丧失和丧失体验是一个东西吗

在精神分析的讨论中，自我意识、无法被象征化的创伤性点位以及丧失的客体一直是其理论关注的重点。本文旨在从这三个方面出发，对小说中塞丝和宠儿的复杂关系进行一次精神分析意义上的解读，试图探究塞丝的精神机制以及宠儿对她的造成的影响。首先，本文认为塞丝自我意识的高峰产生于宠儿的死亡。其次，塞丝被成为鬼魂的宠儿袭扰，从理论上来说，宠儿在象征界之中的账单并没有被还清，因此以一种活死人的方式回归。再次，小说的最后可以被视作塞丝完成了对于丧失客体的哀悼，这也使得她得以挣脱过去投入未来的生活。因此，整本小说也可以被视作塞丝精神的康复之旅。

石黑一雄的作品主题以“记忆”见长。在石黑一雄诺贝尔文学奖获奖作品《被掩埋的巨人》这本小说中，石黑一雄以母龙的存在和死亡为线索，真实地刻画了不列颠人和萨克逊人在记忆丧失状态下的和平相处，却又以开放式结尾深化了作品主题。本文通过探析母龙散发的“迷雾”这一线索，解读石黑一雄作品中的“记忆”主题以及石黑一雄通过文学作品阐发的对于人类社会的深入思考：创伤记忆应当保留还是被遗忘？留存的创伤记忆又该何去何从？文本得出以下结论：创伤记忆不应因伤痛而被抹去，对待历史的正确态度应该是直面伤痛，铭记历史记忆，吸取教训，避免造成新的创伤。

基于欧文亚隆的存在主义心理治疗理论，探究存在孤独对生命意义感的影响及其作用机制。研究选用了存在孤独量表、领悟社会支持量表及生命意义感量表对251名在校大学生进行线上调查。结果发现，存在孤独与领悟社会支持、生命意义感显著负相关，领悟社会支持与生命意义感显著正相关。存在孤独不仅可以直接负向预测个体的生命意义感，还可以通过领悟社会支持间接负向预测个体的生命意义感。由此得出存在孤独可通过削弱领悟社会支持来降低生命意义感的结论。

生活意义失落作为当代青年人的一个整体心理状态。目前学界已经对这种心理状态的成因进行了一些有益的研究，但是这些研究普遍忽视了“社会加速”这个时代背景。本文基于哈特穆特·罗萨(Hartmut Rosa)的“社会加速”理论，从“事件意义”、“物件意义”、“工作意义”与“人际关系意义”四个方面分析了当代青年人生活意义失落的成因。结论是，“社会加速”通过消解或改变当代青年人生活意义建构过程中的“主客体”地位及其关系、压缩生活意义建构过程中“时间”、改变人际关系中的初级关系与次级关系权重等形式，直接导致了当代青年人生活意义的失落。本文希望可以为关注这个问题的学者提供一些角度与分析方法上的启发。

随着数字技术的发展，其在生死议题上的影响日益显著，引发了广泛的讨论。数字不朽和虚拟已故者的概念已经成为社会学、传播学和心理学研究的热点。尽管这些聊天机器人有助于缓解悲伤情绪，但这种技术在提供情感慰藉的同时，也引发了社会、伦理和法律的广泛讨论，让人们对于生命、死亡和数字技术重新进行了思考。本文章则探讨了AI如何成为人们缅怀逝去亲人的工具，以及这一现象背后数字不朽的社会和带来的心理、伦理影响，深入思考这些新兴技术如何重塑我们对死亡、记忆和社会纽带的理解，以及未来该如何应对。

本文概括分析了近些年来，针对延迟性哀伤障碍(PGD)的研究进展，主要涉及诊断标准、鉴别要点、易感和影响因素以及可能的发病机制。认为目前ICD-11或DSM-5-TR相应的PGD诊断标准，还需要考虑文化差异、跨文化因素，甚至宗教信仰等方面的影响，以便今后制定出具有较广泛适应性的、可操作性的诊断标准。

本文利用CiteSpace软件对CNKI数据库中2006~2022年间188篇丧亲哀伤研究文献进行了可视化分析，发现从2006年开始，国内丧亲哀伤研究经历了初步探索和爆发式增长阶段，现进入平稳期。在作者与机构合作层面呈现出核心研究团体间联系较弱，存在大量孤立研究，且欠缺长期有效的合作的问题。研究热点主要集中在哀伤辅导、丧亲、哀伤、社会工作等话题上，并在研究对象、相关影响因素、哀伤疗愈手段等方面有所拓展。据此，未来的研究应当加强研究者间和机构间的合作交流，并进一步拓展其它研究热点。

目的：通过Meta分析评价安宁疗护对肿瘤患者及其家庭照顾者的生活质量和心理等方面的影响，为相关研究提供循证依据。方法：检索Cochrane Library、PubMed、Embase、Web of Science、中国知网、万方数据库和维普数据库中随机对照试验(RCT)对肿瘤患者和/或家庭照顾者应用安宁疗护干预的研究。检索期从建库至2021年10月10日，进行文献筛选、数据提取和质量评价后，使用Review Manager5.4软件对纳入的文献进行分析。结果：共纳入17篇文献，总样本量2973例(安宁疗护组为1483例，其中肿瘤患者1156例，家庭照顾者327例；常规护理组为1454例，其中肿瘤患者1133例，家庭照顾者321例)。Meta分析结果显示：与常规护理相比，安宁疗护可以改善肿瘤患者的生活质量(P < 0.01)，可减轻肿瘤患者焦虑及抑郁情绪(P < 0.01)，减轻家庭照顾者的焦虑及抑郁情绪(P < 0.01)，降低家庭照顾者的应激水平(P < 0.01)；尚不能认为安宁疗护能够改善肿瘤患者家庭照顾者的生活质量(P = 0.76)。结论：安宁疗护可以提高肿瘤患者的生活质量，减轻肿瘤患者及其家庭照顾者的焦虑和抑郁情绪，降低家庭照顾者的应激水平，暂未发现能够改善家庭照顾者的生活质量，需高质量、大样本研究进一步探讨安宁疗护对肿瘤患者及其家庭照顾者的影响。

《心理危机干预》作为高校心理学专业的重要课程，亟需突破以技术训练为核心的单一教学范式。本文基于表达性艺术治疗与体验式教学理论，构建《心理危机干预》课程的三维教学模式，并在高校开展初步教学实践，以探讨其教学理念与可行性。本研究为一项理论构建与初步应用反思，结论仅基于有限教学样本和质性观察，后续仍需开展系统实证研究以进一步检验其成效与适用性。

大学生抑郁倾向的情绪调节问题是值得关注的问题，本研究主要探讨抑郁倾向个体采用认知重评和表达抑制两种策略调节悲伤和高兴情绪，以及探讨两种情绪调节对悲伤和高兴图片记忆的影响。采用贝克抑郁量表筛选了30名大学生抑郁倾向个体参与实验。结果表明，重评上调组上调显著增强了抑郁倾向个体的悲伤情绪(Ps < 0.05)，重评下调显著降低了个体的悲伤情绪(P < 0.05)；在再认实验中发现，抑郁倾向个体对悲伤情绪的记忆力较差，而使用重评下调和表达抑制这两种情绪调节策略损害了对悲伤和高兴材料的记忆。总之，抑郁倾向大学生采用重评上调和下调可以有效的调节悲伤情绪效价和唤醒，但对高兴情绪效价的调节效果不好，重评下调和表达抑制调节对悲伤和高兴图片的记忆有损害作用。

研究运用语义分析法对“哀”中蕴含的传统哀伤表达的特点探析，传统哀伤表达的特点主要表现在三个方面：其一，哀伤需要表达，一些传统的哀伤表达的方式为丧亲者的哀伤表达提供了途径和平台，丧亲者的哀伤得以表达，负面情绪得以宣泄，有利于丧亲者走出丧亲的阴霾；其二，“哀，闵也”，引申为哀悼之意，其中蕴含了生者与逝者的社会关系，传统葬礼仪式为亲友邻里互帮互助提供了有效的途径，有利于社会关系的维持，体现其社会功能，也为丧亲者提供了社会支持和心理支持，实现团体咨询的心理功能，且“口”在“衣”内，含包裹之意，对应了儒家提倡的“哀而不伤”、“毁不灭性”的哀伤观念，哀伤表达的节制性；其三，哀伤表达具有阶段性，从丧亲初期浓烈的哀伤表达到后面缓缓的释放，是一个逐步释放的过程。

本文主要探讨一位车祸遗族妇女经历九次，每次1.5~2小时的会谈后，其哀伤经验的转化。另外，本文亦探讨当事人面对配偶死亡的调适方式及影响其哀伤复原的正负向因子。研究方法以临床数据进行质性分析。研究结果发现当事人在生理症状、悲伤情绪、对死亡的想法、人际关系，以及对肇事者态度等方面有明显的哀伤转化。而影响其哀伤转化的负向因子包括：1) 长时期司法诉讼和民事调解过程的挫折；2) 肇事者及其家属事后态度不友善；3) 当事人的依赖性格；4) 无法向母亲表达先生死亡的讯息；5) 死亡的形式突然、无预期导致未竟事宜；6) 死者在家庭中扮演经济支柱及决策者的角色；7) 与死者生前紧密的依附关系；8) 死者死亡时吐舌的样貌；10) 特殊节庆（清明、重阳节）；9) 不可哭、不要牵挂亡魂的宗教教义；11) 华人文化对寡妇的禁锢(寡妇门前是非多，从一而终的婚姻观)。此外，本研究也发现有助于当事人哀伤复原的正向因子，包括：1) 多元的支持系统；2) 对司法正义的信任；3) 肇事者及家属的善意回应；4) 案子求职顺利及工作态度受肯定足以告慰亡夫。除此之外，当事人积极为死者作些事、利用刮砂抒解情绪、参与户外活动转移哀伤痛苦、学习放下让自己走出思念，也帮助先生得以安心离开、同理肇事者事故非其所愿、放下对民事理赔的期待等方式让自己走出悲伤，另一方，当事人也努力规划自己经济的独立，找到生活重心而能重新出发。本研究结果和国外有关哀伤的研究结果(Worden, 2008)有其相似性，但也深受华人文化影响(Hsu & Kahn, 2003; 曹桂荣，2005；蔡文瑜，2001)而有不一样的哀伤经验和影响因素，显示哀伤经验和影响哀伤调适的因素有其宗教和文化的特殊性。

目的：探讨影响中小学生抑郁心理的成因及干预策略。方法：研究采取扎根理论研究方法，运用系统化的步骤，针对中小学生抑郁心理这一普遍现象展开，通过不断从咨询过程与语音记录资料中归纳整合，自下而上得出理论框架。结果：1) 家族影响因素、成长期因素与养育方式因素、压力事件因素、抑郁易感因素是影响中小学生抑郁心理的五大重要因素；2) 五大因素各自对学生的心理发展产生影响，同时也组合在一起产生影响，导致中小学生抑郁心理的形成。结论：导致中小学生抑郁心理的原因复杂多样，每个原因在各自产生影响的同时也在交互作用共同导致了中小学生抑郁心理的成因，所以对于中小学生抑郁得干预，需要集聚学校、医院、咨询师、家庭四个方面的力量和资源，才能有一个全面、深入、长远的干预效果。

基于精神障碍患儿数量的快速增长的现状，其家长的心理状态日益受到关注。既往研究表明，家长在应对孩子精神障碍的过程中普遍承受着显著的心理压力，其主要表现为焦虑、抑郁和社交恐惧。影响家长心理状态的因素复杂多样，包括患儿的疾病特征、家庭功能、社会支持以及家长的个人资源等。本研究旨在探讨精神障碍患儿家长的心理状态及其相关影响因素和干预策略，以期为理解精神障碍患儿家长的心理状态提供新的视角，并为未来的研究方向和临床实践提供参考。

本研究旨在探讨农村留守儿童和非留守儿童在负性情绪面孔注意偏向方面的差异。采用点探测范式，选取68名小学生(其中留守儿童30人，非留守儿童38人)为被试，以面孔图片为刺激材料，比较两组儿童对负性情绪面孔和中性面孔图片的注意偏向。结果显示，留守儿童组对负性情绪面孔图片的注意偏向值显著高于非留守儿童组，而两组在性别、父母文化水平等方面没有显著差异。这表明留守儿童更倾向于注意负性情绪信息，与抑郁倾向相关的注意偏向特点一致。然而，由于样本数量有限，结果的推广性有待进一步检验。总体而言，本研究为留守儿童注意偏向与抑郁的关系提供了初步证据，有助于为留守儿童心理健康的干预提供依据。

随着AIGC技术发展，AI复活技术引发公众关注，但其公众接受心理机制尚缺实证研究。本研究以SCOT理论为框架，结合认知失调视角，采集2024年1~4月微博平台12,274条原创微博，运用情感分析与LDA主题建模，探究公众对该技术的态度与心理建构过程。研究发现，公众情感态度两极分化明显。48%的负面情感聚焦隐私安全隐患与伦理争议，如担忧数据泄露、批判技术僭越生死界限；35%的正面情感源于技术带来的情感慰藉；17%的中性言论关注技术原理。LDA主题建模提炼出伦理隐私、情感寄托、技术可行性、社会文化影响四大核心主题，进一步佐证情感倾向。从心理学层面剖析，个体情感需求、社会文化背景与技术认知是心理建构关键因素。依恋理论与持续联结理论表明，技术可助丧亲者重建情感联结；社会认知理论解释了文化背景对技术接受度的调节作用，传统丧葬文化地区居民因维护文化认同而抵制技术；风险感知理论则体现技术信息透明度、企业信誉度对公众信任的影响。本研究揭示“技术慰藉”与“伦理恐慌”双峰效应，以及基于SCOT框架的认知动态竞争机制，提出“心理学–SCOT双路径”整合模型，为理解争议性技术与公众心理互动提供新视角，对技术研发、应用及政策制定具指导意义，但存在样本与方法局限，后续可深入探究。

