Does worry affect adjustment to bereavement? A longitudinal investigation

Background and objectives: Repetitive thought is a trans-diagnostic risk-factor for development of psychopathology. Research on repetitive thought in bereaved individuals has focused primarily on clarifying the role of rumination, repetitive thinking about past negative events and/or negative emotions. While detrimental effects of rumination have been demonstrated following bereavement, surprisingly few studies have aimed to clarify the role of worry, repetitive thinking about potential future negative events, in adjustment to loss. This study sought to fill this gap in knowledge. Methods/Design: One hundred eighty-three bereaved individuals (85.3% women) filled out questionnaires on sociodemographic and loss-related characteristics, worry, and symptom measures of depression, anxiety, and prolonged grief. After six months, 155 participants completed worry and symptom measures again. Using multiple regression analyses, concurrent and longitudinal associations between loss-related variables, worry, and symptoms of psychopathology were examined. Results: Main results were that worry was strongly positively associated with symptoms of anxiety, depression and prolonged grief concurrently and also predicted higher levels of anxiety, depression and prolonged grief longitudinally. Conclusions: Findings suggest that worry influences adjustment to bereavement negatively and may be a potential target in grief therapy, especially when aiming to reduce anxiety.     

Prolonged grief disorder symptoms in bereaved internally displaced Tiv persons in Nigeria: associations with rumination,rebirth concerns and gender

ABSTRACT

There is burgeoning research on prolonged grief disorder (PGD) among several vulnerable populations but PGD symptoms have been scarcely examined among bereaved internally displaced persons (IDPs). This study investigated the associations of rumination, rebirth concerns and gender with symptoms of PGD following conflict-related bereavement. Participants were 379 Nigerian IDPs who were of the Tiv ethnic group. They provided demographics and completed self-report measures grief and rumination, while concern about rebirth status of the deceased was assessed using a single item which requested participants to indicate whether they had any concerns about the re-incarnation of the deceased. Results showed that gender was not associated with PGD symptoms. High intrusive rumination and high deliberate rumination were associated with increased PGD symptoms in males and females. Rebirth concern was associated with high PGD symptoms in males but not in females. Findings highlight the need for socio-culturally-informed screening/intervention in the wake of conflict-related bereavement.     

Adaptive and Maladaptive Dependency in Bereavement: Distinguishing Prolonged and Resolved Grief Trajectories

Interpersonal dependency is typically viewed as a risk factor for prolonged grief among conjugally bereaved adults. However, emerging empirical evidence and theoretical advances suggest that one manifestation of interpersonal dependency – adaptive dependency – may serve as a protective factor in coping with loss. This study compared adaptive and maladaptive dependency across three matched groups: prolonged grievers, asymptomatically bereaved adults, and a married comparison group. Results suggest a link between adaptive dependency and asymptomatic bereavement, and between maladaptive dependency and prolonged grief.     

Regret resolution, aging, and adapting to loss

Both theory and empirical evidence suggest that people who have unresolved regrets experience lower levels of well-being than do those who resolve their regrets. In this study, the authors examined the role of regret resolution during bereavement by assessing whether (a) regret resolution would aid in adapting to the death of a loved one and (b) older adults would be more successful at resolving their bereavement-related regrets than would younger adults. Mixed models were run with longitudinal data from an age-heterogeneous sample of 147 men and women who were eventually bereaved after providing care for a loved one through a hospice. As expected, regret resolution contributed to adjustment as indicated by postloss patterns of depressive symptoms, well-being, and rumination; further, older adults were more likely to resolve their regrets than were younger adults. Implications for encouraging regret resolution early in bereavement are discussed.     

Religious Doubt and Spiritual Growth Among Adults Bereaved of a Grandparent

Religious beliefs and bereavement provide contexts for personal growth (Benore & Park, 2004). The death of a grandparent may be especially well-suited to prompt such growth. Using data from 164 adults, ages 18 to 51 years, bereaved of a grandparent, the authors examined whether religious doubt relates to current grief via perceived spiritual growth. Mediation analyses showed that fewer religious doubts were associated with spiritual growth in bereavement, but spiritual growth was associated with higher levels of current grief. Results are discussed within a framework for including family processes in bereavement research that includes religious doubt and spiritual growth.     

