Objectives 1. Analyze 1-4 aspects of bereavement that have been impacted by COVID-19 for family caregivers of advanced cancer hospice patients. 2. Evaluate the strategies implemented by family ...caregivers to overcome isolation and maintain connectedness during the Coronavirus pandemic. Research Objective As Coronavirus has spread to the US, it has changed family caregivers' hospice experiences including bereavement. Background To examine the impact of a global pandemic on connectedness and isolation in bereavement among hospice family caregivers using automated phone diaries. Aim We examined phone diaries of bereaved hospice family caregivers of cancer patients from a larger multi-site longitudinal study for COVID and non-COVID related references to isolation and connectedness. Methods Participants were asked to complete daily phone diaries through an automated system from the time they consented to 6 months after the patient's death. Recordings were selected between March 13 and May 15, 2020 from bereaved caregivers. Summative content analysis using deductive codes was conducted to examine diaries for physical/social isolation and connection. Isolation was defined as having no other person in close physical or social contact during bereavement, while connection was defined as feeling attached to others during bereavement. Results Bereaved caregivers' diaries (N=6; bereavement range=2-7 months) were analyzed. Each caregiver completed audio diaries over the bereavement period (range=1 to 42). Of the 59 diaries, 32 (54.24%) made reference to the coronavirus pandemic. Coronavirus references were mentioned by all 6 participants. COVID-related connection was identified 15 times (25.42%), while COVID-related isolation was identified 32 times (54.24%). Non-COVID related connection was identified 20 times (62.5%), while non-COVID related isolation was coded only twice (13.33%). Conclusions and implications Findings from this study suggest COVID-related social isolation was integral to the bereavement experiences of family caregivers. However, despite the pandemic, caregivers expressed maintaining connectedness to others. This study has implications for hospice support services for bereaved caregivers during the pandemic.
Background
Following the recently published 11th version of the WHO International Classification of Diseases (ICD‐11), we sought to examine the risk factors and comorbidities associated with ...posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD).
Method
Cross‐sectional and retrospective design. The sample consisted of 1,051 trauma‐exposed participants from a nationally representative panel of the UK adult population.
Results
A total of 5.3% (95% confidence interval CI = 4.0–6.7%) met the diagnostic criteria for PTSD and 12.9% (95% CI = 10.9–15.0%) for CPTSD. Diagnosis of PTSD was independently associated with being female, being in a relationship, and the recency of traumatic exposure. CPTSD was independently associated with younger age, interpersonal trauma in childhood, and interpersonal trauma in adulthood. Growing up in an urban environment was associated with the diagnosis of PTSD and CPTSD. High rates of physical and mental health comorbidity were observed for PTSD and CPTSD. Those with CPTSD were more likely to endorse symptoms reflecting major depressive disorder (odds ratio OR = 21.85, 95 CI = 12.51–38.04) and generalized anxiety disorder (OR = 24.63, 95 CI = 14.77–41.07). Presence of PTSD (OR = 3.13, 95 CI = 1.81–5.41) and CPTSD (OR = 3.43, 95 CI = 2.37–4.70) increased the likelihood of suicidality by more than three times. Nearly half the participants with PTSD and CPTSD reported the presence of a chronic illness.
Conclusions
CPTSD is a more common, comorbid, debilitating condition compared to PTSD. Further research is now required to identify effective interventions for its treatment.
Experiencing the suicide of a close person is often a major life event, which increases the risk of maladaptive grief reactions, social, physical, and mental health problems, and suicidal behavior in ...the bereaved individuals. However, people bereaved by suicide may also experience long-term positive outcomes regarding personal or post-traumatic growth. The field of suicide bereavement research is evolving rapidly. Hence, this reprint is particularly focused the advance knowledge on bereavement and postvention. In this reprint, you can find papers that enhance our understanding of grief after suicide and how to help those who are bereaved, including studies on suicide grief in specific populations and studies on interventions and support offered to the bereaved or their social environment, in addition studies based on novel methods and studies that contribute to the development of theory or models. We believe that this reprint can add important knowledge on our journey to help suicide-loss survivors in their continued struggle with the loss on their loved ones to suicide.
Objective
While the relationship between attachment anxiety and avoidance and the severity of prolonged grief disorder (PGD) has been well‐studied, less is known about the relationship between ...disorganized attachment and PGD. We test the associations between disorganized attachment and the interaction between it and attachment avoidance and anxiety on PGD.
Method
Participants (N = 258) who had lost a family member from 0.5 to 8.0 years before the survey completed the experiences in close relationships‐revised, the adult disorganized attachment scale, and the PGD‐13 scale.
Results
The model explaining PGD symptoms through attachment, taking into account the level of disorganized attachment, explained variance in PGD significantly better than the model taking into account only the level of attachment anxiety and avoidance as predictors. Additionally, the relationships between attachment avoidance and PGD were positive, negative, or neither, depending on the configuration of the levels of disorganized attachment and attachment anxiety.
Conclusion
Future research into the relationships between attachment and PGD should take into account disorganized attachment. Attachment‐informed grief therapy focused on insecure styles of attachment – including the disorganized style – to the deceased person and other loved ones may prove a promising approach for bereaved persons who experience PGD.
We examined posttraumatic growth for 691 participants of the Tragedy Assistance Program for Survivors (TAPS). Peer mentors of bereaved individuals experienced greater posttraumatic growth (PTG) and ...reported higher psychological health than those who were non-peer mentors. Active involvement in TAPS and resilience consistently and positively predicted all types of PTG. These prediction models were far stronger (R
, AIC) for the suicide-bereaved sample than those bereaved by other causes, and
analyses suggest suicide-bereaved benefitted more than those bereaved by other causes from active participation in TAPS.