恐惧管理理论(Terror Management Theory，简称TMT)是研究死亡心理的经典范式，该理论认为，文化世界观防御、自尊寻求、亲密关系投入是人们缓解死亡焦虑的三种有效方法。新型肺炎疫情是众多社会心理与行为的动机性影响因素。群体在新冠肺炎疫情期的心理反应，可以通过恐惧管理理论的框架进行解释与预测，如外群体排斥、内群体认同、刻板印象、良心偏向、责任偏向、自我服务偏向、亲密关系增强等。本文以恐惧管理理论的三种防御为切入点，理解、预判新冠肺炎疫情对民众心理和行为的影响，从建设中华民族现代文明、提升民族自尊、重建亲密关系及发展死亡相关的临床心理治疗四个方面提出对策建议。

目的：基于抗逆力视角探讨家庭处境不利青少年的自我分化发展。方法：在北京某高校招募父母离异或丧亲家庭大学生6名和曾有留守经历的大学生4名，通过半结构化访谈收集资料，采用类属分析法进行资料分析。结果：1) 早年父母缺位或与父母分离对青少年情绪反应、自我位置、情感隔离及与人融合等自我分化发展构成一定的影响；2) 积极认知、目标专注、情绪控制等个人因素以及家庭支持、人际协助等支持力因素具有缓冲作用。结论：家庭处境不利并不必然导致青少年的自我分化发展不良，影响结果与抗逆力有关。

自古以来，人们通过各种方式来纪念和缅怀逝去的亲人和朋友，这些方式随着时代的变迁和技术的发展而不断演变。最初，人们在石碑上刻下逝者的名字和生平，以此表达对他们的怀念和尊敬。随着媒介化社会的深入，网上纪念馆成为了一种新兴的纪念方式，人们可以在虚拟空间中建立纪念空间，让逝者的音容笑貌得以永久保存。数字悼念与网上纪念馆在融入民众的生活和社会交往方式的过程中，对本土社会的纪念活动、价值观乃至文化含义进行了重新塑造和定义。基于此，本文以媒介与悼念的关系为切入点，探讨网上纪念馆的空间设计策略，从而试图探索媒介在个人关怀领域的新方向和功能延伸。

目的：了解护理专业学生安宁疗护态度现状及其影响因素，为其有效开展安宁疗护课程提供参考依据。方法：便利选取2022年9月~2022年10月青岛市某高校793名护理专业学生为研究对象，采用自编一般资料问卷、福罗尔梅特安宁疗护态度量表、死亡态度描绘量表、生命意义感量表进行问卷调查。结果：护生安宁疗护态度总分为(95.00 ± 13.72)分，死亡态度总分为(94.96 ± 17.23)分，生命意义感总分为(98.51 ± 21.43)分，单因素分析显示性别、学历、家中公开谈论死亡情况和是否学过安宁疗护知识在安宁疗护态度总分上差异有统计学意义(P < 0.05)；相关分析发现死亡态度总分及各维度、生活目标与安宁疗护态度相关(P < 0.05)；多元线性回归分析显示性别、是否学过安宁疗护知识、死亡逃避、死亡恐惧、自然接受以及趋近接受是安宁疗护态度的影响因素(P < 0.05)。结论：护理专业学生安宁疗护态度积极性不高，应加强安宁疗护教育，帮助护生建立正性的安宁疗护态度。

本研究以贵州省一个彝族村落(T村)为案例，采用参与式观察法和半结构式访谈法，深入探讨了中国农村地区“多子女独居老人”这一特殊群体所面临的养老困境。研究发现，该群体主要面临四大困境：经济保障方面，养老金微薄，子女经济支持不稳定，导致收入支撑薄弱与支出压力凸显；情感慰藉方面，丧偶、与子女空间分离及数字鸿沟导致代际联结断裂与心理需求缺失；生活照料方面，身体机能下降与家庭支持缺位导致照料资源匮乏与应急响应不足；服务供给方面，农村医疗、养老服务资源短缺且与老人需求不匹配，导致资源适配不足与获取渠道不畅。针对这些困境，研究提出了一个“自我–家庭–社会”三方协同的应对策略框架：在自我层面，激活老人自身的养老潜力；在家庭层面，重塑家庭的养老功能，明确子女责任；在社会层面，发挥社会保障的兜底作用，完善公共服务体系。

在国家加强社会心理服务体系建设背景下，本文针对传统蓝色疗愈与单一数字疗愈的局限，探索二者融合路径。梳理传统蓝色疗愈案例与数字技术应用现状，构建创新设计框架，落地生命体验馆设计，划分三大核心模块，明确技术选型与交互流程，设计效果验证方案。研究为生命体验馆哀伤疗愈提供创新路径，响应国家心理服务建设号召。

目的：调查研究上海市大学生在新一轮新冠肺炎防控封闭管理期间领悟社会支持、相对剥夺感对焦虑抑郁情绪的影响情况。方法：基于整群抽样方法，于2022年5月21日至5月26日期间选取上海3所高校共计164人，采用广泛性焦虑量表GAD-7、抑郁症筛查量表PHQ-9、相对剥夺感量表、领悟社会支持量表PSSS于问卷星平台开展测量。结果：疫情封控期间的大学生焦虑和抑郁得分偏高，且存在性别和年级差异。家庭内支持对大学生的消极情绪有显著的负向预测效应，相对剥夺感对大学生的消极情绪有显著的正向预测效应。结论：应对疫情防控时期大学生出现的焦虑和抑郁情绪，相关管理者应引起重视，强化家校交流和互动，并及时对学生的相对剥夺感、不确定感、紧张感等进行心理疏导和积极干预。

本文探讨了起源于西方文化背景下的创伤后成长概念在我国本土化研究过程中内容表现上的异同，并通过理论模型的分析，进一步挖掘其产生机制方面的文化差异，建议下一步在个体所属的文化框架内定义和测量创伤后成长，提高临床心理护理工作对于不同文化背景下创伤幸存者干预的文化敏感性。

农村心理健康教育的广泛缺场，受到经济发展、科技进步、家庭、学校教育等外在环境的负向滋养，内在心理资源不断枯竭的威胁，留守青少年儿童问题层出不穷。本文通过案例分析方法，对案例主人公小S在成长过程中，心理健康成长受到损害的外部与内在原因进行深入分析，揭示当前留守儿童面临的心理困境，提出积极应对措施。从宏观的家校社联动入手，对留守青少年儿童所遭遇的环境威胁进行调控，致力于为其营造适合其健康成长的摇篮；从微观个体认知、情绪、意志、行为、人际，人格等层面积极赋能，开发心理资源，以期为农村心理健康教育发展提供方向建议，为其顺利实施作路径探索。

反事实思维是个体对过去发生了的事情进行替换的一种心理模拟过程。早期研究主要集中在反事实思维的理论探讨和产生过程等方面，近年来，反事实思维的测量、行为意向和自我价值保护功能以及反事实情绪等也逐渐受到重视。文章通过整合国内外研究者最新研究成果，探讨了反事实思维的定义、分类、测量方法、功能以及相关研究的新进展，指出反事实效力作为一种新的测量方法，推动了反事实思维的发展，同时对反事实思维在心理健康领域的应用充满期待。

Objective: This study aimed to examine the mediating role of reflective functioning in the relationship between loss experience and emotional maturity among adolescents. Methods and Materials: This descriptive correlational study was conducted with a sample of 390 high school students aged 15 to 18 from various regions of Greece, selected using multistage cluster sampling based on the Krejcie and Morgan sample size table. Participants completed the Core Bereavement Items (CBI) to measure loss experience, the Reflective Functioning Questionnaire (RFQ-8), and the Emotional Maturity Scale (EMS). Data analysis included Pearson correlation using SPSS version 27 and Structural Equation Modeling (SEM) using AMOS version 21. Model fit was evaluated using multiple indices including Chi-square, GFI, AGFI, CFI, RMSEA, and TLI. Findings: Results revealed significant negative correlations between loss experience and both reflective functioning (r = –.41, p < .001) and emotional maturity (r = –.47, p < .001). Reflective functioning was positively correlated with emotional maturity (r = .53, p < .001). SEM findings indicated that the structural model had acceptable fit (χ² = 124.65, df = 48, χ²/df = 2.60, GFI = 0.95, AGFI = 0.92, CFI = 0.96, RMSEA = 0.064, TLI = 0.95). Direct effects were significant from loss experience to reflective functioning (β = –0.41, p < .001) and to emotional maturity (β = –0.35, p < .001), and from reflective functioning to emotional maturity (β = 0.42, p < .001). Reflective functioning partially mediated the relationship between loss experience and emotional maturity (indirect β = –0.17, p < .001). Conclusion: Reflective functioning plays a significant mediating role in how adolescents emotionally mature following experiences of loss, suggesting that enhancing reflective abilities may be a viable intervention strategy to foster resilience and emotional growth during adolescence.

Abstract Congenital loss involves the loss of an immediate family member, specifically a parent or sibling, either during or prior to birth, and bears unique bereavement-related challenges. The current study investigated the unique congenital loss experiences of those who lost a twin sibling in utero. Through analysis of interviews with 18 Jewish Israeli participants who encountered this type of twin loss, a more comprehensive understanding of their experiences was attempted. The research employed a hybrid methodology, combining two qualitative thematic analysis methods: deductive and data-driven inductive approaches. The analysis revealed four themes: incoherency and uncertainty, ownership over a limited story, continuing an unborn bond, and the identity of a “twin-less” twin. The findings underscore the unique nature of twin loss in utero.

This paper addresses the hard-to-manage, work-related phenomenon of suicide. A qualitative, postventive, and protective approach explores how business researchers and teachers may care, inquire, and talk about suicide. The use of fiction and personal experience illustrates a potential affective approach to cope with suicide-related bereavement. Suicide raises ontological, epistemological, and existential questions that defy management as control (typical of prevention strategies), so this paper focuses on postvention, broadening the scope of organizational suicidology to include suicide loss survivors, while suggesting future paths for management-related teaching and research.

PROBLEM Cardiovascular disease (CVD) is the leading cause of death among women. BACKGROUND Adverse pregnancy outcomes, such as stillbirth and recurrent pregnancy loss, are sex-specific risk factors for CVD. Little research investigates CVD preventive healthcare following bereavement. AIM To describe women's preferences and experiences regarding CVD preventive healthcare after bereavement and identify their questions to inform future research and intervention design. METHODS A participatory, qualitative approach was adopted, involving a Lived Experience Expert Group to plan, conduct and interpret focus groups with women who experienced stillbirth or recurrent pregnancy loss. Focus groups involved facilitated group discussion, and a nominal group technique activity to prioritise questions about CVD risk. Focus group transcripts were analysed thematically. FINDINGS Sixteen women participated, all previously unaware of the association between their bereavement and increased CVD risk. Two major themes emerged: women have unmet needs for supportive care after bereavement, and a cautious desire for information about CVD risk. The 'top ten' questions focussed on improving bereavement care, preventing CVD, and concerns beyond CVD. DISCUSSION Although women valued information about CVD risk, they were concerned about adding to the burden of bereaved women, especially in the context of inadequate bereavement care. CONCLUSION Gaps in bereavement care have an enduring impact on women after early pregnancy loss and stillbirth. Beyond improving women's experiences and mental health outcomes, improving bereavement care may also support uptake of long-term CVD preventive healthcare.

Despite increased interest in the impact of external events on counsellors, surprisingly little has been written on counsellor bereavement. To address the research question: How do bereavement counsellors experience therapeutic work after the death of their parent? Interviews were conducted with four bereaved counsellors who reflected on its impact on their work. Data were analysed using Interpretative Phenomenological Analysis (IPA). Three major themes emerged; how decisions about returning to work were informed by colleagues and supervision; the benefits of returning to work and the use of ‘bracketing’; long-term implications for practice including heightened empathy with clients’ and disclosure of loss. In addition, participants felt they had insufficient guidance regarding fitness to practice. The possible limitations of the study were that self-selection may have introduced an element of bias to the results. These findings support existing literature and also revealed potential gaps in grief and loss training for counsellors and supervisors. A particular training issue for supervisors might be identifying and discussing fitness to practice issues with supervisees. There are also implications for counsellors in terms of the use of self-disclosure in therapy. Suggested further research to explore the use of self-disclosure in greater depth.

Abstract The Dual Process Model of Coping with Bereavement (DPM) proposes that there is an adaptive oscillation between loss-oriented (LO) and restorative-oriented (RO) coping processes. Empirical data supports these processes, but the oscillation process is not well-understood. This study explored the correspondence between the DPM and lived experience of bereaved people, with an additional investigation of perceived changes in grief over time. Using a cooperative inquiry inspired participatory research design, nine bereaved adults and three researchers met nine times to discuss experiences of grief. Knowledge production took place through ongoing sharing, exploration, and reflection upon personal experiences and grief theory. Support was found for the LO and RO processes, but they were perceived to overlap. Support was also found for the oscillation process, which was found to hold learning properties. Time off from grief was not supported. Perspectives on how and why grief experiences change over time emerged, emphasizing the importance of acceptance, learning, time, and contextual factors.

