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.     

Predictors of complicated grief

Abstract

This study examined whether process variables predict an outcome of complicated grief. A turbulent and prolonged grief was predicted to occur after the death of a spouse in subjects who had self-blame, used the deceased for an extension of self, had ambivalence toward the deceased, or overcontrolled emotional responses. Ninety subjects were examined at 6, 14, and 25 months after the loss via a self-report battery of process variables and a structured clinical interview designed to assess symptoms. Subjects with complicated grief were compared with those with normative grief. Predictions were supported only in tertiary data analyses; they were not supported well in the primary and secondary statistical analyses. The authors concluded that either self-reports of process variables are inadequate measures or the theory that led to these measures and predictions is in need of revision.     

Mental ghosts and the process of grief

Abstract

Grieving the death of a loved one is an experience that many people will face at least once in their lifetime, but the lack of widely accepted guidelines as to what constitutes “normal” grieving results in mourning being a common experience with little universality. Memories may keep the deceased alive in the minds of the survivor and may even interfere with the formation of new relationships. This article considers the process of grieving the loss of a spouse and some of the individual factors, such as age, sex, and personal beliefs, that may account for variability in grief experiences. While several modeh detailing the grief process are discussed, the inappropriateness of establishing expectations for the nature and duration of grief is argued for.     

Enhancing attributional style as a resiliency factor in depressogenic stress generation

Abstract

There is a growing body of evidence that suggests depression and cognitive vulnerabilities to depression may lead individuals to generate stressful events. However, there has been no study to date that has directly examined factors that may lead individuals to be less likely to generate stressful events. The present study examines whether an enhancing attributional style, the tendency to make global and stable inferences following occurrence of a positive event, functions as a resiliency factor in stress generation. One hundred and sixty-seven female students completed measures of depression symptoms and attributional style at baseline and occurrence of life events since baseline at a four-week follow-up. Results indicated that an enhancing attributional style predicted decreased levels of stressful events over the following four weeks, even when controlling for depression symptoms. The findings of this study suggest that there may be resiliency factors that can help protect individuals from the generation of stressful events.     

Do Patients With Psychosis Experience Loss and Grief As a Result of Their Illness?

BACKGROUND: Depression and suicidality are frequently reported in patients with psychosis and schizophrenia, but the grief process that may be associated with this illness has not been systematically studied. In this study, we examined whether patients diagnosed with psychosis identify, grieve, and mourn losses engendered by the illness. METHOD: 24 patients diagnosed with psychosis in the past five years were surveyed to indicate whether their illness led to losses, and to describe their responses to the losses. Psychosis-related perceived losses were surveyed using three subscales of a loss and grief questionnaire (loss of self, self-care, and roles). Their relationship with beliefs about the illness, symptomatology, coping style, and self-efficacy and insight was studied. RESULTS: 23 (96%) patients named specific losses, and 16 patients (67%) reported feelings associated with grief and mourning. More than half reported loss of self-esteem at the onset of illness and only half saw themselves as having improved in the past month. Patients reported more loss within the past month than at the onset of illness. In the past month, patients with an intact sense of self experienced greater self-efficacy (r = .568, p < .004) while those with loss of self reported feelings of shame (r = ?.582, p < .003). Only patients with insight associated the onset of illness with loss. In the past month, most patients saw themselves as experiencing loss. DISCUSSION: The study results suggest that at some distance from diagnosis, patients still experience themselves as having much loss due to their illness. These unresolved feelings may indicate complicated mourning. Insight appears to be associated with the ability to look back at the onset of the illness and recognize that it engendered losses. Further study of the process of and barriers to grief and mourning is recommended. In clinical practice, the assessment of grief as a part of post-psychotic recovery could lead to providing more appropriate treatment and lead to a positive outcome.     

The nature of grief: Loss of love relationships in young adulthood

Abstract

Grieving following the loss of a love relationship in young adulthood was examined. College students completed the loss version of the Grief Experience Inventory (GEI), another questionnaire, and an adaptation of the Texas Revised Inventory of Grief (TRIG). The results indicated that the more intimate the relationship had been, the greater the grief experienced. In addition, the more marriage had been considered, the greater the grief. Grief was disenfranchised primarily by family members, unless marriage had been considered. Few gender differences were seen, except that women both considered marriage and initiated the breakup more often. The specific feelings attached to the grieving were noted more often on the TRIG adaptation than on the GEI. The findings point to the significance of recognizing grief reactions in counseling and psychotherapy for depression in young adults.     

Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief

Background: Research about termination for fetal abnormality (TFA) suggests that it is a traumatic event with potential negative psychological consequences. However, evidence also indicates that following traumatic events individuals may experience growth. Although TFA’s negative psychological outcomes are well documented, little is known of the potential for growth following this event. Therefore, the study’s objectives were to measure posttraumatic growth (PTG) post-TFA, examine the relationship between PTG, perinatal grief and coping, and determine the predictors of PTG.