Reciprocal Relations of Worry,Rumination, and Psychopathology Symptoms After Loss: A Prospective Cohort Study

Bereavement can precipitate symptoms of depression, prolonged grief disorder, and posttraumatic stress disorder. Targeting repetitive negative thought (i.e., worry, rumination) in treatment may help reduce post-loss psychopathology. Yet, evidence on longitudinal associations of depressive rumination and worry with post-loss psychopathology symptoms has been mixed and the directions of effects are still unclear. Recently bereaved adults (78% female) completed questionnaires assessing depressive rumination (brooding), worry, and depression, prolonged grief and posttraumatic stress symptoms 11 times in 1.5 month intervals. We applied random-intercept cross-lagged panel models (RICLPMs) to examine reciprocal within-person associations between worry and psychopathology symptoms, between rumination and these symptoms, and between worry and rumination. Main findings were that worry showed reciprocal relationships with psychopathology symptoms (although worry did not consistently predict prolonged grief symptoms). Depressive rumination was predicted by psychopathology symptoms, but not vice versa. Worry showed reciprocal relations with depressive rumination. Findings suggest that worry may be part of a downward spiral, enhancing psychopathology symptoms following loss, whereas depressive rumination is solely a consequence of such symptoms.     

The effects of late-life spousal bereavement over a 30-month interval

Self-report measures of grief, depression, and general psychopathology were studied in widows and widowers over a 2.5-year period following death of their partner. A comparison sample of men and women was also followed for the same period. Differences in severity of depression and psychopathology previously reported at 2 months postloss (Gallagher, Breckenridge, Thompson, & Peterson, 1983) diminished to nonsignificant levels at 12 and 30 months. However, significant differences between bereaved and comparison subjects on measures of grief were still apparent 30 months after spousal loss. A main effect of gender for depression and psychopathology (but not for grief) was found at 2 and 12 months: Women reported more distress than men regardless of bereavement status. Results indicate that the experience of grief persists for at least 30 months in both older men and women who have lost their spouse.     

Irrational Beliefs and Basic Assumptions in Bereaved University Students: A Comparison Study

Several authors have argued that the loss of a loved one triggers changes in people's beliefs and assumptions, and that these changes play a role in emotional problems after bereavement. The present study was an attempt to investigate these hypotheses. Thirty students who had been confronted with the death of a parent or sibling, on average nearly 3 years ago, were compared with 30 nonbereaved matched control subjects on different measures assessing basic assumptions and irrational beliefs as defined in REBT. In line with the notion that bereavement has an impact on people's basic assumptions, results showed that bereaved students had a less positive view of the meaningfulness of the world and the worthiness of the self than their nonbereaved counterparts. Also, in accord with the notion that the tendency to think irrationally is likely to increase after a stressful life event, the bereaved were found to have higher levels of irrational thinking. Furthermore, it was found that the degree to which bereaved individuals endorsed general as well as bereavement-specific irrational beliefs was significantly associated with the intensity of symptoms of traumatic grief. Conversely, none of the basic assumptions was associated with traumatic grief. Beliefs reflecting low frustration tolerance explained most variance in traumatic grief. Clinical and theoretical implications of these findings are discussed.     

复杂哀伤丧亲女孩的箱庭疗法个案研究

通过19次个体箱庭和2次家庭箱庭治疗,对一名12岁复杂哀伤的丧亲女孩W进行了个案研究。发现:(1)箱庭治疗能提高丧亲青少年的个体和家庭功能,促进青少年个体和家庭哀伤任务的完成;(2)W的个体箱庭经历了在混乱重复中寻找秩序、重建自我、转化与整合、自我治愈力展现四个阶段;(3)W的哀伤经验经历了在治疗者促进下分享—象征性表达—主动地象征性表达—直接而主动地表达哀伤经验最终获得哀伤任务完成的变化过程。     

Psychopathology Symptoms,Rumination and Autobiographical Memory Specificity: Do Associations Hold After Bereavement?

Symptoms of psychopathology are associated with overgeneral memory retrieval. Overgeneral memory is hypothesized to be the result of an emotion regulatory process, dampening emotional reactions associated with retrieval of distressing specific memories. However, higher post‐loss symptom severity has been related to higher specificity of loss‐related memories recalled on the Autobiographical Memory Test. This may imply that such memories are ‘immune’ to the reduced specificity effect. We aimed to test this idea by investigating, for the first time, associations of depressive and complicated grief symptoms and depressive and grief rumination with autobiographical memory specificity on a sentence‐completion task (SCEPT) in a bereaved sample. One hundred ninety‐one adult mourners (89% women) filled out questionnaires and the SCEPT. A main finding was that higher depressive and complicated grief symptom and grief rumination levels were associated with reduced specificity of non‐loss‐related memories but not with specificity of loss‐related memories. Implications of these results are discussed. Copyright © 2015 John Wiley & Sons, Ltd.     