The COVID-19 pandemic significantly interrupted the grieving experiences of bereaved families and drastically changed their ways of dealing with loss. Our study aims to gain an in-depth understanding of the experience of bereaved relatives of patients who died in palliative care units during the COVID-19 pandemic. The phenomenological research design included sixteen family members of hospitalized palliative patients who died from November 2021 to June 2022. The study involved conducting qualitative in-depth semi-structured interviews with family members 12–24 months after the death of their loved ones. The interviews aimed to gather information about the experiences of the families both before and after the death. The COREQ guidelines were applied in the study. Participants were mainly female (n = 13) with a mean age of 47.25 (SD = 12.58). Data were analysed using the Interpretative Phenomenology Analysis (IPA). The following three categories were identified: (1) navigating loved ones’ final weeks and days (troubled deaths); (2) the last farewell was robbed; (3) looking for adjustment after loss. One overall main theme emerged, which was as follows: “Struggling between stolen moments and painful losses to get back into the flow of life”. This study provides novel insights into end-of-life care and bereavement from the perspectives of family. Our findings suggest that developing and promoting family-centred culture can lead to compassionate palliative care focused on a myriad ways of affirming that their loved one matters.

The "Trauer Netzwerk Niedersachsen" ("Bereavement Network Lower Saxony" (BNLS)) aims at supporting families after the loss of a child or teenager due to various causes. This study aims to describe the experiences of bereaved family members with the BNLS counsellors. 12 semi-structured interviews were conducted with parents who had received or were currently receiving BNLS counselling. The interviews revealed the vital role counselling played aiding individuals cope with their grief. Participants valued the bereavement support, which was often lacking in their personal support networks. Counselling assisted parents in returning to daily life and caring for loved ones. Discussing "death" and "dying" helped participants find peace with their loss. Our findings suggest that bereavement counselling should be considered an essential component of healthcare for family members dealing with the loss of a child. Additionally, there is need for awareness and publicity for both the BNLS and its bereavement counselling services.

No abstract available

Background Adolescents commonly experience loss due to death, and perceived closeness to the deceased can often increase the intensity of bereavement. Adolescents and early young adult (AeYA) oncology patients may recall previous losses or experience new losses, possibly of other children with cancer, while coping with their own increased risk of mortality. The bereavement experiences of AeYA patients are not well described in the literature. Methods and findings This analysis of bereavement sought to describe the prevalence and types of losses, the support following a death, and the impact of loss on AeYAs aged 13–21 years with malignant disease (or a hematologic disorder requiring allogeneic transplant). Participants were receiving active oncologic therapy or had completed therapy within the past 3 years. Participants completed a bereavement questionnaire and inventories on depression, anxiety, and somatization. The cross-sectional study enrolled 153 AeYAs (95% participation), most (88%) of whom had experienced a loss due to death. The most commonly reported losses were of a grandparent (58%) or friend (37%). Peer deaths were predominantly cancer related (66%). Many participants (39%) self-identified a loss as "very significant.” As loss significance increased, AeYAs were more likely to report that it had changed their life “a lot/enormously” (P<0.0001), that they were grieving “slowly or never got over it” (P<0.0001), and that they felt a need for more professional help (P = 0.026). Peer loss was associated with increased risk of adverse psychological outcomes (P = 0.029), as was parental loss (P = 0.018). Conclusions Most AeYAs with serious illness experience the grief process as slow or ongoing. Peer or parental loss was associated with increased risk of negative mental health outcomes. Given the high prevalence of peer loss, screening for bereavement problems is warranted in AeYAs with cancer, and further research on grief and bereavement is needed in AeYAs with serious illness.

Abstract Attending to bereaved peoples’ lived experiences offers considerable potential for better understanding how to improve support following loss. In-depth interviews (n = 36) and solicited diaries (n = 23) were conducted with bereaved adults following a death in palliative or residential aged care. A constructivist grounded theory approach guided data analysis, through which three themes were derived: making sense of the lived experience of bereavement; relationships in bereavement; and bereavement over time. The results reveal the nuances within everyday experiences of bereavement, in particular the multiplicity of affinities, present or lacking, in social support and recognition.

Bereavement by suicide for people in later life is significantly under-researched. Research on ageing and suicide has yet to address the experiences of those bereaved by suicide and how such a devastating loss affects the ageing experience. Objectives: We explored the substantive issues involved in bereavement by suicide and its impact on later life. Methods: This was a co-produced qualitative study. Peer researchers with lived experience conducted in-depth interviews with twenty-four people aged 60–92 years. A phenomenological approach informed the data analysis. Main Findings: Themes described included (1) moral injury and trauma; (2) the rippling effect on wider family and networks; (3) transitions and adaptations of bereaved people and how their ‘living experience’ impacted on ageing. Conclusions: It is important to understand how individual experiences of suicide intersect with ageing and the significance of targeted assessment and intervention for those bereaved by suicide in ageing policies and support.

Face-to-face ‘Pet Bereavement Counselling’ (PBC) has been established in private practice to support bereaved animal companion owners, however, to date no research has been conducted on PBC. This study aimed to contribute to the existing knowledge base on animal companion loss and provide a preliminary research base on the potential salience of PBC. Six qualified and accredited PBC therapists were recruited and took part in semi-structured interviews. An inductive thematic analysis revealed participants’ perspectives on the acknowledgement of animal companion loss societally and within counselling professions, the diverse ways animal companion loss can impact on bereaved owners, as well as the distinctive attributes and delivery of PBC. The findings have implications for how animal companion loss is conceptualised within counselling professions, teaching and research. Future research recommendations include exploring how bereaved owners experience PBC and how mental health professionals can build upon the support provided to bereaved owners.

Background and aim The loss of a loved one through death is practically an inevitable part of the human experience. However, not all grieving people cope with this blow in the same way. One of the factors that may differentiate the grieving reactions of mourners in the face of this lesion is the strategies that the person uses in this situation to adapt and manage the situation. A valid and reliable tool is also needed to measure and evaluate coping strategies. The aim of this study was to translate and determine the characteristics of psychological tools for measuring coping with experiences of grief and loss (28 items) in people living in Tehran. Materials and methods This is a methodological study with a descriptive cross-sectional design that after obtaining written permission from the original developer and according to the WHO protocol, the Persian version of the questionnaire was completed by 480 people who experienced mourn in Tehran in February 2021 to October 2021. Then, the Face validity, Content validity and Construct validity of questionnaire were assessed. Cronbach’s alpha coefficient, McDonald’s omega and Test-retest were used to determine the reliability. Results Cronbach’s alpha for all items was 0.91 and intra-class correlation coefficient was 0.86, both of which indicate the reliability of the Persian version of the CABLE tool. Based on exploratory factor analysis, maximum likelihood ( n  = 260) and confirmatory factor analysis ( n  = 220) six factors were identified. Factors can explain 50% of the total variance observed. The model had an acceptable fit: GFI: 0.88, CFI: 0.96, IFI: 0.96, NFI: 0.92, PNFI: 0.82, RAMSEA: 0.058, CMIN / DF: 2.37 RMR: 0.056. Internal consistency and construct validity of the questionnaire were confirmed. Conclusion The findings of the present study indicate that the Persian version of CABLE has the appropriate validity and reliability to assess the compliance with the experiences of grief and loss in Persian population.

As they age, many seniors leave their homes to live in a seniors’ residence. Since those residences are both living environments and places where death happens from time to time, seniors who live there will be confronted to the loss of other residents. How is grief experienced by seniors in this setting? Research on this topic has been close to nonexistent. As part of a qualitative research project, we met 26 individuals older than the age of 65 years who had experienced the loss of another resident. Following our interviews, we conducted a thematic analysis of the data. Our results show that communication practices surrounding end of live and death vary from one seniors’ residence to the next. We highlight the strengths and limitations of these practices as well as their impacts on bereaved seniors. We discuss the ways in which our participants felt their grief was considered by others, look at the meanings of silence and communication and reflect on potential intervention strategies.

The death of a child by suicide is a severe trauma, placing parents at greater risk of psychological morbidity and physical health problems compared to other causes of death. However, few studies have examined the aftermath and bereavement experience for parents following the death of a child to suicide, limiting the ability to guide effective postvention services through empirical research. The current study, which was part of a larger longitudinal investigation of suicide bereavement in Queensland, Australia, examined the individual experiences of both mothers and fathers bereaved by suicide over time, specifically at the six month and 12 month time points after their loss. Bereaved parents who had provided written consent to be contacted for research purposes were identified through the Queensland Suicide Register, and took part in individual, semi-structured interviews. Generic qualitative analysis identified three key themes: searching for answers and sense-making, coping strategies and support, and finding meaning and purpose. Some participants showed indications of meaning-making and post-traumatic growth at 12 months after the suicide. According to the dual process model of bereavement, it is likely that participants were still oscillating between sense-making and meaning making, indicating that adapting to bereavement is a dynamic and fluctuating process.

Perinatal loss, including fetal and infant death, is a devastating experience for parents, resulting in long-term adverse physical and psychosocial outcomes. However, little is known about what services might best support grieving parents. We aimed to understand the role of professional bereavement photography in assisting the grieving process of parents who have lost a fetus or infant, by examining the perspectives of bereaved parents, professional photographers, and health care professionals. Twenty semistructured interviews were conducted, and interview transcripts were analyzed using modified grounded theory. Twenty-three individuals participated, including 6 bereaved parents, 8 photographers, and 9 health care professionals. Analyses generated 5 major themes describing ways in which the photographs were valuable to parents: validation of the experience, permission to share, creation of a permanent and tangible legacy, creation of positive memories, and moving forward after the loss. Hospitals should consider incorporation of professional bereavement photography services into palliative care and bereavement programs.

Introduction Recalling personal memories on the loss and deriving new meanings from them is deemed necessary for adapting to bereavement. Recent studies suggest that games can afford players meaningful experiences that can support players through stressful life events, but its potential on the meaning-making of loss has not been much explored. To address this gap, we investigated the bereaved players' experiences of playing commercial video games that elicited their personal memories of loss and what meanings they derived from those experiences. Method Twelve adult players with bereavement experiences (six male, six female, age range: 20-31) played two video games (Bear's Restaurant and Spiritfarer). Their experiences during and after gameplay were tracked via play diaries and in-depth interviews. Data was analyzed using thematic analysis method. Results We discovered seven themes on the meanings that players made from their gameplay experience: “Recalling memories”, “Avoiding engagement with the pain”, “Recognizing positive emotions”, “Acknowledging the deceased's perspective”, “Reviewing the meaning of loss”, “Planning a better future”, and “Fulfilling a wish”. Our findings indicate that bereaved players recalled and related their autobiographical memories to their in-game experiences. Furthermore, they derived new meanings on both the loss and their post-loss life after playing video games. Discussion We discuss how video games can provide a unique meaning-making experience to bereaved players by affording them an agency to actively reconstruct their narrative of loss and facilitating the sharing of grief.

Abstract Bereavement hallucinations (BHs) were assessed in 175 conjugally bereaved participants 4 years post loss, to explore whether BHs were: (a) associated with psychological distress and (b) predicted by sociodemographic variables, personality and/or coping style. Participants with BHs scored significantly higher than those without BHs on prolonged grief, post-traumatic stress, depression symptoms, and emotional loneliness. Hierarchical logistic regression analysis showed avoidant coping, openness to experience, and length of marriage to significantly predict BHs, while detached coping was negatively associated with BHs. This study suggests that BHs may be an indicator of psychological distress in bereavement.

Abstract To understand the lived experience of parents who have lost their child to a chronic life-limiting condition, six major databases were searched by adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Articles were screened for appropriateness using the Sample, Phenomenon of Interest, Design, Evaluation, Research type tool, and relevant qualitative studies were selected for full-text data analysis using Thematic Synthesis. Findings were categorized into 13 themes that were further organized into a four-phase trajectory of parental bereavement experience of child loss, namely: Liminal Margin, Holding Space, Navigating Losses, and Reconstructing Lives. The findings are discussed in the light of existing literature with practical recommendations for enhancing parental bereavement support services.

No abstract available

BACKGROUND Perinatal bereavement is traumatic for many parents. Not only is the experience itself emotionally painful, the impact on their lives is made more difficult if midwives are unable to provide appropriate care to the parents. AIM OF THE STUDY To explore within an Irish context, the psychosocial factors that impact on midwives' confidence to provide bereavement support to parents who have experienced a perinatal loss. DESIGN A mixed methods sequential explanatory design was used to complete this two-phased study from August 2013 to July 2014. Ethical approval was granted from Ethics Committees of three maternity hospitals and a University in Ireland. The recruitment process for the survey occurred in August 2013 and July 2014 for the focus groups. METHODS A series of univariate and multivariate analysis were used to analyze the quantitative data using IBM Statistical Package for the Social Sciences (SPSS; version 20). The qualitative data were analyzed using qualitative content analysis. Steps were taken to ensure data validity and reliability. RESULTS The overall meta-inference of this study is that the majority of the midwives did not have adequate levels of confidence to provide bereavement support to grieving parents. The psychosocial factors that impact on midwives' confidence were identified as the midwives' awareness of the needs of bereaved parents, their own inner strength and the organizational support they received at their place of work. CONCLUSION Improving midwives' bereavement support knowledge and skills is essential for promoting their confidence. Midwives also need adequate emotional and practical support from their organizations.

INTRODUCTION Addiction support and recovery is a multi-faceted support context in which practitioners work with clients who present with increased mortality risks. Drug-related deaths are understood to be a risk factor for complicated grief-reactions but, to date, research has neglected to explore the intricacies of drug-related client loss for practitioners who work with clients experiencing addiction. Due to wider expectations of professional endurance and the demanding nature of health care, grief-related reactions associated with the loss of a client may go unprocessed and, therefore, result in long-term health implications. METHOD Fifteen health care professionals took part in individual semi-structured interviews, which were analyzed using reflexive thematic analysis. Participants represented various disciplines in addiction support and recovery, including homelessness, inclusion health, addiction, and emergency medicine. RESULTS Three core themes emerged encapsulating the experience of drug-related bereavement for HCPs who support people experiencing addiction, as follows: (i) Grief Beneath the Surface, (ii) The Cost of Caring, and (iii) Finding Closure. The findings identified acute grief-related reactions in HCPs such as self-blame and shame, alongside fears of litigation and questions of clinical competency. Participants' accounts of drug-related client loss emphasized a deep professional connection with those that they work with, with grief-responses akin to the loss of peers, family members, and other close connections. The bereavement experience was complicated by unique compounding variables associated with drug-related deaths, but also by incongruity between their emotional responses to death and their professional responsibilities. CONCLUSIONS This article highlights the complex nature of drug-related client loss, and despite their social positioning as experts in their field, HCPs' reactions to client deaths were predominantly human responses to loss. The article identified a need for targeted postvention protocols that address complicated grief while also allowing staff to resume occupational functioning in a measured manner.