Design: An online, retrospective survey was conducted with 161 women.

Methods: Eligible participants were women over 18 who had undergone TFA. Participants were recruited from a support organisation. They completed the Brief COPE, Short Perinatal Grief Scale and Posttraumatic Growth Inventory. Data were analysed using regression analyses.

Results: Moderate levels of PTG were observed for “relating to others,” “personal strengths” and “appreciation of life.” “Positive reframing” was a significant predictor of PTG. Despite using mainly “adaptive” coping strategies, women’s grief levels were high.

Conclusions: “Adaptive” coping strategies such as, “positive reframing” are relevant to TFA. They may act as protective factors against distress and as foundations for growth, implicating that interventions such as Cognitive Behavioural Therapy, which aim to reframe women’s experience, may be beneficial.     

The Use of Rituals in Grieving for a Miscarriage or Stillbirth

Abstract

Preparation for their changing roles in family and society, as well as readying their intimate space for the arrival of an infant, totally engage expectant parents. Miscarriage or stillbirth may bring on a grief storm that strips away many tender roots and branches of new life in the community that the parents have been nurturing. Creation and participation in a grief ritual can bring the grieving parents to a healing resolution. This article describes the healing efficacy of ritual, its elements, and how a compassionate therapist can create one in collaboration with grieving clients.     

The Underlying Structure of Grief: A Taxometric Investigation of Prolonged and Normal Reactions to Loss

Recent studies have supported the distinctiveness of complicated and prolonged forms of grief as a cluster of symptoms that is separate from other psychiatric disorders. The distinction between prolonged and normal reactions to loss remains unclear, however, with some believing that prolonged grief represents a qualitatively distinct clinical entity and others conceptualizing it as the extreme end of a continuum. Thus, in this study a taxometric methodology was used to examine the underlying structure of grief. Participants included 1,069 bereaved individuals who had lost a first-degree relative. Each participant completed the Dutch version of the Inventory of Complicated Grief–Revised, which was used to create indicators of prolonged grief. The mean above and mean below a cut (MAMBAC) and maximum eigenvalue (MAXEIG) tests supported a dimensional conceptualization, indicating that pathological reactions might be best defined by the severity of grief symptoms rather than the presence or absence of specific symptoms.

Does self-compassion protect adolescents who are victimized or suffer from academic difficulties from depression?

ABSTRACT

Adolescents face many social and academic difficulties which, if not managed properly, can lead to depression. Self-compassion, a kind and caring orientation towards oneself, has emerged as a possible resilience factor alleviating depression. Self-compassion comprises two factors: self-compassion and self-coldness. The present study set out to investigate whether self-compassion weakens or self-coldness strengthens the association between depression and two difficult circumstances: victimization and academic difficulties (ADs). The sample consisted of 2383 students who had recently made the transition to upper secondary education. The study was cross-sectional and employed a hierarchical regression analysis approach. Strongest interactions were followed up with simple slope analysis. Self-compassion (inversely), self-coldness, ADs, and victimization were statistically significant predictors of depression. Self-compassion weakened the association between ADs and depression. The results suggest encountering difficulties in adolescence and depression are related and that self-compassion may moderate the association.     

Parental grief of a perinatal loss: A comparison of individual and relationship variables

Abstract

This study focuses on the comparison of individual variables of bereavement, depression, and stress with variables associated with the couple relationship, including cohesion, adaptability, communication, satisfaction, and partner support. In total, 24 couples completed self-report instruments within 2 weeks after a miscarriage. Mothers had significantly stronger grief reactions than fathers. Fathers and mothers perceived their relationships similarly as highly functional. Except for mothers' depression and their satisfaction with the couple relationship, the correlations between individual and relationship variables were rather weak. Implications of the results for family professionals are discussed.     

Parental socialization of emotion and depression in adulthood: The role of attitudes toward sadness

IntroductionLack of parental care and high parental control have systematically been linked to depression. Dysfunctional schemas explain this relationship.ObjectiveWe propose that a retrospective evaluation of unsupportive parental socialization of emotion should predict depression in adulthood and that this relationship should be mediated by negative attitudes toward sadness.MethodOne hundred and forty undergraduate students (mean age of 22) completed a questionnaire for assessing the socialization of emotion (QSE), another for evaluating types of attitudes toward sadness (QAFET), and the Brief Symptom Inventory Depression scale (BSI-D).ResultsResults show that four attitudes toward sadness, namely perception of sadness as a complaint, anger against the self if sad, fear of being rejected if sad and fear of where sadness might lead, each partially mediate the relationship between unsupportive parental socialization of emotion and adult depression.ConclusionOur findings have both theoretical and practical implications. On the one hand, we demonstrated that unsupportive parental socialization of emotion and some attitudes toward sadness both predict depression. On the other hand, our results justify a closer look at parental socialization of emotion and attitudes toward sadness when clinically investigating depression.     

