The impact of a subsequent pregnancy on grief and emotional adjustment following a perinatal loss

The present study examined the impact of a subsequent pregnancy on emotional adjustment associated with a previous perinatal loss and on the following components of parental grief—active grief, difficulty coping, despair. Participants included 25 women and 24 partners who were expecting a baby for the first time since their loss and 25 women and 18 partners who were not expecting and had not had a child or pregnancy after their loss. Depressive symptomatology, anxiety, marital adjustment, as well as active grief, despair, and difficulty coping were measured. Mothers who were not pregnant were experiencing significantly higher levels of despair and difficulty coping than pregnant mothers, independently from the effect of time elapsed since the loss. For the fathers, no significant group effect in emotional distress or intensity of grief was found. Women reported significantly higher levels of negative affectivity than men. A new pregnancy may be associated with a beneficial effect on the mourning process of women with a previous perinatal loss, primarily by decreasing their despair and difficulty coping. However, in our sample, grief intensity remained high, suggesting that the mourning process may not be hindered by a subsequent pregnancy.     

Tools for Many Trades: Reaffirming the Use of Grief Counselling by Health, Welfare and Pastoral Workers

The use of counselling is increasingly questioned as an appropriate and viable activity for professionals in statutory and general settings whose work roles and tasks are varied. This paper looks specifically at grief counselling and examines some of the reasons why applications of grief theories and grief counselling by such workers have been narrow and limited. It then suggests a framework for teaching the subject, offering relevant applications. Finally, it points to developing areas of grief counselling in multi-disciplinary contexts and argues that working with grief and loss must be recognised and fostered as core, generic skills for the non-specialist.     

Common Grief,Complex Grieving

In this article, the author reflects on the changes during the last 25 years in our understanding of grief and on the emerging new issues in the field of loss and grief studies. He identifies several significant issues, including the implications of violent death for public and private grief, the increased attention upon the family as a mourner, and new ritual patterns emerging out of changes in funeral practices in recent years. The essay concludes by briefly considering a number of issues shaping grief and our care for those who mourn.     

Promoting Meaning-Making to Help our Patients Grieve: An Exemplar for Genetic Counselors and Other Health Care Professionals

Genetic counselors and other health professionals frequently meet with patients who are grieving a loss. It is thus helpful for medical professionals to be familiar with approaches to bereavement counseling. Grief theory has evolved over the last few decades, from primarily stage theories of grief such as Kübler-Ross’s “five stages of grief” to frameworks that promote more complex and long-term ways to cope with a loss. Herein I present one recent grief theory – meaning-making - and describe how it can be applied to help parents of children with disabilities grieve the loss of the child that they expected. In particular, I describe a scenario that many genetic counselors face - meeting with the parents of a child with Down syndrome. I outline the research done on the reactions, grief and coping experienced by parents in this circumstance, and I present suggestions for encouraging healthy coping and adjustment for parents, based on the meaning-making perspective. The meaning-making theory can also be applied to many of the other losses faced by genetic counseling patients.     

Youth Mental Illness and the Family: Parents’ Loss and Grief

Parents and family members whose adult child or relative has a mental illness endure significant losses, to which they respond with grief. Such grief may negatively affect family members’ physical and psychological health and also the relationship with their relative. Yet, research in this field is sparse. Very few studies have examined parents’ loss and grief in the context of the patient being a child or teen. It is not clear the extent to which parents’ loss and grief in response to their child or adolescent’s mental illness is similar or different to the accounts of older parents and family members caring for an adult relative with major psychopathology (e.g., Schizophrenia, Bipolar disorder). Parental loss and grief is not often addressed in child and adolescent mental health services’ provision of care; alarmingly, little is known about how best to support parents who access these services. The present study aimed to bridge this knowledge gap and identify the therapeutic needs of this younger parent population. Comprehensive interviews were conducted with 14 parents and one custodial grandparent of a youth aged 18 years or younger who was currently attending a child and adolescent mental health service. An inductive thematic analysis identified six themes; parents’ narrative of finding out, profound and pervasive loss, complex grief, waning support, the challenges of caregiving and a call for assistance. It can be inferred from these results that youth mental illness can constitute a source of loss and grief for parents. Participants’ loss and grief was largely consistent with the experience of families caring for an adult relative with major psychopathology. Opportunities for mental health practitioners to support families’ loss and grief were identified. Further studies are needed to enhance understanding of this complex and, to a large extent, ignored familial experience. Results do underscore the importance of clinicians acknowledging parents’ loss and grief and working directly with this experience over the course of youths’ treatment, perhaps in conjunction with family psychoeducation approaches.     