No abstract available

No abstract available

No abstract available

Background: Spousal loss is a profoundly challenging experience, often leading to heightened risks of anxiety, depression, and prolonged grief. In the context of cancer, bereavement is further complicated by the caregiving role and the emotional toll of anticipating the end of life. Palliative care plays a crucial role in alleviating suffering, with Continuous Deep Sedation Until Death (CDSUD) being one approach to managing end-of-life distress. However, the impact of CDSUD on the grieving process remains underexplored. Objective: This study explores the emotional trajectories of bereaved spouses about CDSUD, aiming to identify differences in grief experiences between those whose spouses received CDSUD and those who did not. Methods: From September 2022 to April 2024, 13 participants were recruited from French hospital facilities. They were divided into two groups: Group 1 (n = 7) spouses of patients who received CDSUD, and Group 2 (n = 6) whose spouses did not. Data were collected through online semi-structured interviews and analyzed using ALCESTE software. Results: Group 1 revealed two main themes: (1) Palliative Care, Sedation, and Disease History; (2) Grieving Process, Social Relationship Changes, Couple’s History, and Difficult Moments. Group 2 presented three themes: (1) Disease History, (2) Family Background, and (3) Final Hours and Care Team. CDSUD was associated with an abrupt loss, while in its absence, bereaved spouses described extended caregiving and heightened emotional distress. Conclusion: Bereavement experiences varied based on CDSUD usage, with implications for anticipatory grief and bereavement support. Both groups highlighted the need for enhanced support systems for grieving spouses. Plain language summary How deep sedation at the end of life affects the grieving process of spouses Losing a spouse is an incredibly difficult experience that can lead to sadness, anxiety, and long-term grief. This study looks at how a specific medical practice—Continuous Deep Sedation Until Death (CDSUD)—affects the way surviving spouses cope with loss. CDSUD is a method used in palliative care to relieve severe suffering in terminally ill patients by keeping them unconscious until they pass away. However, its impact on the grieving process of spouses has not been well studied. We interviewed 13 people in France who had recently lost a spouse to cancer. Seven of them had spouses who received CDSUD, while six did not. Their experiences were analyzed to understand the emotional effects of CDSUD. The results showed that spouses whose partners received CDSUD often felt the loss was sudden and abrupt. On the other hand, those whose spouses did not receive CDSUD experienced a longer, more gradual decline, with extended caregiving responsibilities. Both groups faced emotional challenges but in different ways. Our findings suggest that the way a loved one passes away can influence how their spouse grieves. This highlights the need for better emotional support for bereaved spouses, regardless of whether their partner received deep sedation or not.

Film documentaries are an important approach for capturing the public's attention and elevating discussions about uncomfortable or hidden topics such as death and dying, yet little attention has been given to documenting the grief experience of bereaved parents. This article focuses on one specific Collaborative Filmmaking project, Visualizing Loss, and explores the impact of participant-created film from the perspective of the audience members who attended a premiere screening. Audience members were invited to complete a post-screening survey that included questions assessing their knowledge, attitudes and reflections about grief, bereavement, palliative care, and the film. The quantitative data was summarized using descriptive statistics, and the qualitative data was organized and indexed according to common themes, supported by illustrative quotes. Seventy-eight (29%) of the 270 audience members completed the post-screening survey. A majority reported that they were absorbed in the screening (81%) and that the film screening inspired or empowered them (76%). Qualitative comments illustrated that the film deeply resonated with audience members by evoking empathy for parents experiencing loss, offering comfort to those with personal connections, and raising awareness about a rarely discussed issue. These findings underscore the Visualizing Loss film's impact in raising awareness and fostering empathy, making it an effective resource for educating and supporting those affected by grief and loss.

Although classic bereavement theories and research have systematically addressed bereaved people's experiences at the individual level, experiences with grief among the Chinese Shiduers (i.e., older adults in China whose only child has died), as one of the most vulnerable groups of bereaved people, diverge from established empirical research findings and theoretical models. This study adopted the dual process model of bereavement (DPM) and a structural perspective to analyze the particularity of Shiduers' grief work and attempt to theorize a conceptual framework to understand their life experience. The research data come from observation notes obtained by the researcher's participant observation and in-depth interviews with 20 Shiduers and five professionals in Wuhan, China. The findings indicate that the Shiduers experience overload in both the loss-oriented (LO) and restoration-oriented (RO) contexts. Within China's sociocultural context, the structural factors that contribute to overload, and the dynamic oscillation process between the LO and the RO were frequently impeded; this resulted in Shiduers being perpetually immersed in one aspect from which they were unable to escape. This study makes a contribution to the explanation of the difficulties that Shiduers experience when coping with grief and also highlights the failure of the universally validated DPM to analyze their grief.

The experience of grief and bereavement is an unfortunate part of the human experience. Both emotional and physiological responses to loss are normal reactions to bereavement. The aim of the study was to examine if the type of loss someone experienced was related to the magnitude of their expressed symptomology in a nonwidowed specific sample. Specifically, to determine if there is a difference in physical symptoms between participants who experienced grief due to an out-of-order loss (a death before the age of 55) versus those who experienced grief after a natural life progression loss (a death that occurs after the age of 80). Results confirmed that those who bereaved an out-of-order loss experienced significantly more symptomology, both emotional and physiological, than those who lost a loved one aged 55 or older. This study highlights the importance of identifying those at the highest risk for increased grief-related symptomology.

Abstract There have been recent calls to normalize the routine use of bereavement photography to help support perinatal loss and grief. However, much of the research has been limited by the use of small sample sizes conducted almost exclusively with mothers from Western cultural backgrounds. The purpose of this study was to examine parents’ perceptions of the beneficial and negative aspects of perinatal bereavement photography within hospital settings. Data were drawn from a large sample (n = 504) of Australian and New Zealand parents from diverse backgrounds who had used professional perinatal bereavement photography over the past 10 years. A summative content analysis was performed on 489 responses to open-ended survey questions that related to parents’ perceptions of bereavement photography and advice parents wanted to pass on to others. Results highlighted how photography was able to humanize the experience of loss and death. Most participants appreciated the high-quality photographs received and also valued the compassionate, caring, and sensitive interpersonal approach of the photographers. Participants advised other parents to “play it safe” by taking photographs, even if they felt uncertain. Bereaved parents could decide later if they wanted to look at or share photographs. Health professionals were key to normalizing and organizing photography; however, gaining informed consent sensitively from grieving parents is challenging. Therefore, advice for normalizing bereavement photography is included. Suggestions for the professional development of photographers and health professionals are provided. Greater community death literacy education about perinatal loss is recommended.

Working with terminally ill patients is difficult for nurses who provide care for the patient, but since the relationship involves the concepts of life and death, the relationship established also has an emotional aspect. When a nurse begins to develop a relationship with a patient and experiences the loss of the patient or a perceived loss, nurses begin to go through the bereavement process. This bereavement experience is called “professional bereavement.” Professional bereavement has various effects on nurses in terms of physical, psychological and social aspects. Determining the situations of professional bereavement and related factors is important in order to take measures to protect and improve the health of nurses, to identify groups that are likely to experience difficulties, and to plan psychosocial support services for nurses experiencing bereavement.

The current study sheds light on the continuing bonds experience of adult Israeli daughters whose mothers were murdered by their fathers. Through 11 semi structured interviews, common externalized and internalized continuing bonds with the deceased mothers were closely examined. The interpreted results supported the existence of bonds, yet revealed a unique manifestation; the bonds were purposefully and defensively restricted, which seemed to be an adjustive compromise in light of the strong traumatic component of the loss. Our results contribute to the theoretical and clinical understanding of the restrictive effect that trauma components have on loss components in cases of traumatic bereavement.

Abstract Negative expectations concerning social interactions contribute to feelings of loneliness. Since loneliness is one of the most pronounced challenges for bereaved individuals, we investigated grief-specific social expectations and its association with loneliness and grief severity. Initially, we developed an Inventory of Social Expectations in Bereavement (ISEB). Its factorial and psychometric validity was then tested in a bereaved sample (N = 344; 28.3 ± 11.1 years; 74.4% female). A two-factor solution for the scale fit the data best (factor 1: “relationship to others,” factor 2: “relationship to the deceased”) and demonstrated good psychometric validity. Higher ISEB-levels were associated with higher levels in grief severity and loneliness. The results suggest that individual social expectations affect the experience of loneliness after the loss of a significant other. The ISEB assesses these expectations time-efficiently and provides a basis for therapeutic interventions. Expressing expectations as probabilistic beliefs about the future renders them amenable for corrective experiences in clinical practice.

OBJECTIVE This study investigates the subjective experiences of individuals with persistent chemosensory dysfunction following COVID-19 illness. By exploring the perceptual and emotional dimensions of their altered sensory worlds, and using a realist phenomenological approach, the study aims to provide an in-depth understanding of the challenges these individuals face. METHODS Qualitative interviews were conducted with 30 patients undergoing treatment. A descriptive phenomenological approach was applied to analyse the interviews. RESULTS Participants described profound emotional and sensory challenges following chemosensory dysfunction. 'Emotional Discontent' was a key theme, encompassing dissatisfaction, grief over the loss of sensory pleasure, and a sense of indifference toward food. The second theme, 'Sensory Aversion', highlighted participants' reports of discomfort and disgust toward previously enjoyable foods, which had become repellent or intolerable. The third theme, 'Perceptual Disorientation', captured the unpredictability of altered sensory experiences, with elusiveness reflecting the fleeting nature of perceptions and sensory alienation highlighting an intense disconnection from unfamiliar and unreliable senses. CONCLUSION Chemosensory dysfunction following COVID-19 disrupts embodied relationship with food, creating profound emotional challenges. Eating becomes a post-pleasure experience, shifting from a source of enjoyment to a merely functional act. Addressing this requires person-centered interventions that acknowledge the sensory and emotional dimensions of the condition.

The COVID-19 pandemic has led to a public health crisis, with increases in the number of deaths. As a result, the number of bereaved people has increased significantly. In addition, the measures adopted to control the spread of virus have triggered changes in the subjective and collective bereavement experiences. This systematic literature review aims to summarize and reinterpret the results of qualitative studies on the experience of losing family members during the pandemic by a thematic synthesis. The searches were performed in the Web of Science, Scopus, PubMed/MEDLINE, CINAHL, PsycINFO, and LILACS databases. Among 602 articles identified, 14 were included. Evidence was assessed using the Critical Appraisal Skills Programme tool. Two descriptive themes related to the objective were elaborated in addition to one analytical theme, namely: "Pandemic grief: lonely and unresolved". These themes proved to be interrelated and indicate that experiences of loss in this context were negatively impacted by the imperatives of physical distance, restriction of hospital visits, technology-mediated communication, and prohibition or restriction of funerals. These changes resulted in experiences marked by feelings of loneliness and helplessness, which should be considered when planning intervention strategies that favor communication between family members with the afflicted loved one and with the health care team, enabling welcoming and creating alternatives for farewell rituals. The findings may support further research to test intervention protocols, especially to guide public policies and promote psychological support to bereaved family members after their loss.

Most people adapt to bereavement over time. For a minority, the grief persists and may lead to a prolonged grief disorder (PGD). Identifying grievers at risk of PGD may enable specific prevention measures. The present study examined the extent to which the subjective unexpectedness of the death predicted grief outcomes above and beyond known sociodemographic and objective loss-related variables in a sample drawn from a population-representative investigation. In our sample (n = 2,531), 811 participants (Mage 55.1 ± 17.8 years, 59.2% women) had experienced the loss of a significant person six or more months ago. Participants provided demographic and loss-related information, perceptions of the unexpectedness of the death and completed the Prolonged Grief Disorder-13 + 9 (PG-13 + 9). The PG-13 + 9 was used to determine PGD caseness. A binary logistic regression investigated predictors of PGD caseness, and a linear regression predictors of grief severity. ANCOVAs compared PGD symptoms between the groups who had experienced an “expected” vs. “unexpected” loss, while controlling for the relationship to the deceased and time since loss. The loss of a child (OR = 23.66; 95%CI, 6.03–68.28), or a partner (OR = 5.32; 95%CI, 1.79–15.83), the time since loss (OR = 0.99; 95%CI, 0.99–1.00) and the unexpectedness of the death (OR = 3.58; 95%CI, 1.70–7.69) were significant predictors of PGD caseness (Nagelkerke’s R2 = 0.25) and grief severity. Participants who had experienced the loss as unexpected (vs. expected) reported higher scores on all PGD symptoms. Unexpectedness of the death emerged as significant risk factor for PGD, even after controlling for demographic and other loss-related variables. While our findings replicate previous research on the importance of the relationship to the deceased as a risk factor for PGD, they also highlight the importance of assessing the subjective unexpectedness of a death and may help to identify risk groups who can profit from preventive interventions.