Spiritual Distress and Depression in Bereavement: A Meaning-Oriented Contribution

One key focus of a meaning reconstruction model of bereavement concerns spiritual meanings attributed to the death, whether consoling or troubling. Specifically, previous studies in our research program suggest that religiously inclined violent death survivors are at risk for elevated levels of both bereavement distress and complicated spiritual grief, a crisis of faith following loss that refers to the erosion of the mourner’s relationship to God and/or the religious community. However, more research is needed to understand the convergence of depression and spiritual struggle in the context of violent and natural loss. In this study of a diverse sample of 59 American Christians bereaved less than 5 years, we sought to: (1) determine if individuals bereaved by homicide, suicide or fatal accident differed from those bereaved by natural causes in their levels of depression and spiritual coping; (2) investigate the relation between the latter constructs; and (3) ascertain if cause of death mediates the effect of religious coping on depression. We found that: (a) violently bereaved individuals endorsed more negative religious coping, and (b) depression was associated with greater spiritual struggle, particularly a sense of disrupted relationship with God. Contrary to expectations, positive religious coping was unrelated to post-loss depression, and cause of death did not mediate the relationship between spiritual coping and depressive symptomatology. A clinical case study concludes the article, illustrating the interweaving of spiritual and psychological distress in tragic bereavement, and their implications for a meaning-oriented grief therapy.     

Quality and purpose,quantity and chance

Because rumination may allow an idea to stay in one's conscious longer and indecision may result in more time on a given task, it was expected that these two cognitive processes may predict creativity. Self-report measures of rumination, indecision, and creativity were electronically distributed to 85 adults (28 men, 57 women; M age = 32.96 years old). Reflective rumination significantly predicted creativity, moderated by high levels of indecision. This study may resolve previous conflicts between findings on rumination and creativity and introduces indecision as beneficial in the creative process. This study also provided important clinical implications in distinguishing between adaptive and maladaptive rumination suggesting a new cognitive link between creativity and depression.     

Bereaved African American Adults: The Role of Social Support,Religious Coping,and Continuing Bonds

The present study identified relationships between social support, religious coping, continuing bonds, prolonged grief disorder (PGD) symptoms, and the quality of life among bereaved African American adults (N = 154). Perceived social support and less use of negative religious coping strategies predicted a higher quality of life and fewer PGD symptoms. Also, greater perceived social support, less use of negative religious coping strategies, and less use of continuing bonds significantly predicted fewer PGD symptoms. Implications suggest that the conceptualization of grief and loss for African Americans might include social support, religious coping, and continuing bonds.     

Eternal Connection: An Exploratory Study of the Effects of Learning About Near-Death Experiences on Adult Grief

We examined the effectiveness of a near-death experience (NDE) psychoeducational group bereavement intervention in reducing distressing aspects and enhancing a growth aspect of grief among bereaved adults. Participants were 22 females and 2 males (2 African American, 3 Asian, 2 Latina/o, and 17 White non-Latina/o) ranging in age from 20 to 71, with a mean age of 35.3 years. In this experimental design, we randomly assigned 12 participants to the experimental group and 12 participants to the waitlist control group. Effect size findings based on Hogan Grief Reaction Checklist scores indicated modest to substantial benefits of the NDE learning module intervention for bereaved adults in the form of decreased panic behavior, blame and anger, and detachment and increased personal growth. Conclusions include that further research into the effectiveness of NDE-related psychoeducational programs with bereaved individuals is warranted.     

Cross-Lagged Analyses of Prolonged Grief and Depression Symptoms With Insomnia Symptoms

Prolonged grief disorder, characterized by severe, persistent and disabling grief, has recently been added to the DSM-5-TR and ICD-11. Treatment for prolonged grief symptoms shows limited effectiveness. It has been suggested that prolonged grief symptoms exacerbate insomnia symptoms, whereas insomnia symptoms, in turn, may fuel prolonged grief symptoms. To help clarify if treating sleep disturbances may be a viable treatment option for prolonged grief disorder, we examined the proposed reciprocal relationship between symptoms of prolonged grief and insomnia. On three time points across 6-month intervals, 343 bereaved adults (88% female) completed questionnaires to assess prolonged grief, depression, and insomnia symptoms. We applied random intercept cross-lagged panel models (RICLPMs) to assess reciprocal within-person effects between prolonged grief and insomnia symptoms and, as a secondary aim, between depression and insomnia symptoms. Changes in insomnia symptoms predicted changes in prolonged grief symptoms but not vice versa. Additionally, changes in depression and insomnia symptoms showed a reciprocal relationship. Our results suggest that targeting insomnia symptoms after bereavement is a viable option for improving current treatments for prolonged grief disorder.     