Conceptualizing an HIV Diagnosis Through a Model of Grief and Bereavement

For people living with HIV/AIDS, grief and bereavement typically refer to the loss of life felt in the HIV community. However, changes in HIV treatments allow care providers to view HIV grief in a way that considers physical, social, and emotional loss, as well as a loss of the life they had previously pictured for themselves. Kübler‐Ross's ( 1969 ) model of bereavement is presented as a way to conceptualize clients living with HIV who are dealing with grief and bereavement. In addition, popular bereavement counseling approaches relevant to clients with HIV are discussed, and a case illustration is provided.     

Predicting Grief Symptomatology among the Suddenly Bereaved

Social scientists have long been interested in the study of grief and bereavement, but only recently has research focused on the aftereffects of sudden loss. Theory and research alike suggest that grief is multidimensional and that specific grief reactions have a unique set of predictors. The purpose of this study is to examine the relative contribution of risk factors in explaining variations in specific grief reactions following a sudden death. Data for this study come from medical examiners' reports and mail-back surveys of survivors of sudden loss from suicide or accident. The results indicate that several characteristics of the survivor, mode of death, and social support are important determinants of grief symptomatology. This research concludes by directing future theoretical and empirical endeavors to examine more fully the role of relational factors in influencing grief experiences following bereavement.     

The Relationships Among Grief Experience,Problem-Solving Appraisal,and Depression: An Exploratory Study

Abstract

Research has consistently shown a relationship between problem-solving appraisal and depressive symptoms. This study expands that research by including grief symptomatology as a variable. A college student sample completed the Problem-Solving inventory, the Beck Depression Inventory, and the Revised Grief Experience Inventory. Consistent with hypotheses, those individuals who had experienced the death of a close loved one within the previous 5 years reported significantly higher levels of grief and depression than those who had not experienced such a loss. However, the group that had experienced the death of a close loved one did not report significantly worse problem-solving scores than the group that did not. This study also examined the relationships among problem-solving appraisal, depressive symptoms, and grief symptoms within the subsample that had experienced the loss of a close loved one within the previous 5 years. Consistent with predictions, grief symptoms were associated with depressive symptoms and self-appraised ineffective problem solving. The results of this study extend the research on grief and mourning. Also, the results expand our understanding of the grief process by providing preliminary evidence for the role of problem solving in this process     

ADHD and Grief: Diagnosis and Differentiation at One Federally Qualified Health Center

Family physicians provide medical care including diagnosis for children experiencing loss and grief. The cognitive impact of loss includes poor attention and concentration, suggestive of attention deficit hyperactivity disorder (ADHD). Our study examined this phenomenon in a community health center (CHC) utilizing physicians’ surveys and a medical record audit of 378 children diagnosed with ADHD during a three-year period. Results identified ambiguous loss and trauma resulting from family instability, absent parent, domestic violence, abuse, and foster care, often unrecognized by physicians as producing grief accompanied by attention and concentration problems. Findings suggest exploration of repeated ambiguous losses in children with ADHD.     

Does Religious Belief Matter for Grief and Death Anxiety? Experimental Philosophy Meets Psychology of Religion

It is commonly reasoned that religious belief moderates death anxiety and aids in coping with loss. However, a philosophical perspective known as meta‐atheism includes the claim that avowed religious believers grieve deaths and experience death anxiety as intensely as avowed atheists. Thus, we report a study comparing religious believers and nonbelievers on measures of death anxiety and grief. We further investigated the relationships between certain religious beliefs (views of God, afterlife belief, religious orientation) and death anxiety, as well as both painful grief reactions and grief‐related growth. We surveyed 101 participants across the United States, ranging in age (19 to 57), education, and ethnicity. Participants avowing some form of religious belief, in comparison to those not, did not demonstrate lower levels of death anxiety. They did, however, display higher levels of a certain type of death acceptance. Additionally, those professing belief reported less grief and greater growth in response to loss. Greater afterlife belief was not associated with less grief; however, it was associated with both greater grief‐related growth and lower death anxiety.     