ABSTRACT Background: China has the largest population of ‘“loss-of-only-child’ parents, that are also known as Shidu parents in Chinese society; however, little is known about their unresolved grief. Objective: This is the first study to examine the grief symptoms, prevalence, comorbidity and potential predictors of prolonged grief disorder (PGD) in such parents, taking into consideration that the new PGD diagnostic criteria ICD-11 will soon be implemented in China. Methods: 149 Shidu parents completed assessments of PGD (PG-13), PTSD (PCL-C), depression (CES-D) and general psychiatric morbidity (GHQ-12) via in-person interviews. Results: Of the 149 Shidu parents, 22.2% met the PGD criteria, with a mean of 7.59 years post-loss, and 62.4% experienced daily longing or yearning. Regression analysis indicated that fewer years since loss, subjective perception of poor economic situation, female gender and more hospital visits were prominent risk factors for the development of PGD. Older age of the parents at the time of child loss was also associated with PGD. Parents with PGD had higher comorbidity of PTSD or depression compared with those without PGD. Conclusions: There is a high prevalence of PGD and a high rate of comorbidity between PGD and PTSD or depression in Shidu parents in China, which highlights the need of timely developing effective assessments and interventions to prevent PGD in this population, particularly in female, recently bereaved, low-income and aged parents who lost their only child.

OBJECTIVE The need to grieve is not limited to losses due to death of significant others, but it also arises in reaction to various life events which result in a sense of loss. Grief is argued to be a universal and natural reaction also in face of life-theratening illnesses. Cancer is a phenomenon that has to be examined in terms of grief reactions since it inherits multiple losses. The aim of the current study is to test the reliability and validity of the Turkish version of Prolonged Grief Disorder Scale-Patient Form (PG-12-Patient Form), which is used to measure grief symptoms in cancer patients. METHOD Following the finalization of the Turkish form, the scale was applied to a sample of participants composed of 250 outpatients diagnosed with cancer. The participants were also presented with Hopelessness Scale and Illness Related Subjective Appraisals Scale for the purpose of examining criterion validity. RESULTS Principle components analysis revealed that forced one-factor solution explaining 46% of the variance was satisfactory and gave a clearer factor structure than the dimensional solution. The Cronbach's Alpha internal consistency was found to be .88. The total scores obtained from the scale were found to have significant positive relationships with the scales used to test the criterion validity. CONCLUSION The results provide evidence suggesting that the Turkish version of PG-12-Patient Form is a reliable and valid tool to measure grief symptoms in cancer patients.

OBJECTIVE To compare narrative coping with physical and psychological ambiguous loss (AL) and definite loss in terms of distancing (vs. narrative immersion), meaning-making, and subjective biographical consequences. METHODS Thirty adults who had lost a parent to death, to going missing, or to Alzheimer disease (N = 90, 67 females; mean age 36.73 years, SD = 7.27; mean time since loss 9.0 years) narrated two loss-related and three control memories. RESULTS Individuals with AL were not more immersed in the loss experience, but less successful in finding meaning and in evaluating the loss and its consequences positively compared to those with a definite loss. These group differences were not due to differences in depression, posttraumatic stress disorder, and protracted grief. CONCLUSIONS Ambiguity of loss renders meaning-making and coherently narrating loss more difficult, leading to more negative affect, suggesting interventions that help narrating loss coherently in a self-accepting way.

The field of depression research and theory is a preparadigmatic potpourri of different orientations without a central, consensus definition of depression. This study attempted to address these issues by investigating the depression sub-literatures (cognitive–behavioral, psychoanalytic, evolutionary, biomedical, phenomenological, existential–humanistic, cybernetic, environmental, and religious–spiritual theories) using a comparative analytic methodology, which allows for comparing disparate fields that do not share a common definitional set by relating them to a third concept, in this study the construct of “ungrieved futility” (UF) as a dynamic model of depression. UF defines the objective and/or subjective experience of the permanent loss of an attachment object that initiates the normal grief process, but which is blocked by other factors. As such, UF is one entity with two components. The results showed that UF does describe the core definitional statement about depression of most of the literatures, with the exceptions being the biomedical, behavioral, as well as parts of the environmental and spiritual sub-literatures. It also distinguishes those literatures that frame depression as an entity possessing inherent structure and dynamics from those that see it as an epiphenomenon. Finally, the analysis points to an inherent dynamic in depression which has implications for transpersonal psychology. Thus, this study shows that even without overt integrative theorizing, the field itself already has a wide inherent agreement about the structural dynamics of depression that has not been clearly recognized in existing literature.

CONTEXT Health-related quality of life (HRQOL) is highly endorsed, but HRQOL studies scarcely investigate the following: ICU family members; modifiable end-of-life (EOL) ICU-care factors; conjoint associations with prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression; and long-term bereavement outcomes. OBJECTIVE Exploratorily investigate associations of PGD-PTSD-depressive-symptom states (resilient, subthreshold-depression dominant, PGD dominant, and PGD-PTSD-depression comorbid) and quality of EOL ICU care with families' HRQOL 6-24 months post loss. METHODS This cohort study examined symptoms of PGD (11 items of the PG-13), PTSD (Impact of Event Scale-Revised), and depression (Hospital Anxiety and Depression Scale), and HRQOL (Medical Outcomes Study 36-Item Short-Form Health Survey) among 303 ICU family members. Quality of EOL ICU care was measured by objective process-based care-quality indicators abstracted from medical records and classified by subjective family-assessed quality of patient dying and death (QODD). Associations were simultaneously examined by multivariate hierarchical linear modeling with resilient state and high QODD class as reference. RESULTS Physical and mental HRQOL were worse in the three more distressed symptom states, especially mental HRQOL which showed an incremental dose-response effect: subthreshold depression-dominant (β [95% CI]=-2.419 [-3.374, -1.464]), PGD-dominant (-8.366 [-10.116, -6.616]), and PGD-PTSD-depression comorbid (-14.736 [-17.772, -11.700]) states. Mental HRQOL was significantly worse in the three poorer QODD classes: moderate (-1.085 [-2.138, -0.032]), poor to uncertain (-4.362 [-5.616, -3.108]), and worst (-3.239 [-4.433, -2.045]). HRQOL was not associated with objective care-quality indicators. CONCLUSION Bereaved family members' HRQOL was significantly associated with PGD-PTSD-depressive-symptom states and QODD classes-both modifiable through high-quality EOL ICU care.

No abstract available

ABSTRACT Background: Along with the implementation of the one-child policy in China, a special group of bereaved parents called ‘shiduer’ (失独者), meaning parents bereaved by the loss of their only child, emerged. Although previous research has examined the physical and psychological health of this population, individual differences in physical and psychological outcomes are still not well understood. Objective: This study aimed to identify heterogenous subgroups of Chinese bereaved parents who lost their only child based on the physical and psychological health of this population as well as the predictive factors of each subgroup. Method: Latent profile analysis was used to explore underlying patterns of physical and psychological indicators including subjective physical health, negative psychological outcomes (i.e. depression, post-traumatic stress disorder and prolonged grief disorder) and positive psychological outcomes (i.e. post-traumatic growth) among a sample of Chinese bereaved parents who lost their only child (N = 536). A three-step approach was used to examine the effects of covariates including quality of spousal relationship and recruitment channels on psychological and physical outcomes. Results: A three-profile model identified severity-based groupings of a ‘resilient’ subgroup (n = 153), a ‘coping’ subgroup (n = 338) and a ‘dysfunctional’ subgroup (n = 45). Less satisfaction with spousal relationship and recruitment from institutions in the community and online self-help groups (vs. offline support groups) are associated with the membership of the ‘coping’ or ‘dysfunctional’ subgroup compared to the ‘resilient’ subgroup. Conclusions: There is heterogeneity regarding the physical and psychological health of Chinese parents after losing their only child. The predictive effects of the quality of spousal relationship and the recruitment channels could provide directions for professional intervention.

No abstract available

No abstract available

No abstract available

ABSTRACT Background: A strong social safety net may play a key role in protecting people from developing prolonged grief disorder (PGD) after a traumatic loss. This has mainly been investigated cross-sectionally, whereby people usually report on their social life and PGD reactions during the past month. However, retrospectively recalling experiences is prone to recall bias. Objective: As such, we investigated the associations between pleasantness of social interactions and PGD reactions in traumatically bereaved people using Ecological Momentary Assessment (EMA). Methods: People whose loved one died due to homicide, suicide, or accident at least 12 months earlier (N = 36, 78% women, Mage = 56, 47% met PGD criteria) received smartphone-based surveys five times per day for two weeks. Surveys included questions about PGD intensity (e.g. ‘In the past 3 hours, did you yearn for your loved one?’ 0 = not at all, 6 = extremely) and their quality of social life (e.g. ‘In the past 3 hours, how did you find being with others?’ 0 = very unpleasant, 6 = very pleasant). Linear mixed models were used. Results: Based on 2520 measurement occasions, we found that when a person enjoyed their social life more than usual, they grieved less (B = −0.141, SE = 0.020, p < .001). However, whether a person’s social life was more or less pleasant than their peers was not related to their PGD levels. Conclusions: This EMA study highlights the importance of accounting for individual variability in grief reactions after loss and highlights the potential utility of strengthening one’s social safety net as a way to reduce the burden of PGD. HIGHLIGHTS The link between one’s social life and prolonged grief reactions was examined using ecological momentary assessment in traumatically bereaved people. We found that when people perceived their social interactions or time spent alone to be more pleasant than usual, they grieved less. Also, when people were in the presence of others, they grieved less. Strengthening one’s social safety net after traumatic loss seems clinically useful.

OBJECTIVE Nondeath losses and experiences of grief can impact mental health but are understudied among parents of children with complex medical conditions. This study leverages online crowdsourcing, an approach that gathers diverse ideas by soliciting contributions from an online community, to characterize losses experienced by parents of children with congenital heart disease (CHD). METHODS Eighty parents of children with CHD and a prior history of cardiac surgery and hospitalization across 44 US hospitals responded to open-ended questions on a private social networking site as part of a larger study. Data were coded and analyzed using a hybrid inductive-deductive approach, and themes regarding the ways that loss and grief were experienced by parents were identified. RESULTS Six themes were identified: (1) loss of identity was an overarching theme that cut across the other themes; (2) loss of sense of security/predictability; (3) loss of "normal/healthy" pregnancy, birth, and child; (4) work/financial loss; (5) loss of parent-infant bonding and parenting experiences; and (6) loss of/impact on relationships. To support families with their experiences of nondeath losses, parent participants recommended that health care professionals acknowledge and normalize grief, provide memory and meaning-making opportunities, support parents in establishing a bond with their baby, facilitate parent participation in inpatient care, and offer general psychosocial support. CONCLUSIONS Acknowledging and normalizing nondeath losses and grief is paramount to supporting families of children with CHD. A thorough understanding of the types of losses experienced is necessary to better support parents and promote healthy family and child outcomes.

Background: Pregnancy loss is a profoundly traumatic event that can leave lasting emotional and psychological effects. While subsequent pregnancies are often thought to ease grief, many women continue to experience unresolved distress. Objective: This pilot study examined demographic, reproductive, and psychosocial correlates of grief intensity after pregnancy loss among women in the third trimester of a subsequent pregnancy. Methods: Twenty partnered women who had experienced a prior pregnancy loss, now beyond the gestational age of that loss, were recruited from childbirth classes. Participants completed standardized measures of grief, social support, spirituality, post-traumatic stress, and depression. Results: Grief intensity was significantly related to education, gestational age at loss, perceived social support, and symptoms of post-traumatic stress and depression. Conclusions: Findings suggest that while subsequent pregnancies may soften grief, they have limited impact on PTSD and depressive symptoms. Targeted interventions remain critical for healing.

Background. The growing number of losses due to war, the COVID-19 pandemic, and social crises underscores the need to differentiate between normal and pathological grief. Delayed diagnosis of prolonged grief disorder (PGD) increases the risk of depression, suicidality, and psychosomatic disorders. Objective: to systematize theoretical concepts and empirical research for distinguishing normal and pathological grief, and to analyze the mental health of individuals who lost a loved one due to the full-scale Russian invasion of Ukraine, with a subsequent assessment of potential mental disorders and the effectiveness of modern therapeutic approaches, including pharmacological interventions. Materials and methods. This study integrates a review of scholarly literature from various scientific databases (2014–2024) and findings of own clinical observations. A total of 96 patients aged 25–55 who had experienced a loss were clinically examined. The Traumatic Grief Inventory-Self Report Plus (TGI-SR+) was used for initial scre-ening. 58 patients met the criteria for PGD according to the TGI-SR+ and were further evaluated using the Montgomery-sberg Depression Rating Scale (MADRS) to assess depressive symptoms. Results. PGD was confirmed as a distinct diagnostic category with well-defined criteria. Its core features include persistent emotional suffering, anxiety symptoms, and social maladjustment persisting six months after the loss. The literature review supports the effectiveness of combining psychotherapeutic and pharmacological interventions. In this study, PGD patients were stratified into two subgroups based on MADRS scores: group 1 — moderate depression (n = 31; MADRS 24.42 ± 2.17), group 2 — mild depression (n = 37; MADRS 12.41 ± 2.82). All patients received escitalopram: up to 20 mg in group 1 and up to 10 mg in group 2. One month after treatment initiation, MADRS scores significantly decreased in both groups: to 8.06 ± 1.80 in group 1 and to 4.68 ± 1.48 in group 2 (p < 0.05). Conclusions. A deeper understanding of loss and the grieving process enables timely diagnosis of pathological grief. Under wartime conditions, families of the deceased and mis-sing people often experience intense grief that, when prolonged, can develop into PGD. In such cases, antidepressant support may be appropriate. Escitalopram proved effective in alleviating depressive symptoms associated with PGD.