中国丧亲个体社会支持体验的质性研究

本研究通过对28位丧亲者进行深度访谈,使用解释现象学分析法对质性数据进行分析,探索中国丧亲个体的社会支持体验。结果显示,丧亲社会支持的内容包括后事处理、情感支持、生活恢复帮助,经济与物资支持等。支持来源除家人和朋友之外,还包括同事、相同经历者,以及相关机构等。社会支持通过调节情绪、改变认知等方式促进个体对丧亲的适应。本研究结果为最新丧亲社会支持模型提供了支持,同时也反映出中国社会对丧亲人群的社会支持特色。     

Counselling strategies for bereaved people offered in primary care

The aim of this study was to identify strategies that general practice-based counsellors used when offering support to bereaved clients. Over the last decade, there has been a rapid growth in the provision of counselling services associated with British primary care services. A study was designed involving qualitative methods of data collection (semi-structured interviews) and analysis (a grounded theory approach). Counsellors were recruited from two cities in Southern Britain (Plymouth and Southampton). Twenty nine (76% response rate) counsellors agreed to participate (Southampton n = 15, Plymouth, n = 14). Semi-structured face-to-face audio-taped interviews elicited information about their perceptions of the appropriateness of general practitioner referrals, counselling strategies and models of bereavement. Analysis indicated that counsellors saw bereavement counselling within a broader agenda of work concerned with loss and relationship management. Many drew on eclectic approaches to bereavement counselling and specific strategies included: facilitating telling of the 'story' of the loss; engaging in active listening and valuing allowing people to talk; establishing a supportive relationship; and enabling the bereaved person to deal with unfinished business and to say 'goodbye'. Counsellors drew on implicit stage/phase models of grief that assumed levels of distress reduced over time. The value of these strategies requires more exploration.     

Parental Bereavement After Suicide and Accident: A Comparative Study

In what way is the bereavement process following suicide different from other types of bereavement? The participants were 30 survivors of suicide and 30 survivors of car accidents who were interviewed twice at an average of six months, and the second measure was taken at an average of nine months after the death, with standardized questionnaires to measure depression and grief reaction. Measures of shame, social support, family adaptation, psychological distress, and prior losses were also obtained during the second interview. All survivors were parents who had lost a son aged between 18 and 35 years. The results indicate that suicide survivors were more depressed than accident survivors at the first measure but this difference disappeared at the second measure. Survivors of suicide experienced greater feelings of shame and had experienced more life events after the death than did accident survivors. There was also a greater history of loss in parents bereaved by suicide. Parental bereavement after suicide appears to differ in several ways from other types of bereavement and appears to happen more often in vulnerable families.     

Psychopathy and Functions of Aggression in Emerging Adulthood: Moderation by Anger Rumination and Gender

Psychopathy has been previously identified as a risk factor for aggression (Porter and Woodworth 2006). However, few studies have considered specific relationships with functional subtypes of aggression, or how gender and anger rumination affect these relationships in emerging adulthood. We hypothesized that primary psychopathy would be uniquely related to proactive aggression (PA) and secondary psychopathy to reactive aggression (RA), and that these relationships would be amplified by anger rumination, and potentially influenced further by gender. Undergraduate students (N = 610; 73.3 % female) ages 18–20 completed self-report measures of anger rumination, psychopathy, and aggression, and hypotheses were tested using hierarchical regression. As predicted, anger rumination enhanced the association between secondary psychopathy and RA. It also amplified the relationship between primary psychopathy and PA, but only at very high levels of anger rumination. Gender moderated interactions between primary and secondary psychopathy on aggression. For men, primary psychopathy attenuated the secondary psychopathy – RA relationship, but not for women. These findings fill an important gap in the literature by demonstrating how tendencies to ruminate on anger and psychopathic traits interact to influence functional subtypes of aggression in young men versus women.     

On‐Line Support and Resources for People Bereaved through Suicide: What Is Available?

The Internet is a potentially valuable source of information for the bereaved, but the current knowledge regarding the type and quality of online material on suicide bereavement is very limited. This study was designed to explore the types of online information and support available for people bereaved by suicide and the quality of such resources. Four popular Internet search engines were searched using terms related to suicide bereavement and support. Although a wide range of Internet resources exist for people bereaved by suicide, these resources may not meet basic quality standards. It is unknown who uses these sites, how such material is used, and whether it helps people to cope effectively with grief after suicide.