A Matter of Life and Death: Understanding Continuing Bonds and Post-traumatic Growth When Young Adults Experience the Loss of a Close Friend

Young adults establish networks of friends for companionship, support, assistance, and resource exchange. Friends have been found to play an essential role in promoting young adults’ health and well-being. Yet, relatively little is known about how young adults cope with the death of a close friend. Studies of grief and bereavement in adulthood focus primarily on the death of a family member. In the present qualitative study, we examined the narrative accounts of 20 young adults (ages 21–34) to describe the prevalence and nature of continuing bonds and post-traumatic growth experiences in coping with the death of a close friend. Participants completed semi-structured interviews in which they described the circumstances of their friend’s death, the nature of their friendship, whether and how they continued their relationship with their deceased friend, and the impact of their friend’s death in their everyday lives. Overall, young adults articulated ways that they continued their relationship with the deceased friend that included personal communication, personal change, and homage activities. Post-traumatic growth experiences as a result of their friend’s death included behavioral changes and personal changes in outlook. The narratives of all participants reflected their simultaneous experience of continuing relationship ties with the deceased and a sense of personal growth as a result of their friend’s death. We report areas of overlap and distinctions between expressions of continuing bonds and post-traumatic growth in the lived experience of young adults coping with the loss of a friend. Implications of findings for future research are discussed.     

持续性联结及其与丧亲后适应的关系

生者与逝者的关系不会因为死亡而终止, 在逝者离世之后, 生者可能继续与逝者保持持续的、内在的联结, 这被称为“持续性联结”。持续性联结在不同文化中均普遍存在, 已有研究从联结控制点、联结的引发者等维度对其进行分类, 近年来, 持续性联结对丧亲后适应的影响成为丧亲及哀伤研究中的热点。持续性联结与丧亲后适应的关系呈现出复杂且不一致的研究结论。未来的研究应该在本土文化背景下去探索持续性联结的表现及特定意义, 思考持续性联结的分类并编制本土化的测量工具, 与此同时, 应该在理论驱动下去开展持续性联结与适应关系的实证研究。     

Grief shortly after suicide and natural death: a comparative study among spouses and first-degree relatives

Chronic dysfunction after complicated grief is not rare and emphasizes the need to identify bereaved individuals at risk. Three months following bereavement, self-reported psychiatric and general health of 153 relatives of 74 suicides was worse than of 70 relatives of 39 natural deaths. Moreover, the felt need for professional help was higher among the former, even after adjustment for expectedness of death, sociodemographic differences, and relatives'/spouses' neuroticism. This suggests that suicide-bereaved individuals may constitute a high-risk group of mourners in need of targeted postvention.     

Effects of attachment bereavement and pre-event conditions on subsequent depressive symptoms in older adults

A sample of 1,411 older adults (age 55+) who had been interviewed both prior to and after bereavement were studied, allowing for pre-event controls. Those who had lost a parent, spouse, or child had the strongest depressive reactions, as predicted by an attachment-bonding hypothesis; however, material losses were also related to depression. Although bereavement/loss events were clearly related to subsequent depression even after pre-event depression, resources, and events were controlled, certain pre-event characteristics were predictive of the bereavement/loss events, including prior undesirable events, age, and urban/rural residency. A further analysis of 1,007 persons with two post-event interviews (at 6-month to 1-year follow-up) revealed an initial depressive reaction to a bereavement/loss event, which then dissipated completely within 1 year's time. Generally, bereavement appeared to have limited etiologic importance.     

Interaction of depression and bereavement on mental health in the elderly

Three hundred ninety-three elderly adults aged 55 and older were divided into 1 of 9 subgroups in a 3 (bereavement group: survivors of spouses who died by natural death or by suicide and nonbereaved control Ss) x 3 (depression group: none, mild, and moderate-severe) design over 4 times of measurement--1 month, 6 months, 1 year, and 2.5 years after death of spouse. Significant Bereavement x Depression Group effects were obtained on Brief Symptom Inventory scores. The moderate-severe depression/suicide subgroup had the greatest psychiatric complications with bereavement. Results indicated that elderly persons with significant clinical depression at the time of a spouse's death were at significant risk for psychological complications during the bereavement process, and survivors of spouses who had committed suicide were even more at risk within the greatest depression group.     

“Bearing my fruit into the grave”: experiences of anticipatory grieving and bereavement among Zimbabwean HIV positive women with loss of their only child

This study aimed to explore the bereavement experiences of HIV positive women who had lost their only child. Participants were 10 women living with HIV (age range?=?24–35 years) and with loss of their only child. Data on experiences of anticipatory grief and bereavement among HIV positive women were collected over a period of six months. The data were analysed thematically. Findings suggest the women to have traumatic memories of their deceased children and also from the marital disharmony which followed the loss. The participants reported to have questioned their womanhood since they did not have any surviving child and dreaded the fact that they would die childless. Women also reported a sense of persona worthlessness following the death of the child and lived in fear and uncertainty of the future concerning their own mortality.     