Background: Grief has previously been described in pathological terms, characterized by several stages. In the past three decades, new perspectives on grief as a reaction to the loss of a significant other have emerged. It shows that grief is an individual process based on circumstances surrounding the death and the bereaved person’s life situation, rather than being predetermined. Objective: The aim of the study was to show how grief is perceived by people who have lost a significant other, and it focuses on bereavement support, how the death affects the bereaved person’s living conditions, how the bereaved person deals with grief, and if grief is expressed differently depending on whether it was an expected death (ED) or an unexpected death (UED). Design: A cross-sectional design was used with data collected anonymously using an online survey with semi-structured answers and options for participants to add their own comments, and it was analyzed descriptively. Result: Support in grief was mainly given by family and friends, and the perceived need was primarily for emotional support or emotional support combined with practical support, and to a greater extent for UEDs and women. For some bereaved persons, health caregivers and religious institutions provided support outside their own network. Grief can affect how people socialize with others and change social relationships. People can deal with grief in social as well as religious ways in the company of friends, through everyday conversations, spending time in nature, and having a spiritual outlook on life, and with the help of pets. Conclusion: The results can contribute to an increased understanding of grief after the loss of a significant other and how grief affects the bereaved person’s life depending on whether it is an ED or a UED. There was a difference between the genders, with women perceiving a need for and receiving different forms of support and to a greater extent than men. Plain language summary Understanding support and coping in grief Grief has long been described as a mental health disorder and characterized by multiple stages. In the last three decades, research has shown new perspectives on grief as a normal reaction to the loss of a significant other. It has shown that grief is an individual process based on the circumstances surrounding the death, the bereaved person’s social life situation, different forms of support and how the bereaved person deals with their changed life situation. The aim of this study was to investigate what support in grief can look like and the coping strategies that are used. The grieving process can vary depending on how the death affects the bereaved person’s living conditions, how they deal with grief, and whether it was perceived as an expected death (ED) or an unexpected death (UED). The study took the form of an online survey with data collected as anonymous semi-structured answers, with options for participants to add their own comments, and it was analysed descriptively. The results showed that support in grief was mainly provided by family and friends, regardless of whether it was an ED or a UED. For some bereaved persons, health caregivers and religious institutions provided support outside their own network. The participants mainly reported a need for emotional support and emotional support combined with practical support. Grief can influence how people socialize with others and lead to changes in social relationships. People can cope with grief in social and religious ways, by socializing with friends, and through everyday conversations, spending time in nature and having a spiritual outlook on life, and with the help of pets. The conclusions drawn from the results can contribute to a greater understanding of the bereavement of a significant other and how grief influences the life circumstances of a bereaved person in many ways.

No abstract available

Introduction Several factors can influence the journey of perinatal grief in mothers, including the quality of care during this experience. The objective of our study was to investigate the factors influencing the perception of grieving women during the perinatal period and identify the role of medical and paramedical healthcare professionals in psychological support. Objectives To determine the factors influencing the perception of fetal loss in grieving mothers. Methods This was a descriptive, longitudinal, retrospective study conducted between july 2021 and march 2022 at the Fetal Pathology Department of the Center for Maternity and Neonatology in Tunis, Tunisia. The study included women who experienced perinatal loss and underwent fetal pathology examination. The study was conducted in two stages: Initial consultation at the Fetal Pathology Department, five weeks after the date of expulsion, for perinatal grief counseling. Follow-up interview one year after the date of expulsion: The participants were contacted via telephone for an average duration of twenty minutes .The assessment of perinatal grief during both interviews was conducted using the shortened version of the Perinatal Grief Scale (PGS) Results The mean age of the patients was 31.41 years (± 5.15). The average gravidity was 2.47 (± 1.43). More than half of the patients had no living children (n=41). The majority of patients had no notable pathological history. Six patients had been followed in psychiatry, and five had a history of subfertility. The majority of patients (n=61) reported having good marital relationships. Among the participants, 20% (n=14) had a high Perinatal Grief Scale (PGS) score (PGS >= 91) at five weeks post-loss and were subsequently referred for psychiatric consultation. At one year, all participants had a PGS score > 91, demonstrating the effectiveness of psychiatric management. Multivariate analysis identified four independent factors associated with a high PGS score at five weeks: absence of living children (OR=0.59; 95% CI [0.36-0.98]; p=0.04), quality of marital relationship (OR=1.2; 95% CI [1.1-3.9]; p=0.02), family support (OR=2.52; 95% CI [1.55-4.12]; p<0.001), and quality of loss disclosure (OR=2.52; 95% CI [1.32-3.77]; p=0.003). Conclusions To identify patients at high risk of developing complicated grief and improve the quality of psychological care, it is necessary to implement appropriate protocols, provide training to healthcare personnel, and establish well-equipped healthcare facilities. Disclosure of Interest None Declared

No abstract available

Objective: While recovery from psychosis is possible, recovery is a multidimensional construct driven by various factors. One relevant factor to recovery from psychosis that has often been overlooked in the psychotherapy literature is the importance of facing loss and processing grief in relation to psychosis. Methods: A review of the existing empirical literature on grief associated with psychosis was conducted. Clinicians with significant therapeutic experience working with persons with psychosis reviewed cases to examine the losses the patients had suffered and how they responded to these losses. The clinicians considered essential principles that are relevant when helping patients with psychosis integrate loss and process grief. Results: Persons who have experienced psychosis often experience the loss of role functioning, interpersonal relationships, cognition, and self-concept. However, when these losses are not fully integrated into the person’s identity, it can result in either more losses due to denial and metacognitive impairments or increased hopelessness and depression due to internalized stigma. Five elements in psychotherapy of psychosis were identified that can facilitate the integration of loss and processing of grief: understand the personal experience of the psychotic episode, attend to feelings of grief and the primary loss, explore the meaning of psychotic symptoms and identity implications, integrate psychotic vulnerabilities into the sense of self, and foster realistic hope in the face of an uncertain future. Conclusion: Psychotherapy can enable persons with psychosis to make meaning of their losses, process their grief, integrate their psychotic vulnerability into their sense of self, and develop realistic hope.

Objective Complicated grief reactions follow some pregnancy outcomes, like miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. Stigma can delay treatment and worsen outcomes. Screening tools such as the Edinburgh Postnatal Depression Scale detect complicated grief poorly, and specific tools for prolonged or complicated grief after a reproductive loss are cumbersome. In this study, a five-item questionnaire to detect complicated grief after reproductive loss of any type was designed and preliminary validated. Methods A questionnaire patterned after the extensively validated Brief Grief Questionnaire (BGQ) was created by a group of physicians and lay advocates to employ non-traumatic but specific language related to grief after miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. One hundred and forty women at a large academic center were recruited in person and via social media to validate the questionnaire with well-studied instruments for anxiety (7-item Panic Disorder Severity Scale, PDSS), trauma (22-item Impact of Events Scale), and reproductive grief and depressive symptoms (33-item Perinatal Grief Scale [PGS]). Results The response rate was 74.9%. Of the 140 participants, 18 (12.8%) experienced their loss during high-risk pregnancies, and 65 (46.4%) were recruited via social media. Seventy-one (51%) respondents had a score > 4, a positive screen for the BGQ. On average, women experienced their loss 2 years prior to participation (IQR 1-5 years). Cronbach's alpha was 0.77 (95% CI: 0.69-0.83). The goodness of fit indices of the model met Fornell and Larker criteria (RMSEA = 0.167, CFI = 0.89, SRMR = 0.06). The AVE was 0.42 and the CR 0.78. Conclusions This investigator-created screening tool is internally consistent and meets preliminary criteria for discriminant validity. This tool can be refined prior to testing for sensitivity and specificity in screening for complicated grief after a reproductive loss.

Objectives: Anticipatory grief is associated with post-bereavement grief; however, reports on the influence of pre-loss depression are limited. Therefore, we investigated the association between the anticipatory grief of family members and post-loss and post-depression grief adjusted for pre-loss depression. Methods: This cohort study included the family members of dying patients with cancer. Questionnaires were distributed to them during hospitalization in four inpatient palliative care units from 2016 to 2017. We also administered follow-up questionnaires after their bereavement in 2018. The pre-bereavement questionnaire consisted of three items from the Anticipatory Grief Scale for Families Caring for a Terminally Ill Person for assessing anticipated grief and the Patient Health Questionnaire 9 for assessing depression. The Brief Grief Questionnaire was used to assess post-loss grief. Results: We distributed 181 pre-bereavement questionnaires to the family members; 112 (62%) responded to the pre-bereavement survey, out of which 71 (63%) responded to the post-bereavement survey. Anticipatory grief was significantly associated with pre-loss (ρ = 0.37, ρ < 0.001) and post-loss (ρ = 0.24, P = 0.009) depression and marginally associated with post-loss grief (ρ = 0.15, P = 0.10). Pre-loss depression was also significantly associated with post-loss depression (ρ = 0.50, P < 0.001) and post-loss grief (ρ = 0.41, P < 0.001). However, anticipatory grief was not significantly associated with post-loss depression (P = 0.35) and post-loss grief (P = 0.65) after adjusting for pre-loss depression. Significance of Results: Bereaved families who experienced anticipatory grief had worse post-bereavement depression. However, this association was not statistically significant after adjusting for pre-bereavement depression. Post-bereavement depression may be in a continuum with pre-loss depression, and anticipatory grief does not independently affect post-loss reactions.

Background: Suicide loss survivors (SLSs) commonly experience negative grief responses, including symptoms of prolonged grief disorder (PGD). Cognitive-behavioral models propose that both anxious and depressive avoidance (DA) are critical factors in the onset and maintenance of prolonged grief. Objectives: This study aimed to evaluate the construct validity and reliability of the Persian version of the Depressive and Anxious Avoidance in Prolonged Grief Questionnaire (DAAPGQ) among Iranian SLSs. Methods: A cross-sectional study was conducted between 2023 and 2024. A total of 170 suicide survivors were selected through convenience and snowball sampling. Participants completed the DAAPGQ, the Prolonged Grief Disorder Scale-13-Revised (PG-13-R), the Hospital Anxiety and Depression Scale (HADS), and the Utrecht Grief Rumination Scale (UGRS). Construct validity was investigated using confirmatory factor analysis (CFA), assessing both a correlated two-factor model and a higher-order factor model. Convergent and discriminant validity were examined via average variance extracted (AVE), average shared variance (ASV), and maximum shared variance (MSV). Concurrent validity was assessed through correlations with relevant psychological constructs. Internal consistency was estimated using Cronbach’s alpha and McDonald’s omega coefficients. Results: The CFA results showed that both the correlated two-factor model and the higher-order factor model provided satisfactory model fit, with the higher-order factor solution demonstrating slightly superior indices. Internal consistency for the total scale was excellent (Cronbach’s α = 0.91; McDonald’s ω = 0.91), and subscales for DA (α = 0.91, ω = 0.91) and anxious avoidance (AA, α = 0.82, ω = 0.84) were also robust. Both subscales had AVE values above 0.50 and exceeded ASV and MSV, supporting construct validity. The DAAPGQ scores were positively associated with PGD, depression, anxiety, and rumination, and negatively with time since loss. Hierarchical regression showed DA (β = 0.553, P < 0.001) and AA (β = 0.242, P < 0.001) significantly predicted PGD symptoms, with the final model explaining 66.4% of the variance. Conclusions: The Persian DAAPGQ is a psychometrically sound measure for the assessment of depressive and AA in SLSs with symptoms of prolonged grief.

Abstract Objectives Parents’ experiences of loss and grief in the context of caring for a child with life-limiting severe neurological conditions are complex. Supportive interventions delivered by multidisciplinary teams have the potential to mitigate illness-related and anticipatory grief before and after bereavement. To date, the literature on professionals’ discussion of loss and grief with parents has not been synthesized. This systematic review aims to synthesize the evidence to establish what is known about professionals’ experience of these discussions with this population, with particular emphasis on timing, frequency, and the setting in which discussions occur. Methods A scoping review was developed, informed by the Preferred Reporting Items for Systematic Reviews and Meta analyses – Scoping Extension guidelines and the PCC (Population, Concept, Context) framework. Three electronic databases (PsycINFO, CINAHL, and PubMED) were searched using medical subject heading (MeSH) terms and keywords search strings in January 2023. The search was not limited to year of publication. Overall, 35 articles were analyzed using a combination of descriptive analysis and thematic synthesis. Results Two overarching themes were identified, “loss and grief are part of this context” and “lack of recognition of loss and grief,” illustrating that despite the lack of evidence of explicit discussion of these issues, some aspects of loss and grief appeared to guide or implicitly influence healthcare professionals’ practice. Failure to acknowledge loss and grief was associated with an increase in parental distress and had implications for future care planning. Significance of results Healthcare professionals are well placed to discuss loss and grief with parents of children with life-limiting severe neurological conditions. However, these discussions are only implicitly reported in the literature. Findings suggest that some professionals avoided discussing loss and grief. Bereavement outcomes are not typically considered in findings of the papers reviewed. Based on these findings, future research should focus on what this means for understanding professionals’ capacity to engage with loss and grief.

