability was excellent for the TGI-SR+ (McDonald's ω = .97) and ICD-11 and DSM-5-TR criteria for PGD (McDonald's ω = .95, respectively). We also demonstrated a very high temporal stability for the TGI-SR+ total score (ICC = .91, p < .0001) and ICD-11 PGD and DSM-5-TR PGD (ICC = .90, and ICC =.88, ps < .0001, respectively). The concurrent validity of the instrument was also demonstrated, such that the TGI-SR+ total score and all combinations were positively and significantly associated with the levels of depression, anxiety, and post-traumatic stress symptoms. However, the effect sizes were moderate. We conclude that for research and clinical use among French bereaved populations, the TGI-SR+ is a sound tool with very good psychometric properties.

Online cognitive-behavioural therapy for traumatically bereaved people: study protocol for a randomised waitlist-controlled trial

INTRODUCTION

The traumatic death of a loved one, such as death due to a traffic accident, can precipitate persistent complex bereavement disorder (PCBD) and comorbid post-traumatic stress disorder (PTSD) and depression. Waitlist-controlled trials have shown that grief-specific cognitive-behavioural therapy (CBT) is an effective treatment for such mental health problems. This is the first study that will examine the effectiveness of online CBT (vs waitlist controls) in a sample exclusively comprised of people bereaved by a traumatic death. Our primary hypothesis is that people allocated to the online CBT condition will show larger reductions in PCBD, PTSD and depression symptom levels at post-treatment than people allocated to a waitlist. We further expect that reductions in symptom levels during treatment are associated with reductions of negative cognitions and avoidance behaviours and the experience of fewer accident-related stressors. Moreover, the effect of the quality of the therapeutic alliance on treatment effects and drop-out rates will be explored.

METHODS AND ANALYSIS

A two-arm (online CBT vs waiting list) open-label parallel randomised controlled trial will be conducted. Participants will complete questionnaires at pretreatment and 12 and 20 weeks after study enrolment. Eligible for participation are Dutch adults who lost a loved one at least 1 year earlier due to a traffic accident and report clinically relevant levels of PCBD, PTSD and/or depression. Multilevel modelling will be used.

ETHICS AND DISSEMINATION

Ethics approval has been received by the Medical Ethics Review Board of the University Medical Center Groningen (METc UMCG: M20.252121). This study will provide new insights in the effectiveness of online CBT for traumatically bereaved people. If the treatment is demonstrated to be effective, it will be made publicly accessible. Findings will be disseminated among lay people (eg, through newsletters and media performances), our collaborators (eg, through presentations at support organisations), and clinicians and researchers (eg, through conference presentations and scientific journal articles).

TRIAL REGISTRATION NUMBER

NL7497.

Creative arts in psychotherapy for traumatized children in South Africa: An evaluation study

Aim

To evaluate the feasibility and effect of a 10-session creative arts in psychotherapy group programme on posttraumatic stress symptoms, behavioural problems, and posttraumatic growth, in children who experienced a traumatic event.

Design

A multicentre non-randomized controlled trial with a treatment and a control condition conducted in South Africa (4 sites).

Methods

125 children aged 7 to 13 years were assigned either to the treatment condition receiving creative arts in psychotherapy or a control condition with a low-level supportive programme without treatment. Attrition rates were 63.4% and in total 47 children completed the programme and questionnaires assessing posttraumatic stress, posttraumatic growth and behaviour problems both at baseline and follow-up; 23 in the treatment group and 24 in the control group. Adjusted mean differences were analysed using ANCOVA with bootstrapping.

Results

Results showed that both hyperarousal symptoms (d = 0.61) and avoidance symptoms (d = 0.41) decreased more in the treatment group compared to the control group. There was no significant effect of the intervention found for reported levels of behavioural problems and posttraumatic growth.

Conclusion

In spite of severe challenges implementing and executing this pioneering study in underprivileged areas of South Africa, support was found for creative arts in psychotherapy reducing hyperarousal and avoidance symptoms, but not for other symptoms. Valuable lessons were learned on feasibility of implementing this intervention in a developing context.

Delighted when approved by others, to pieces when rejected: children's social anxiety magnifies the linkage between self- and other-evaluations

BACKGROUND

Socially anxious children tend to attach great importance to others' evaluations of them. However, the extent to which they base their momentary feelings of self-worth (i.e., state self-esteem) on social (dis)approval is unclear. It is also unclear whether this exceedingly approval-based self-esteem is a common correlate of social anxiety and depression, or specifically linked to one or the other.