Temporary and Long-Term Consequences of Bereavement on Happiness

In this article, we examine the temporary and long-term consequences of the death of a parent or child on happiness. According to set-point theory external conditions are expected to only have a short-term or limited influence on happiness. This directly contradicts the basic assumption of affective theories on happiness, which states that major life-events have a lasting influence on well-being. Moreover, we test whether the association between bereavement and happiness is equally strong across the life course. To test our hypotheses we make use of the fourth wave of the European Values Study. Our research findings demonstrate that people who lost their father, mother or child are more likely to feel unhappy than people without this experience. Ten years after the death of a parent or child we still find a significant difference in happiness between people who have and have not experienced this loss. The assumption of set-point theory, that major life evens only have a temporary impact on SWB, is not supported by our data. Moreover, the association between bereavement and SWB strongly differs across the life-course. We might even conclude that the age at which the loss occurred is more decisive for the strength of the association between bereavement and SWB than the duration of the loss.     

Unexpected death,religious coping and conjugal bereavement outcomes in Africa (Togo)

This pioneering study in sub-Saharan African context examined the role played by religious strategies (religious coping, religious community support (RCS)) in the conjugal bereavement process and its outcomes depending on the expected or unexpected death. Based on cross-sectional approach, the study targeted Togolese bereaved spouses (N?=?162). The mean period of mourning was 112.52 months (SD?=?94.72). The results of a hierarchical regression revealed that RCS was positively associated with grief symptoms when the death was expected and, unsurprisingly, the negative religious coping predicted grief symptoms when the death was sudden and unexpected. Religious strategies would play a threefold role: providing refuge and comfort, regulating the bereavement distress and serving resources to give meaning to the loss of the beloved. Theoretical and clinical implications of these findings are discussed.     

Primary Care for the Elderly Bereaved: Recommendations for Medical Education

The aim of this study was to explore the current practices of primary care physicians (PCPs) in providing bereavement care to elderly patients, with implications for medical education. A total of 63 PCPs answered a brief online survey about their typical practices, barriers, comfort level with bereavement, and confidence in their ability to diagnose prolonged grief disorder (PGD). They were recruited through an online newsletter and contacts of one of the authors. The results found that two-thirds of the PCPs do not routinely screen their elderly patients for recent losses, nor do they refer to mental health clinicians when loss is identified. Barriers included not learning of the deaths in patients’ lives and lack of time during clinic visits. Those PCPs who had experienced their own losses were significantly more comfortable in speaking to patients about recent losses and more confident in their ability to diagnose PGD. We recommend bereavement education be incorporated into the medical school curriculum from the outset, utilizing the psychological principle of graded exposure to bereaved individuals.     

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.     

The distinctive moral personality of care exemplars

Positive emotion following bereavement was examined in a prospective longitudinal study. Participants lost a spouse (n?=?250) and were interviewed prior to the death, 6 months after the death, and in some cases 18 and 48 months after the death. Early theorists suggested that positive emotion during times of distress may indicate pathology. In contrast, more recent theorists suggest that positive emotion is desirable even during times of distress. In this analysis, positive emotion was associated with desirable outcomes (less depressed mood, more social support received, more social provision to others) and this effect was not diminished among people reporting elevated levels of distress. Also, the simultaneous occurrence of positive emotion and distress was not associated with pre-existing emotional instability. Those experiencing positive emotion reported lower levels of grief, but not qualitatively different grief. The findings suggest that positive emotion tends to be associated with desirable outcomes even among people reporting elevated distress.     

Children's bereavement reactions following death of the father

The war situation compelled a reinvestigation into the characteristics, course, the outcome, and the variety of bereavement reactions in early childhood. In this study, the behaviors and changes reported by the mothers and teachers of 24 normal kibbutz children over a period of 1 to 16 months after bereavement are presented. The findings lead to one clear and central conclusion: The death of a father in war brings about a severe stress situation for the child at both the preschool and the middle-childhood age. The abrupt disequilibrium created by the death itself and the resulting changes in the family place very difficult demands on the adaptation and coping capacities of the child.In this sample of normal children with no special problems before the loss, ample evidence of acute emotional strain along with noticeable grief reactions were found in the early months of bereavement. A marked increase in the number and variety of symptomatic behavior changes testified to the seriousness of the threat to the child's sense of well-being after notification of the death. Ten of the 22 children between the ages of 2 and 10 years reacted to the trauma severely and were so markedly hindered in their daily functioning that psychological help was considered imperative. The disorganizing effect of the trauma of the loss of a father as reflected in this high percentage of disturbance in normal children indicates that without doubt a child who has lost a parent is a child at risk. It is therefore desirable if not imperative that there be more balance in the efforts to help bereaved families.1979, Fall     

Children's bereavement reactions following death of the father

The war situation compelled a reinvestigation into the characteristics, course, the outcome, and the variety of bereavement reactions in early childhood. In this study, the behaviors and changes reported by the mothers and teachers of 24 normal kibbutz children over a period of 1 to 6 months after bereavement are presented. The findings lead to one clear and central conclusion: The death of a father in war brings about a severe stress situation for the child at both the preschool and the middle-childhood age. The abrupt disequilibrium created by the death itself and the resulting changes in the family place very difficult demands on the adaptation and coping capacities of the child.In this sample of normal children with no special problems before the loss, ample evidence of acute emotional strain along with noticeable grief reactions were found in the early months of bereavement. A marked increase in the number and variety of symptomatic behavior changes testified to the seriousness of the threat to the child's sense of well-being after notification of the death. Ten of the 22 children between the ages of 2 and 10 years reacted to the trauma severely and were so markedly hindered in their daily functioning that psychological help was considered imperative. The disorganizing effect of the trauma of the loss of a father as reflected in this high percentage of disturbance in normal children indicates that without doubt a child who has lost a parent is a child at risk. It is therefore desirable if not imperative that there be more balance in the efforts to help bereaved families.     