ABSTRACT Background Acute grief appears more severe after COVID-19 deaths than natural deaths. Prolonged grief disorder (PGD) also appears prevalent following COVID-19 deaths. Researchers hypothesize that specific loss characteristics and pandemic-related circumstances may precipitate more severe grief following COVID-19 deaths compared to (other) natural deaths. Systematic research on these hypotheses may help identify those most at risk for severe grief reactions, yet it is scant. Objective To compare loss characteristics, loss circumstances, and grief levels among people bereaved due to COVID-19, natural, and unnatural causes. Methods Adults bereaved through COVID-19 (n = 99), natural causes (n = 1006), and unnatural causes (n = 161) completed an online survey. We administered self-report measures of demographic variables (i.e., age, gender), loss characteristics (i.e., time since loss, relationship with the deceased, intensive care admission, expectedness of death), loss circumstances (i.e., saying goodbye appropriately, COVID-19 infection, quarantine, financial setbacks, social support satisfaction, altered funeral arrangements, funeral satisfaction), and prolonged grief symptoms. Results COVID-19 deaths (vs. other deaths) more often were parental deaths and less often child deaths. COVID-19 deaths (vs. natural deaths) were more often unexpected and characterized by an inability to say goodbye appropriately. People bereaved due to COVID-19 (vs. other deaths) were more often infected and quarantined. COVID-19 deaths (vs. other deaths) more often involved intensive care admission and altered funeral arrangements. COVID-19 deaths yielded higher grief levels than natural deaths (but not unnatural deaths). Expectedness of the death and the inability to say goodbye appropriately explained this effect. Conclusions Bereavement due to COVID-19 is characterized by a unique set of loss characteristics and circumstances and elevated grief levels. Improving opportunities to say goodbye before and after death (e.g., by means of rituals) may provide an important means to prevent and reduce severe grief following COVID-19 deaths. HIGHLIGHTS COVID-19 deaths have unique loss characteristics and circumstances and elicit more severe grief than natural deaths. Death expectedness and the ability to say goodbye appropriately appear important in understanding, preventing and treating grief following COVID-19 deaths.

Climate change is no longer an abstract dilemma but a lived reality, experienced not only through changing material conditions but also across the psychological landscapes of people worldwide. While extensive literature documents the physical consequences of rising sea levels, extreme temperatures and growing food insecurity, far less attention has been given to how these disruptions influence subjective well-being across regions. Drawing on a global dataset covering 32 countries from both the Global North and the Global South, this paper examines the intersection of environmental degradation with psychological resilience, emotional health and life satisfaction. Using data from the World Risk Report, the Gallup Global Emotions Report, and IPCC climate vulnerability assessments, the study identifies a strong negative relationship; populations exposed to high climate risk, on average, happiness scores 22 points lower than those living in more stable environments. Qualitative evidence deepens these findings, revealing widespread climate anxiety, displacement-induced trauma and the erosion of community ties. Pacific Island communities face existential threats of cultural loss due to rising sea levels, while farmers in Sub-Saharan Africa experience profound ecological grief as drought devastates livelihoods. To bridge the gap between objective climate impacts and subjective well-being, the paper argues for a transdisciplinary approach that integrates psychological resilience into adaptation planning. Accordingly, it proposes the Human Climate Resilience Matrix, a policy tool combining climate risk indicators with psychosocial measures, advocating adaptation strategies that are both emotionally intelligent and scientifically robust.

BACKGROUND Although evidence-based Prolonged Grief Disorder treatments (PGDT) exist, pretreatment characteristics associated with differential improvement remain unidentified. To identify clinical factors relevant to optimizing PGDT outcomes, we used unsupervised and supervised machine learning to study treatment effects from a double-blinded, placebo-controlled, randomized clinical trial. METHODS Patients were randomized into four treatment groups for 20 weeks: citalopram with grief-informed clinical management, citalopram with PGDT, pill placebo with PGDT, or pill placebo with clinical management. The trial included 333 PGD patients aged 18-95 years (M = 53.9; SD = 14.4). Symptom trajectories were assessed using latent growth mixture modeling based on Inventory for Complicated Grief scores collected every 4 weeks. The relationship between patient-level characteristics and assigned trajectories was examined using logistic regression with elastic net regularization based on the administration of citalopram, PGDT, and risk factors for developing PGD. RESULTS Three response trajectories were identified: lesser severity responders (60 %, n = 200), greater severity responders (18.02 %, n = 60), and non-responders (21.92 %, n = 73). Significant differences between greater severity responders and non-responders emerged by Week 8, persisting through the 6-month follow-up assessment. The elastic net model (AUC = 0.702; F1 = 0.777) indicated that higher baseline depression severity, grief-related functional impairment, and not receiving PGDT were associated with a decreased probability of response. LIMITATIONS An independent validation cohort of PGDT patients is needed to further study generalizability of findings. CONCLUSIONS Differential PGDT courses and the role of depression severity and grief-related functional impairment in treatment non-response were identified. These findings underscore the importance of determining clinical factors relevant to optimizing individual treatment strategies.

No abstract available

ABSTRACT Objective Bereavement is among the most impactful psychosocial stressors for cardiovascular health, and hypertensive episodes accompanying bereavement-related distress are one putative mechanism for this effect. The present study examined hemodynamic responses to the Grief Recall (GR), a promising method for studying the effects of acute grief on cardiovascular function, and the relationship of grief severity to blood pressure (BP) response. Methods N = 59 participants within 1 year of the loss of a close loved one completed the GR, a semistructured interview protocol for eliciting bereavement-related distress (a “grief pang”) and cardiovascular response. Systolic (SBP) and diastolic BP (DBP) were measured at two time points: a) an attention-control baseline and (2) after a 10-minute GR interview. Baseline versus post-GR SBP and DBP differences (i.e., BP response) were measured. Grief severity was examined as a predictor of SBP and DBP response, as well as BP recovery Results SBP and DBP increased significantly after GR (SBP, +21.10 mm Hg; DBP, +8.10 mm Hg). Adjusting for variables relevant to cardiovascular function and bereavement (antihypertensive medication use, days since death, gender, age), grief severity predicted the magnitude of increase after GR in SBP but not DBP. No relationship of grief severity and recovery was observed. Conclusions The observed association between hemodynamic response and grief severity suggests a mechanistic contribution from hemodynamic effects of acute grief episodes to the cardiovascular impact of grief. This is the first study to show that increased symptoms of prolonged grief disorder are associated with an elevated SBP response. The GR may have further utility for research examining physiological responses to bereavement-related emotions.

Internet-based psychological interventions have proven effective in the treatment of prolonged grief disorder (PGD). Yet, some patients do not benefit from treatment in a clinically significant way. We aimed to examine predictors of symptom reduction in an Internet-based intervention for PGD after cancer bereavement, in order to identify possible treatment mechanisms and discern directions for future intervention design. A secondary analysis of data from a randomized wait-list controlled trial on an Internet-based intervention for PGD after cancer bereavement was conducted. Multiple regression models were used (1) to test for the influence of pretreatment PGD, working alliance, avoidance and gender on PGD symptom reduction; and (2) to explore further predictors of treatment success with a best subset selection protocol. The regression models explained 18% (Model 1) and 34% (Model 2) of variance in symptom reduction. Participants with more favorable symptom change had more severe pretreatment PGD scores and better working alliance. Those with lower social support and less posttraumatic growth experienced more PGD symptom change. In conclusion, therapeutic alliance is an important factor that should be monitored and fostered. Findings regarding social support and posttraumatic growth need further replication and clarification.

Accelerated resolution therapy (ART) is a psychotherapy for the treatment of prolonged grief disorder (PGD) defined as severe, enduring longing for the lost person. Currently, ART lacks examination of intrapersonal processes, like expectancy, as behavioural mechanisms for action. Therefore, the purpose of this paper was to present the findings on participants' treatment expectations of ART for PGD and then discuss potential hypotheses for future testing. This study was a primary qualitative descriptive analysis of prospectively collected interview data (collected 2017-2019) accrued as part of a randomised, wait-list controlled clinical trial in bereaved hospice family caregivers in the United States. The sample included 29 former informal caregivers who were at least 1-year post death of their care recipient. They were primarily female, older (67.4 ± 7.1 years), and a little over half (n = 18) had been married to their care recipient. Thematic analysis resulted in three distinct themes with six sub-themes: The role of knowledge in expectations (sub-themes uncertainty, prior knowledge); The role of personality in expectations (sub-themes openness, positive affect); and Expecting a process (sub-themes cognitive processes, affective processes) which described the interaction of person and process in shaping expectations of our intervention. An across theme analysis of the specificity of the participants' expectations uncovered that knowledge and personality inform expectations of ART and that individuals who verbalise a process for recovery tend to be very specific in their expectations. Three hypotheses for testing are put forward and implications for practice, research and policy discussed.

OBJECTIVE Posttraumatic stress disorder and prolonged grief disorder (PGD) arise following major life stressors and may share some overlapping symptomatology. This study aimed to examine the presence and response to treatment of posttraumatic stress symptoms (PTSS) in bereaved adults with a primary diagnosis of PGD. METHODS A randomized controlled trial of 395 adults with PGD (defined as an Inventory of Complicated Grief score ≥ 30 plus confirmation on structured clinical interview) randomly assigned participants to either complicated grief treatment (CGT) with citalopram, CGT plus placebo, citalopram, or placebo between March 2010 and September 2014. This secondary analysis examined the presence of PTSS (per the Davidson Trauma Scale) at baseline and change in PTSS with treatment using longitudinal mixed-effects regression and examined the role of violent compared to nonviolent deaths (loss type). RESULTS High levels of PTSS were present at baseline, regardless of loss type, and were associated with increased functional impairment (P < .001). CGT with placebo demonstrated efficacy for PTSS compared to placebo in both threshold (OR = 2.71; 95% CI, 1.13-6.52; P = .026) and continuous (P < .001; effect size d = 0.47) analyses, and analyses were suggestive of a greater effect for CGT plus citalopram compared to citalopram alone (threshold analysis: OR = 2.84; 95% CI, 1.20-6.70; P = .017; continuous analysis: P = .053; d = 0.25). In contrast, citalopram did not differ from placebo, and CGT plus citalopram did not differ from CGT plus placebo. CONCLUSIONS Bereavement-related PTSS are common in bereaved adults with PGD in the context of both violent and nonviolent death and are associated with poorer functioning. CGT shows efficacy for PTSS, while the antidepressant citalopram does not. TRIAL REGISTRATION : ClinicalTrials.gov identifier: NCT01179568.

Abstract Older adults are at an increased risk of developing Prolonged Grief Disorder (PGD) due to the heightened chances of experiencing a loss, lower levels of cognitive functioning, and heightened rates of loneliness and depression. Currently, the Prolonged Grief Disorder-13 Revised (PG-13-R) is the only measure specifically designed to assess for PGD. The PG-13-R was developed to reduce misdiagnoses of PGD and avoid pathologizing normal grief, as research has found grief to be a distinct psychological response to bereavement. The present study compared the PG-13-R to other measures of similarly presenting mental health disorders. Our sample consisted of 120 racially and ethnically diverse adults aged 50 and older who completed measures of grief, depression, anxiety, post-traumatic stress disorder (PTSD) and loneliness using REDCap. Correlation coefficients were computed using SPSS Version 29 to investigate convergent and discriminant validity of the PG-13-R and other mental health disorder measures. The results showed the PG-13-R was strongly correlated with the PTSD measure (r = 0.67, p < 0.001), moderately correlated with the anxiety measure (r = 0.49, p < 0.001), and weakly correlated with measures of depression (r = 0.39, p < 0.001) and loneliness (r = 0.34, p < 0.001). This suggests the PG-13-R and PTSD measure are capturing aspects of a related concept. The PG-13-R could be further refined to capture unique features of grief, distinct from PTSD, to improve the quality of grief assessment. Continuing to improve existing measures further equips mental health professionals to serve the community by advancing the identification, assessment, and treatment of mental health disorders.

ABSTRACT Background: Prolonged Grief Disorder (PGD) has recently been included in both the ICD-11 and DSM-5-TR diagnostic manuals. Studying its prevalence and correlates across cultures is vital for more effective identification, treatment, and prevention. Objective: This study aimed to examine prevalence rates of ICD-11-based PGD, in a representative Slovakian sample in response to deaths of loved ones occurring during the previous year. Further aims were to examine the factor structure of PGD symptoms and correlates of summed PGD item scores and PGD ‘caseness’. Method: Self-reported data on PGD, depression, anxiety, alcohol use, and descriptive characteristics were gathered from a representative sample of the Slovak population (N = 319). Results: Data were gathered from N = 1853 people; 319 participants (17.2%) reported a loss in the past year. The prevalence of probable PGD among these bereaved participants was 1.99% for recent losses (<6 months, n = 151) and 7.75% for more distant losses (6–12 months, n = 130). The most frequently endorsed symptoms included longing/yearning for the deceased, sadness, denial/unrealness, and difficulty accepting the death. PGD symptoms had a unitary factor structure which was consistent for subsamples bereaved 1–5 and 6–12 months. The severity of PGD varied with kinship. Depression and anxiety, but not alcohol misuse, were associated with PGD severity and PGD caseness. Conclusions: These findings underscore that a significant group of people develop PGD between 6–12 months following a loss. This emphasises the need for targeted psychological interventions.

Abstract Prolonged Grief Disorder (PGD) manifests as a long-lasting and incapacitating response to bereavement. The goal of this qualitative study is to understand the intricate interplay of risk and protective factors that underlie PGD by exploring into the perspectives of expert clinicians in Pakistan. Our investigation encompassed in-depth interviews with eight clinical experts comprising clinical psychologists (N = 4, possessing Higher Education Commission-recognized degrees) and psychiatrists (N = 4, certified by Pakistan Medical Commission). Collectively, these professionals possessed a wealth of knowledge exceeding five years in the specialized management of PGD. Thematic analysis of the transcribed interviews, conducted using NVIVO, revealed a comprehensive taxonomy of risk factors contributing to PGD. These encompassed maladaptive thought patterns, psychological distress, attachment styles, and environmental factors. We identified a host of protective factors that may mitigate the development of PGD. These encompassed cultural, social, and familial support systems, individual coping mechanisms, and various treatment modalities.

