•Psychological distress intensified in individuals who lost close ones due to COVID-19.•Psychological distress intensified in individuals who presents psychiatric diagnostic previously to ...COVID-19.•Increase of symptoms of anxiety, depression, phobia, paranoia, hostility, interpersonal subjectivity, obsessive compulsive disorder, and psychoticism in individuals who presents previously psychiatric diagnostic and who lost close ones due Covid-19.
The COVID-19 pandemic has been a disturbing experience of proximity to death. As the pandemic goes on, the mixed experience of loss of a close family or friends added to the unpredictability of economic changes and the social isolation can elicit negative manifestations of affection, and psychological distress. The whole experience negatively affects individuals with or without previous mental health disorders. Objective: The present study is a cohort aimed to analyze the effect of the salience of mortality during the covid-19 pandemic on the mental health of a sample of the Brazilian population. Method: 9,024 Brazilians were evaluated based on the data collection performed through the online Brief Symptom Inventory (BSI), during the social isolation period. Participants were divided into four groups, G1 (2,256) without previous history of mental disorders (MD), G2 (2,256) with a previous history of MD and both no loss of family or friends due to direct effect of SARS-COV2 infection, G3 (2256) with a previous history of MD and without a loss and G4 (2256), with a prior MD and reported a loss of family or friend due to direct effect of SARS-COV2 infection. The group data was analyzed using the covariance analysis - ANCOVA. Results: The loss of a family member or friend due to direct effect of SARS-COV2 infection amplifies psychological distress. This effect seems to be dramatically increased in individuals with a previous history of mental disorders. The population with loss should be target of mitigation actions to minimize the pandemic effects.
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Prolonged grief disorder has recently been added to the International Classification of Diseases, 11th edition and the Diagnostic and Statistical Manual of Mental Disorders 5, Text Revision. This ...historical development is often presented as a linear process culminating in the inclusion of valid, clinically relevant prolonged grief disorder criteria in diagnostic handbooks. The present contribution provides an overview of work contradicting this dominant narrative. First, I show that the developmental history of prolonged grief disorder has been nonlinear and that this yields questions on generalizability and problems with measurement of the newest criteria sets. Second, I highlight an important gap in the validity evidence: the distinction of prolonged grief disorder from normal grief. Third, I discuss concerns relating to the societal effects of the inclusion of prolonged grief disorder in diagnostic handbooks, including the medicalization of grief, development and adverse effects of pharmacotherapy and stigmatization. A more realistic, balanced view on the history, validity and societal impact of prolonged grief disorder appears appropriate. I recommend stringent validation of assessment instruments for prolonged grief disorder, convergence of criteria-sets, closing gaps in validity evidence and developing strategies to mitigate the negative effects of grief diagnoses.
Sibling bereavement is one of the most distressing adverse life events during childhood but has received less attention in research than other forms of childhood bereavement. This integrative review ...identifies potential risk and protective factors for maladaptive coping following sibling bereavement and the influence of these factors on adjustment to loss.
Articles were limited to peer-reviewed studies, published in English in 2000 and beyond. Target population was bereaved siblings 0–18 years, and outcomes examined grief experiences by child self-report or parent-proxy report.
The Whittemore and Knafl integrative framework was applied. Multidimensional Grief Theory guided the review with twenty-five studies synthesized across its domains: Separation Distress, Existential/Identity Crisis, and Circumstance-Related Distress.
Adjustment following sibling death is a complex process associated with a host of risk and protective factors that contribute to the bereavement process for this population. Age, sex, circumstance-related factors, continuing bonds, parental distress, and limited social support were critical influencing factors.
Definitive predictor variables were not identified but a combination of variables that influence the adjustment of bereaved siblings are discussed.
Future research is needed to explore the risk and protective factors of maladaptive coping to inform intervention development to promote individual and family adjustment following sibling death.