There is a need for an interview-based measure to assess Prolonged Grief Disorder (PGD) included in the text revision of the fifth Diagnostic and Statistical Manual for Mental Disorder (DSM-5-TR) and ...11th edition of the International Classification of Disease (ICD-11). We evaluated the psychometric properties of the Traumatic Grief Inventory-Clinician Administered (TGI-CA); a new interview measuring DSM-5-TR and ICD-11 PGD severity and probable caseness.
In 211 Dutch and 222 German bereaved adults, the: (i) factor structure, (ii) internal consistency, (iii) test-retest reliability, (iv) measurement invariance across subgroups (e.g., differing in language), (v) prevalence of probable caseness, (vi) convergent validity, and (vii) known-groups validity were examined.
Confirmatory factor analyses (CFAs) showed acceptable fit for the unidimensional model for DSM-5-TR and ICD-11 PGD. Omega values indicated good internal consistency. Test-retest reliability was high. Multi-group CFAs demonstrated configural and metric invariance for DSM-5-TR and ICD-11 PGD criteria for all group-comparisons; for some we found support for scalar invariance. Rates of probable caseness for DSM-5-TR PGD were lower than ICD-11 PGD. Optimal agreement in probable caseness was reached when increasing the number of accessory symptoms for ICD-11 PGD from 1+ to 3+. Convergent and known-groups validity was demonstrated for both criteria-sets.
The TGI-CA was developed to assess PGD severity and probable caseness. Clinical diagnostic interviews for PGD are needed.
The TGI-CA seems a reliable and valid interview for DSM-5-TR and ICD-11 PGD symptomatology. More research in larger and more diverse samples is needed to further test its psychometric properties.
•The Traumatic Grief Inventory-Clinician Administered (TGI-CA) was developed.•The TGI-CA is a new measure to assess DSM-5-TR and ICD-11 prolonged grief severity.•The TGI-CA is a valid and reliable tool that can be used in research and practice.
His world view colored by growing up in 1980s Ethiopia, where death governed time and temperament, Dagmawi Woubshet offers a startlingly fresh interpretation of melancholy and mourning during the ...early years of the AIDS epidemic in The Calendar of Loss.
When society denies a patient’s disease and then forbids survivors mourning rites, how does a child bear witness to a parent’s death or a lover grieve for his beloved? Looking at a range of high and popular works of grief—including elegies, eulogies, epistles to the dead, funerals, and obituaries—Woubshet identifies a unique expression of mourning that emerged in the 1980s and early 1990s in direct response to the AIDS catastrophe. What Woubshet dubs a “poetics of compounding loss” expresses what it was like for queer mourners to grapple with the death of lovers and friends in rapid succession while also coming to terms with the fact of their own imminent mortality. The time, consolation, and closure that allow the bereaved to get through loss were for the mourners in this book painfully thwarted, since with each passing friend, and with mounting numbers of the dead, they were provided with yet more evidence of the certain fatality of the virus inside them.
Ultimately, the book argues, these disprized mourners turned to their sorrow as a necessary vehicle of survival, placing open grief at the center of art and protest, insisting that lives could be saved through the very speech acts precipitated by death. An innovative and moving study, The Calendar of Loss illuminates how AIDS mourning confounds and traverses how we have come to think about loss and grief, insisting that the bereaved can confront death in the face of shame and stigma in eloquent ways that also imply a fierce political sensibility and a longing for justice.
The circumstances of coronavirus disease (COVID-19)-related deaths embed multiple traumatic characteristics, alongside several external factors that can disenfranchise individual grief. In this ...context, severe forms of traumatic distress, guilt, somatization, regret, anger, and unspecific symptoms not yet included in prolonged grief disorder (PGD) criteria could emerge. This article (a) analyzes factors related to bereavement in the context of the COVID-19 pandemic; (b) proposes avenues for meaning-making practices to facilitate individual and collective mourning process; and (c) invites clinicians to pay attention to the traumatic characteristics of COVID-19-related deaths adopting a holistic approach of PGD clinical manifestations, as well as in evaluation and treatment of cases.
We propose an integrative risk factor framework to enhance understanding of individual differences in adjustment to bereavement and to encourage more systematic analysis of factors contributing to ...bereavement outcome (e.g., examination of interactions between variables and establishing pathways in the adaptation process). The examination of individual differences in adaptation to bereavement is essential for practical (e.g. targeting high risk individuals for intervention) and theoretical (e.g. testing the validity of theoretical claims about sources of differences) purposes. And yet, existing theoretical approaches have not led to systematic empirical examination and empirical studies in the current literature are fraught with shortcomings. Derived from Cognitive Stress Theory Lazarus, R. S. & Folkman, S. (1984).
Stress, appraisal, and coping. New York: Springer and the stressor-specific Dual Process Model of Coping with Bereavement Stroebe, M. S., & Schut, H. A. W. (1999). The dual process model of coping with bereavement: Rationale and description.
Death Studies,
23, 197–224, the framework incorporates an analysis of stressors, intra/interpersonal risk/protective factors, and appraisal and coping processes that are postulated to impact on outcome. Advantages of using the approach are outlined. Challenges in undertaking such research are addressed.
The contagiousness of some illnesses (e.g., COVID-19) limits the ways in which families can interact with their dying loved ones who have been admitted to the hospital, especially in the intensive ...care unit. As a result, nurses have developed culturally relevant strategies for virtual bereavement care for patients and families predeath, perideath, and postdeath. Specific ways nurses can support, communicate, and facilitate meaningful rituals when patients die in isolation are provided in this article.
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