Circumstances of Death and Complicated Grief: Indirect Associations Through Meaning Made of Loss

Losses by violent means and the loss of primary attachment figures may increase the likelihood of developing a chronic and severe grief response (referred to as complicated grief, or CG). Path analysis was used to examine the relationships between these risk factors and CG symptoms. College student participants filled out online questionnaires relating to their bereavement. Analyses provided support for statistical models whereby meaning made of the loss fully mediated the association between cause of death and CG symptoms and partially mediated the association between relationship to the deceased and CG symptoms. Although based on cross-sectional data, these findings provide additional support for meaning-oriented understandings of adaptation to loss.     

Beyond Broken Bonds and Broken Hearts: The Bonding of Theories of Attachment and Grief

Attachment theory describes the establishment and long-term impact of infants' early relationships. Theories of grief and mourning have acknowledged that the disruption of attachment bonds is loss and grief, but the attachment literature shows little development toward a conceptual linkage with these theories. The connection is important given the current discussion of whether bonds with the deceased are broken or continued. The purpose of this article is to link the strengths of each perspective to inform us about the process of grief as mourners work through the reconstruction of their relationships. It presents a developmental model integrating attachment theory and cognitive developmental approaches in order to further our understanding of the processes involved in loss and grief.     

Neither Bereavement nor Grief: Coping with the Death of a Cherished Person in the Cunda-sutta

Though bereavement and grief have been common human experience throughout recorded history, how bereavement is viewed and grief coped with varies from one philosophical tradition to another. By examining features running throughout the Cunda-sutta, this paper demonstrates a shift from the ordinary conception of bereavement to an insightful understanding of not-bereavement. If one possesses insight into how worldly convention shapes ordinary conceptions of bereavement, then one need not associate bereavement with loss and grief. For ordinary people, grief may be regarded as a natural response to loss. However, in light of the emptiness of bereavement, the emphasis can be shifted from coping with grief to the understanding of not-grief and to the cultivation of mental abilities conducive to moving forward on the right path. By examining the reasoning of neither bereavement nor grief, this paper sheds new light on a rarely acknowledged perspective on coping with the death of a cherished person.     

Parental Mourning and Children's Behavior

This article alerts professionals to sibling death as a possible reason for behaviors exhibited by young clients. Aside from their own grief, children are affected by parental mourning over a child's death and accompanying changes in the family environment. Children show their distress in a variety of behaviors, some of which appear to be unrelated to the loss. Four areas of concern are presented with case illustrations: cognitive distortions, reactions to parents' distress and preoccupation with the loss, being a replacement child, and effects of parents' failure to work through their grief. Suggestions for helping children and parents include using a genogram for identifying loss, helping the family talk about the death, and providing a support group for children.     

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.     

Grief Counseling: A Funeral Home—Based Model

Loss and grief are issues that require special understanding and skills from the counselor. This article describes how one funeral home implemented an innovative response to loss involving death by inaugurating a thorough professional grief counseling program for its clientele and the community it serves.     

A Journey into Grief

The experience of the death of her Grandmother immerses the author in an intimate experience of grief. She reflects on her journey into grief and presents insights into grief's impact on her personal story as well as her professional life, i.e., her clinical work as a young psychoanalyst-in-training. Other metaphors and dream images, such as life, death, home, homelessness, silence, speech, story, voicelessness, aloneness and loneliness echo throughout the reflection as the author attempts to articulate an understanding of the profound Self-change birthed by death, grief and loss.     

Identity continuity and loss after death,divorce, and job loss

This paper examined the relationship of constructs identified by identity continuity and attachment theories of grief to adjustment to loss from the framework of identity theory. Connections between loss salience, identity construal, and balance of identity construal on grief intensity via their association with post-loss identity disruption were examined across three types of self-relevant losses; death of a family member, job loss, or divorce. We hypothesized that lower salience, higher endorsement of identity attributes represented by relational and individualistic self-construals, and an overall balance across identity attributes would be related to decreased grief severity across all types of loss. Results supported hypotheses with the exception that the hypothesized ameliorative effect of increases in relational self-construal was only seen in the bereaved group.     

Acknowledging the Archetypal Elements of Grief

The universality of grief as a soul-aching experience within the human condition is evident in even the oldest recorded stories and myths around the world. Theories and scientific studies in the past few decades have attempted to understand the phenomenon of grief, forming a significant body of research and a myriad of ideas and guidelines for the grieving process. Acknowledgment and appreciation of the archetypal elements of grief broadens our understanding of the painful emotions that arise as part of a natural reaction in the aftermath of loss and can assist helping professionals to make wise choices for therapeutic interventions in clinical practice.