•This review is the first known to synthesize the current state of the science on grief experiences of siblings.•We examine and integrate literature on risk and protective factors for maladaptive grief.•Sibling bereavement is one of the most distressing childhood life events.•Bereaved siblings are at risk for negative physical and psychological outcomes.•Sibling bereavement is influenced by individual factors and socioenvironmental contexts.
Aims:
The purpose of this systematic literature review is to describe the interventions for bereaved parents, evaluate intervention effectiveness through study methodology rigor, replicability, and ...theoretical foundations.
Methods:
We searched MEDLINE via PubMed (1966-2018), CINAHL (1937-present), PsycINFO (1887-present), and Embase (1947-present) using various search words and MeSH terms related to the study purpose. A blinded screening of title/abstract was performed, with conflicting inclusion decisions resolved through group discussions. Matrices for remaining articles were created and discussed among the team. The levels of evidence of the 9 records were rated from very low to high based on the Grading of Recommendations Assessment, Development, and Evaluation guidelines.
Results:
Our initial pool included 1025 articles. After the screening of titles/abstracts, 63 articles were retained for full-text reviews. Evaluated based on the inclusion/exclusion criteria, 9 records met the review criteria. Of the 9 records, 1 was graded as very low, 3 low, and 5 low to moderate. The interventions for bereaved parents varied from using single-model interventions such as expressive arts therapy and telephone support to multimodal interventions that combined resources (ie, peer support, resource packets, and health-care support). Only 1 study explicitly illustrated how its bereavement intervention was designed based on the proposed theoretical model.
Conclusions:
This review highlights the need for individualized, well-tested, and effective bereavement care interventions to support bereaved parents. In summary, the state of the science on interventions for bereaved parents is poor and much work needs to be done to effectively address the needs of bereaved parents, including both their physical and emotional health needs.
The field of bereavement research and care is at a tipping point. The introduction of prolonged grief disorder (PGD) in the International Classification of Diseases (ICD-11) has ignited clinical ...interest in this new disorder, along with debate over challenges in validating and implementing these new criteria. At the same time, the global COVID-19 pandemic has launched several local and international efforts to provide urgent support and comfort for individuals and communities suffering from grief. Recently, grief experts have called for a collective response to these complicated bereavements and possible increase in PGD due to COVID-19. Here we outline a new European network that aims to unite a community of grief researchers and clinicians to provide accessible, evidence-based support particularly during times of unprecedent crisis.
The Bereavement Network Europe (BNE) has been developed with two main aims. Firstly, to develop expert agreed, internationally acceptable guidelines for bereavement care through a three-tiered approach. Secondly, to provide a platform for researchers and clinicians to share knowledge, collaborate, and develop consensus protocols to facilitate the introduction of PGD to diverse stakeholders.
This article outlines the current status and aims of the BNE along with the plans for upcoming network initiatives and the three-tiered bereavement care guidelines in response to the COVID-19 pandemic.
•The COVID-19 epidemic has highlighted possible mental health difficulties for bereaved.•We present the new disorder, prolonged grief disorder (PGD) and a new European network.•We present the new disorder, prolonged grief disorder (PGD) and a new European network.•We introduce a platform for European clinicians and researchers to unite to develop evidence-based guidelines.•We outline the aims of the Bereavement Network Europe and a three-tiered system of bereavement care response to COVID-19.
Bereavement care is considered an integral component of quality end-of-life care endorsed by the palliative care movement. However, few hospitals and health care institutions offer universal ...bereavement care to all families of patients who die. The current coronavirus disease 2019 pandemic has highlighted this gap and created a sense of urgency, from a public health perspective, for institutions to provide support to bereaved family members. In this article, drawing on the palliative care and bereavement literature, we offer suggestions about how to incorporate palliative care tools and psychological strategies into bereavement care for families during this pandemic.