Bereavement anxieties and health amongst the Australian-Italian Catholic community

This article is based on survey of 269 households in the state of Victoria, Australia. It elicits some useful guidelines for professional caregivers in relation to eight cultural/religious groups including Australian-born Christians and Arab-born Muslims. The focus here is upon the relationships between the Australian Italian community and personal health outcomes during bereavement. The following sub-strata are examined: community differences in relation to grief and loss practices and traditions; the value of religious communal support and counseling; symptomatological differences from psychosocial and educational perspectives; psychopathological/psychiatric symptoms and beliefs and practice concerning the afterlife. Significant differences were revealed between the sexes on such matters as health problems, grief expressions, psychosomatic manifestations, communication with the dead, beliefs in the afterlife and interpretation of the meaning of loss. Differences in these findings will assist professional caregivers who deal with families experiencing personal death loss to broaden their own perspectives on bereavement, offering specific counselling strategies and care-giving interventions.     

A teenager revisits her father's death during childhood: a study in resilience and healthy mourning

"Debbie," 14, was 8 when her father died. During 4 interviews over 3 months, Debbie described the impact of his death as she progressed from childhood to adolescence. Themes drawn from her experience were related to theories of development, bereavement, and resilience. Triangulating interviews with her mother and brother established validity. Results indicated that Debbie experienced healthy mourning--without depression or other debilitating effects--due to supportive people in her family, her strong self-concept, and her capacity to think through her experiences positively. Evidence of protective factors, notably Debbie's relationship with her mother, contributed to her resilience. The author concludes that childhood bereavement studies and resilience research can be mutually informative and that dialogue between their practitioners should increase.     

Resilience to loss and chronic grief: a prospective study from preloss to 18-months postloss

The vast majority of bereavement research is conducted after a loss has occurred. Thus, knowledge of the divergent trajectories of grieving or their antecedent predictors is lacking. This study gathered prospective data on 205 individuals several years prior to the death of their spouse and at 6- and 18-months postloss. Five core bereavement patterns were identified: common grief, chronic grief, chronic depression, improvement during bereavement, and resilience. Common grief was relatively infrequent, and the resilient pattern most frequent. The authors tested key hypotheses in the literature pertaining to chronic grief and resilience by identifying the preloss predictors of each pattern. Chronic grief was associated with preloss dependency and resilience with preloss acceptance of death and belief in a just world.     

Parental grief following the death of an infant—a follow-up over one year

The course of parental bereavement during the first year following an infant's death was investigated. Also, the differences in mothers' and fathers' reactions, the differences according to the mothers' occupational role, and the similarities in couples' reactions were studied. From a total sample of 59 families, 13 families answered their questionnaires at all three time points (1, 6 and 13 months), 22 families responded at two time points, and 37 families responded at some point following the loss. Measures relating to anxiety, depression, bodily discomfort, general well being and impact of event were used at the three time points. The results showed that grief, as measured by the different inventories, decreased over time. The decrease was most evident from 6 to 13 months, and most prominent in women. A considerable number of the parents were still actively dealing with the loss all through the first year of bereavement. In most couples the mother reported most distress. Mothers were significantly more depressed than fathers at all time points, and mothers also had significantly higher anxiety and lower general health at 1 and 13 months, and intrusive scores of 1 and 6 months. Women at home evidenced more grief at all three time points than women employed outside the home. A high or low score in one spouse was more strongly correlated with a similar score in the other at 1 and 13 months, than at 6 months. The implications for counselling of parents, with special emphasis on the employment situation of the mother, is emphasized.     

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.     

School Management and Eco-systemic Support for Bereaved Children and their Teachers

This paper is about how bereaved children are supported in school. After narrating parts of a case study of one bereaved family and their interaction with schools over a prolonged period, it explores some educational management implications of bereavement, grief and loss. It argues that the effectiveness of interactions by the individual teacher will have a correlation with the support systems created by the educational management team. The structures and ethos of care created by management are a vital part of recovery in bereavement. Evidence from the case study proved typical of wider study in the field of the educational management of bereavement. Indications were that educators responsible for whole-school response had training and support issues needing urgent address. In particular, the process of establishing, in school, a climate of successful, meaningful and open communications about death relies on the provision of personal support systems for the teachers. Such support is dependent upon an educational management team that is able and willing to prioritize these issues and to challenge aspects of its own management thinking.