Psychological consequences of collective violence in childhood: the case of Monterrey,Mexico / Consecuencias psicológicas de la violencia colectiva en la niñez: el caso de Monterrey,México

Abstract

During the last years, different types of violence have severely damaged Mexico. In this paper we examine the consequences that violence could have in children, one of the most vulnerable segments of society. In short, we predict that exposure to any type of violence will lead to higher depression and that this could be explained through the effects of violence on childhood well-being. Our hypothesis was supported in two studies, showing that exposure to street violence (Study 1, N = 607) and exposure to collective violence (Study 2, N = 172) can increase childhood depression. Moreover, in both studies, this effect was explained by the decrease of childhood well-being caused by violence exposure. The implications of these results are discussed.     

Anxious and depressive avoidance behavior in post-loss psychopathology: a longitudinal study

Background: Avoidance behavior is a central component of cognitive behavioral theories of bereavement-related psychopathology. Yet, its role is still not well understood. This study examined associations of anxious and depressive avoidance behaviors with concurrently and prospectively assessed symptom-levels of prolonged grief disorder (PGD), depression, and posttraumatic stress disorder (PTSD). Design and Methods: Two hundred and ninety-one individuals, confronted with loss maximally three years earlier, completed self-report measures of anxious and depressive avoidance and emotional distress and again completed distress measures one year later. Results: Anxious and depressive avoidance were concurrently associated with symptom-levels of PGD, depression, and PTSD, even when controlling for the shared variance between both forms of avoidance and relevant socio-demographic and loss-related variables. Prospective analyses showed that baseline anxious avoidance predicted increased symptom-levels of PGD, depression, and PTSD one year later, among participants who were in their first year of bereavement but not among those who were beyond this first year. Baseline depressive avoidance was significantly associated with elevated PTSD one year later, irrespective of time since loss. Conclusions: Both anxious and depressive avoidance are associated with different indices of poor long-term adjustment following loss. However, anxious avoidance seems primarily detrimental in the first year of bereavement.     

Emotional and behavioural problems in children dealing with maternal breast cancer: a literature review

ABSTRACT

A significant number of breast cancer survivors are living with their minor children. In this review we investigated the impact of maternal breast cancer on children. A literature search conducted through PubMed, Scopus, Cochrane Library and CINAHL yielded 26 relevant studies, which documented a variety of effects. Evidence has been presented that dealing with maternal breast cancer can cause uncertainty, anxiety and depression in children, but may also lead to enhanced social and academic performance. The risk of problems in these children is reported to be associated with both low parental affective responsiveness and excessive parental involvement. Internalising child problems were shown to be linked with maternal depression and family dysfunction, and externalising problems with family dysfunction and communication problems. Some of these problems may be modified by interventions for supporting these families, which should be designed to include both parents and children, and also the healthcare personnel.     

A short-term grief and loss therapy group: Group members' experiences

Abstract

This article is an evaluative study of a short-term grief and loss therapy group conducted at a large Midwestern university's counseling center. The group was held for students who had experienced loss through death of a significant person. The author examines brief group psychotherapy, special considerations of the college student's grief experience, an adaptation of the brief group model for grieving students, and data gathered from the members of the therapy group. Students' scores on a grief instrument showed mixed results. Group members made journal entries at four times during the group experience. They reported that the group was a supportive and helpful experience; five of Yalom's (1995) eleven therapeutic factors could be discerned. Recommendations regarding the treatment of grieving students in a group setting are made.     

Association between leisure time physical activity and stress,social support and coping: A cluster-analytical approach

ObjectivesIdentifying risk clusters of stress, anxiety and depression, taking into consideration social support and coping, two important factors through which leisure time physical activity may have stress-reducing effects, may lead to more effective exercise treatment strategies for stress. The aim of this study was to investigate whether stress, social support and coping cluster in meaningful ways in the general adult population, and whether individuals of these clusters also differ in anxiety, depression and different types of leisure time physical activity.DesignCross-sectional study in a randomly chosen community based sample of adults in the Flemish region of Belgium.MethodA sample of 2616 Flemish adults, aged 18–75, completed two self-report computerized questionnaires on mental health, physical activity and demographic characteristics in the presence of a scientific staff member.ResultsThree reliable clusters were identified in both males and females. The first cluster showed high levels of stress and ineffective coping and low levels of social support. The second one showed the opposite, and the third one an intermediate profile. Anxiety and depression were highest in persons of the stressed cluster and diminished gradually over the intermediate and the nonstressed ones. Sports participation and not other types of leisure time physical activity was significantly lower in the stressed cluster.ConclusionsBy means of cluster analysis, risk groups of stress, anxiety and depression in adult males and females can be identified. Sports participation may have a beneficial effect in these at-risk groups.