Family members of cancer patients experience major changes in their daily lives due to their loved one's illness. The associated stress spreads across all aspects of their lives, physical, emotional, ...psychological and social, and due to risk of physical and mental illness posed, these family members are referred to as secondary patients. With advances in cancer medicine, family participation is required in various aspects of patient decision‒making, and families must address many challenges, not just nursing. After the patient's death, the family then becomes the bereaved family. The bereaved families of patients who died of cancer have characteristic burdens such as"regret"", unhelpful communication", and"anniversary reactions", and it is necessary to take appropriate measures while paying attention to the risk of physical and mental illness among the family members. In addition, it is important to have knowledge not only of physical and mental problems but also legal problems that arise, and to ask a specialist when necessary to support patients, families, and bereaved families.
Severe, persistent and disabling grief occurs among a sizable minority experiencing bereavement, with diagnostic manuals newly including complicated grief (CG) disorders. Sleep disturbances/disorders ...have been established as worsening affective and stress-related conditions. However, the role of sleep difficulties in bereavement and CG has not received similar scientific attention. We therefore conducted a systematic review with narrative syntheses on this topic to clarify the role of sleep in bereavement (PROSPERO: CRD42018093145). We searched PubMed, Web of Science and PsychInfo for peer-reviewed English-language articles including (at least one) bereaved sample and sleep disturbance measure. We identified 85 articles on 12.294 participants. We answered seven pre-defined research questions demonstrating: high prevalence of sleep disturbances in bereavement; positive associations of grief intensity with sleep difficulties; preliminary indications of risk factors of post-loss sleep disturbance; higher prevalence of sleep disturbances in CG, enhanced by psychiatric comorbidity (i.e., depression); and initial evidence of causal relationships between (complicated) grief and sleep. Grief therapy partly improves sleep difficulties, yet no intervention studies have specifically targeted sleep problems in bereaved persons. Causal relationships between sleep and grief require further examination in intensive longitudinal investigations, including randomized trials, thereby clarifying whether treating sleep problems enhances CG treatment effects.
•Psychometric properties of DSM-5 PCBD and ICD-11 PGD have not been previously compared.•A three-factor model of PCBD and a two-factor model of PGD yielded acceptable fit.•The prevalence of probable ...PCBD (6.4%) was significantly lower than PGD (18.0%).•Predictive validity differed between PCBD and PGD.•Findings provide preliminary evidence for the validity of PCBD and PGD.
Persistent complex bereavement disorder (PCBD) is a disorder of grief included in DSM-5 Section 3. Prolonged Grief Disorder (PGD) is a disorder of grief that will enter the forthcoming ICD-11. This study evaluated the factor structure, prevalence, and validity of disturbed grief as per DSM-5 and ICD-11.
With data from a community sample (N =512), we used confirmatory factor analysis (CFA) to evaluate the fit of different factor models for PCBD and PGD, determined diagnostic rates for probable PCBD and PGD, and used sensitivity/specificity analyses to evaluate the performance of individual items as indicators of PCBD and PGD. We calculated associations of PCBD-caseness and PGD-caseness with concurrently assessed symptoms of posttraumatic stress disorder (PTSD) and depression and, in a subset of 280 participants, with these same symptoms assessed one year later, to examine concurrent and predictive validity of PCBD and PGD.
For PCBD-symptoms, a three-factor model with distinct factors of separation distress, reactive distress, and social/identity disruption fit the data well; for PGD-symptoms a two-factor model with distinct separation distress symptoms and additional symptom (e.g., guilt, anger, blame) yielded acceptable model fit. Overall, items evidenced strong sensitivity and negative predictive power, and relatively poor specificity and positive predictive power. The prevalence of probable DSM-5 PCBD (6.4%) was significantly lower than the prevalence of ICD-11 PGD (18.0%). Both PCBD and PGD were significantly associated with concurrent overall grief, depression, and PTSD; PCBD but not PGD was associated with symptoms one year beyond baseline.
Limitations include our reliance on self-reported data and symptoms of PCBD and PGD being derived from two questionnaires.
Findings provide preliminary evidence for the validity of both the PCBD and PGD constructs, albeit that prevalence rates of both constructs and predictive validity differ—which needs further scrutiny.
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