METHODS

Changes in children's state self-esteem were obtained in response to a manipulated peer evaluation outcome. Participants (N = 188) aged 10 to 13 took part in a rigged online computer contest and were randomized to receive positive or negative peer feedback. Self-reported state self-esteem was assessed via computer at baseline and immediately post-feedback. The predictive effects of self-reported social anxiety and depression symptoms on changes in state self-esteem were investigated.

RESULTS

Hierarchical multiple regression analyses showed that children with higher social anxiety, as indexed by the fear of negative evaluation component, experienced significantly stronger increases in state self-esteem following peer approval (β = .26, p < .05), and significantly stronger decreases in state self-esteem following peer disapproval (β = -.23, p < .05). In both conditions depressive symptoms did not predict changes in state self-esteem (ps > .20).

CONCLUSIONS

Socially anxious children's state self-esteem is strongly contingent on social approval. Because basing one's self-esteem on external validation has multiple negative consequences, these findings highlight the importance of teaching these children skills (e.g., making cognitive reappraisals) to weaken the linkage between other- and self-evaluations.

Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11

BACKGROUND

Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction.

METHODS AND FINDINGS

A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment.

CONCLUSIONS

The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for Editors' Summary.

Is UV-B radiation affecting charophycean algae in shallow freshwater systems?

The objective of this study was to determine the effects of UV-B radiation on charophycean algae under natural conditions, since charophytes enhance water transparency in freshwater systems and levels of UV-B radiation have increased by ozone depletion. Potential and actual UV-B effects were studied by combining a glasshouse experiment in which plants were exposed to various levels of UV-B radiation and field measurements in two freshwater systems dominated by charophytes in the Netherlands. The glasshouse experiment showed that charophytes were sensitive to UV-B radiation. UV-B radiation negatively affected growth, while it increased levels of DNA damage in Chara aspera. Moreover, the charophytes did not seem to develop UV-B screens to protect against UV-B radiation since no increase in UV-B absorbing compounds was found. At field conditions, both spectroradiometrical measurements and DNA dosimeters showed that UV-B radiation was attenuated quickly in both freshwater systems, indicating that UV-B does not reach the submerged charophyte vegetation. However, specific conditions, like fluctuating water tables, may result in UV-B exposure to charophytes for certain periods annually.

Diel patterns of UVBR-induced DNA damage in picoplankton size fractions from the Gulf of Aqaba, Red Sea

This study focuses on the impact of natural levels of UVBR (ultraviolet-B radiation: 280 to 315 nm) on bacterio- and phytoplankton (<10 microm) from the Gulf of Aqaba, Red Sea. Incident biologically effective doses (BEDs) and attenuation of biologically effective radiation in the water column were measured using a DNA biodosimeter. UVBR-induced DNA damage was measured as cyclobutane pyrimidine dimers (CPDs), using an antibody directed to CPDs followed by chemiluminescent detection. Depth profiles of DNA damage were determined in two plankton size fractions (0.2 to 0.8 microm and 0.8 to 10 microm) collected down to 50 m depth. Furthermore, accumulation and removal of CPDs were monitored in surface plankton samples during several daily cycles. Small plankton (plankton <10 microm) composition was determined by flow cytometry. The plankton community in the Gulf of Aqaba was dominated by nonphototrophic bacteria and the free-living prochlorophyte Prochlorococcus spp. (<0.8 microm). In general, no DNA damage could be detected in dosimeter DNA below 15 m. In contrast, DNA damage (up to 124 CPD Mnucl-1) could be detected in all bacterio- and phytoplankton samples. DNA damage accumulated throughout the day, indicating that plankton in the Gulf of Aqaba undergo UVBR stress via CPD induction. Although the numbers of CPDs decreased during darkness, both size fractions showed some residual DNA damage at the end of the night. This suggests that dark repair processes did not remove all CPDs, or that part of the plankton community was incapable of repair at all. CPD levels in the two size fractions showed no significant differences in situ. During full solar radiation exposures (samples incubated in bags), more CPDs were detected in the smaller (0.2 to 0.8 microm) size fraction as compared to the larger (0.8 to 10 microm) size fraction. In these experiments, initial plankton composition was significantly different from the field samples. This implies that a shift in the population structure or irradiance conditions can lead to a significant change in UVBR sensitivity. In conclusion, the results show that the picoplankton-dominated phyto- and bacterioplankton communities in the clear surface waters from the Gulf of Aqaba undergo UVBR stress. Repair pathways are not sufficient to eliminate damage during or after UVBR exposure hours, suggesting photomortality as a potential loss parameter of the plankton community.