Prolonged grief disorder (PGD) is a condition of persistent, intense grief and PGD-targeted psychotherapy (PGDT) is an efficacious treatment. This study aimed to compare participants with PGD who self-identified as Black versus White, with respect to baseline features and response to PGDT. We performed a secondary data analysis of 55 Black and 455 White adults from two randomized clinical trials. Racial differences in baseline features were examined using Chi-squared and T-tests. We compared assessment completion and treatment response rates (PGDT vs. no PGDT) by race and evaluated posttreatment self-reported measures using linear models. There were racial differences in the cause of death, relation to the deceased, and taking comfort in religion. Black participants had similar ratings to their counterparts on impairment and grief severity at baseline. However, they had higher scores on a baseline measure of typical grief-related beliefs. Both racial groups had significantly greater response rates to PGDT than the comparison treatment. Similarly, PGDT resulted in lower posttreatment impairment than the comparison treatment for both racial groups. However, only the White participants had a difference in posttreatment grief severity between the treatment groups. This study supports the idea that PGD characteristics are similar in Black and White treatment seeking individuals, and that Black and White participants display improvement in response to PGDT.

ABSTRACT Background: Prolonged grief disorder (PGD) causes significant impairment in approximately 7% of bereaved people. Although cognitive behaviour therapy (CBT) has been shown to effectively treat PGD, there is a need to identify predictors of treatment non-response. Methods: PGD patients (N = 80) were randomly allocated to receive 10 weekly two-hour group CBT sessions and (a) four individual sessions of exposure therapy or (b) CBT without exposure. PGD was assessed by self-report measures at baseline, post-treatment (N = 61), and six-months (N = 56) after treatment. Results: Post-treatment assessments indicated that greater reduction in grief severity relative to pretreatment levels was associated with being in the CBT/Exposure condition, and lower baseline levels of self-blame and avoidance. At follow-up, greater grief symptom reduction was associated with being in the CBT/Exposure condition and lower levels of avoidance. Conclusions: These patterns suggest that strategies that target excessive self-blame and avoidance during treatment may enhance response to grief-focused cognitive behaviour therapy.

This letter discusses the current challenge in classification and treatment of DSM-5-TR prolonged grief disorder. Prolonged grief disorder (PGD) is among the new mental disorders included in the DSM-5-TR section II, a chapter about trauma and stressor-related disorders. By definition, PGD is a maladaptive response to the death of a loved one characterized by a period of at least 12 months of persistent yearning for or preoccupation with the deceased and disabling symptoms such as disbelief about the death, avoidance, emotional numbness, identity disruption, intense emotional pain, loneliness, a sense that life is meaningless, and failure to move forward. This syndrome occurs in 9.8% of bereaved survivors and may be associated with increased risk of medical conditions (e.g., cardiovascular disease, cancer, and immunological dysfunction), substance use disorders (particularly increased tobacco and alcohol use), suicidality, and diminished quality of life. Given that PGD has clinical similarities with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), recent studies have evaluated selective serotonin reuptake inhibitors (SSRIs) in the treatment of this novel DSM-5-TR diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

We have read with interest the recent debate paper ‘ Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability ’ by Killikelly and Maercker (2018). Establishing prolonged grief disorder (PGD) in the ICD-11 has been a long-anticipated development that is likely to provide a great impetus for research and treatment development for bereaved persons experiencing severe grief reactions. We appreciate the authors ’ thorough historical analysis of the development of disorders for pathological grief and the clear explana-tion of the guiding principles in the establishment of the ICD-11 PGD criteria. We nevertheless disagree with two central claims made in this paper. Specifically, we take issue with assertions that prior research on a variety of qualitatively different precursor criteria for grief disorders (1) offers valid diagnostic guidelines for the inclusion of PGD in the ICD-11, and (2) confirms that the novel ICD-11 PGD criteria provide the same valid symptom structure as these precursor criteria.

Grief is a normal response following the death of a beloved one. Prolonged grief disorder is defined when grief is intense and has persisted for an atypically long period of time; more than 6 months (ICD-11) or more than 12 months (DSM- 5TR). This article discusses the conceptual distance between this new disorder and that of classical descriptions, as considered in a distinct Section of the DSM-5. These differences suggest disagreements among different working groups for disorders. Freud's perspective on mourning and melancholia (mayor depression disorder) pertains also to a classical scope. The grief work is exemplified with an autobiographical case, that illustrates how borders between normal and pathological grief are blurred. Although a new disorder might assist an ever longer-lived population that becomes widow, the risk is the medicalization of grief.

The field of bereavement research and care is at a tipping point. The introduction of prolonged grief disorder (PGD) in the International Classification of Diseases (ICD-11) has ignited clinical interest in this new disorder, along with debate over challenges in validating and implementing these new criteria. At the same time, the global COVID-19 pandemic has launched several local and international efforts to provide urgent support and comfort for individuals and communities suffering from grief. Recently, grief experts have called for a collective response to these complicated bereavements and possible increase in PGD due to COVID-19. Here we outline a new European network that aims to unite a community of grief researchers and clinicians to provide accessible, evidence-based support particularly during times of unprecedent crisis. The Bereavement Network Europe (BNE) has been developed with two main aims. Firstly, to develop expert agreed, internationally acceptable guidelines for bereavement care through a three-tiered approach. Secondly, to provide a platform for researchers and clinicians to share knowledge, collaborate, and develop consensus protocols to facilitate the introduction of PGD to diverse stakeholders. This article outlines the current status and aims of the BNE along with the plans for upcoming network initiatives and the three-tiered bereavement care guidelines in response to the COVID-19 pandemic.

ABSTRACT Objective: The present study investigated the role of the two theoretically derived mediators in the treatment of Prolonged Grief Disorder (PGD). Mediators were changes in avoidance and maladaptive cognitions. An additional hypothesis tested whether these candidate mediators are specific to CBT-based Complicated Grief Treatment (CGT) compared to Interpersonal Therapy (IPT). Method: We performed secondary analyses with assessment completers (n = 131) from a randomized-controlled trial with older adults with PGD. Patients received 16 sessions of CGT or IPT. Outcomes were treatment response and reductions in grief symptoms and grief-related related impairment. Results: Reductions in avoidance between baseline and week 16 mediated reductions in grief symptoms and grief-related impairment. Reductions in maladaptive grief-related cognitions over the same period mediated treatment response, reductions in grief symptoms and grief-related impairment. There were no significant treatment-mediator interactions. We could not establish that mediators changed before the outcomes. Conclusion: Results are consistent with theoretical models of PGD, including the CGT treatment model. Despite different therapeutic procedures, we found no significant interaction effect, but CGT produced larger effects. Future research needs to establish a timeline of change through the use of multiple measurements of mediators and outcomes. Trial registration: ClinicalTrials.gov identifier: NCT01244295.

More recently, the prolonged grief disorder (PGD) has been recognized as a mental health disorder following bereavement, which is distinct from depression and PTSD. However, the number and proposed symptom items vary across the ICD-11 and the DSM-5-TR criteria for PG. The Traumatic Grief Inventory-Self Report Plus (TGI-SR+), which is an updated version of the TGI-SR, is currently the only robust instrument that assesses PG according to the ICD-11 and DSM-5-TR criteria. For research and clinical use among French-speaking countries, the forward-backward procedure was applied to translate the TGI-SR+ into French language. Exploratory factor analysis and parallel analysis converged towards a two-dimensional structure for the TGI-SR+, representing adaptation difficulties and traumatic separation distress. However, items mapping onto ICD-11 and DSM-5-TR criteria for PG represented a one-dimensional structure. Findings based on item response theory method provided strong evidence for discriminative characteristics of the items The internal reliability was excellent for the TGI-SR+ (McDonald's ω = .97) and ICD-11 and DSM-5-TR criteria for PGD (McDonald's ω = .95, respectively). We also demonstrated a very high temporal stability for the TGI-SR+ total score (ICC = .91, p < .0001) and ICD-11 PGD and DSM-5-TR PGD (ICC = .90, and ICC =.88, ps < .0001, respectively). The concurrent validity of the instrument was also demonstrated, such that the TGI-SR+ total score and all combinations were positively and significantly associated with the levels of depression, anxiety, and post-traumatic stress symptoms. However, the effect sizes were moderate. We conclude that for research and clinical use among French bereaved populations, the TGI-SR+ is a sound tool with very good psychometric properties.

Bereaved parents may experience diverse psychological symptoms. Possible interventions are not yet well established. In this study, the psychological symptoms of 323 bereaved parents (mean age = 39.97, SD = 7.21, 52.0% female), referred to a 4-week family-oriented rehabilitation (FOR) program, were assessed. The baseline assessments indicated that 160 (49.5%) parents showed symptoms of prolonged grief disorder (PGD). Complicated grief was indicated in 272 (84.2%), depression in 191 (59.1%), and posttraumatic stress disorder in 242 (74.9%) parents. Mothers were at higher risk of complicated grief (p ≤ .001), depression (p = .029), and posttraumatic stress disorder (p = .004), compared to fathers. Significant remissions of symptoms between admission and discharge from the program are presented as symptoms of complicated grief, depression, and posttraumatic stress. The effect sizes ranged between d = 0.68 and 1.22. In addition, significantly fewer parents fulfilled PGD criteria on discharge from the FOR program (p ≤ .001). The special FOR program appears promising with regard to improving the bereaved parents’ mental health.

Background: Prolonged grief disorder (PGD) has been included in the new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Research has demonstrated the crucial role of various responses concerning grief, and the occurrence of grief responses is culture-dependent. Investigation of grief response in Iran is necessary. Objectives: The present study aimed to study the psychometric properties of the Grief Response Scale (GRS) in a sample of bereaved university students. Methods: This cross-sectional study was conducted among university students in Iran in 2024. The sample included 315 bereaved university students (82% female, 18% male) with a mean age of 30.4 years (SD = 10.8); most participants were single and held a bachelor’s degree. Exploratory and confirmatory factor analyses were used to investigate construct validity. Reliability was determined by Cronbach’s alpha and McDonald’s omega. Results: Six factors accounting for 61.99% of the variance were revealed by exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) demonstrated an acceptable fit [χ2/df = 2.655, Comparative Fit Index (CFI) = 0.848, root-mean-square error of approximation (RMSEA) = 0.073], supporting the construct validity of the Persian GRS. The total Cronbach’s alpha value was 0.70, and the total McDonald’s omega value was 0.72, demonstrating adequate reliability. Conclusions: The GRS is a reliable and valid tool for measuring grief reactions in Iranian students, with potential use in mental health screening, clinical evaluation, and intervention planning in school and community settings.

Between 44% and 87% of active duty service members and veterans who deployed following the September 11, 2001, terrorist attacks know someone who was killed or seriously injured in combat. Considering the high frequency and known impact of traumatic loss, it is important to understand if and how traumatic loss may impede posttraumatic stress disorder (PTSD) treatment progress in military personnel. Additionally, experiencing a traumatic loss elevates the risk of developing prolonged grief disorder (PGD), which is associated with higher levels of PTSD symptoms, more functional impairment, and more lifetime suicide attempts among military personnel. Given what is known about the association between PGD and PTSD in treatment-seeking service members and veterans, it is also important to understand whether grief-related symptom severity negatively impacts PTSD treatment response. The current study examined associations among traumatic loss, complicated grief, depressive symptoms, and PTSD treatment response among military personnel (N = 127) who participated in variable-length cognitive processing therapy (CPT). There was no direct, F(2, 125) = 0.77, p = .465, or indirect, β = .02, p = .677, association between a traumatic loss index event and PTSD treatment response compared with other trauma types. Prior assessments of depressive symptom severity were directly related to PTSD at later assessments across two models, ps < .001-p = .021 Participants with a traumatic loss index trauma demonstrated significant reductions in complicated grief, depressive symptoms, and PTSD following CPT, ps < .001, ds = -0.61--0.83. Implications, study limitations, and suggestions for future research are presented.

Mourning is a natural response to a loss and a condition which most people experience several times during their lives. Most individuals adjust adequately to the loss of a relative, neverthless, a small but noteworthy proportion of bereaved individuals experience a syndrome of prolonged psychological distress in relation to bereavement. Prolonged distress and disability in connection with bereavement has been termed Complicated Grief (CG) or Prolonged Grief Disorder (PGD). The purpose of this paper is to analyze the literature on loss and mourning making a review of the main studies published between 1993 and 2013, identified through a search conducted on Medline/PubMed, in order to describe the epidemiological and clinical aspects of "normal" grief and "complicated" grief, pointing out the path of the clinical definition of PGD and proposed diagnostic criteria for inclusion in the next edition of the Diagnostic and Statistic Manual of Mental Disorders, Fifth edition (DSM-5). The two main diagnostic systems proposed by Horowitz and Prigerson are also compared.

This review focuses on the similarities and differences between prolonged grief disorder (PGD) and post-traumatic stress disorder (PTSD). It highlights how a PTSD-related understanding aids the investigation and clinical management of PGD. Grief has long been understood as a natural response to bereavement, as serious psychological and physiological stress has been regarded as a potential outcome of extreme or traumatic stress. PTSD was first included in DSM-III in 1980. In the mid-1980s, the first systematic investigation began into whether there is an extreme or pathological form of mourning. Meanwhile, there is much research literature on complicated, traumatic, or prolonged grief This literature is reviewed in this article, with the following questions: Is it possible to distinguish normal from non-normal grief? Which clinical presentation does PGD have—and how does this compare with PTSD? Finally, diagnostic, preventive, and therapeutic approaches and existing tools are presented.

No abstract available

No abstract available

Commentary on: Johannsen M, Damholdt MF, Zachariae R, et al . Psychological interventions for grief in adults: a systematic review and meta-analysis of randomised controlled trials. J Affect Disord 2019;253:69–86. doi: 10.1016/j.jad.2019.04.065 Grief is a normal response to the death of a loved one. Most people could adapt to such loss over time. However, some bereaved individuals have persistent grief symptoms. Prolonged grief disorder (PGD) was a new diagnosis in the International Classification of Diseases, 11th Revision (ICD-11).1 Prolonged grief (PG) is associated with functional impairment, psychological …

Prolonged grief disorder (PGD) is a new diagnosis in the 11th edition of the International Classification of Diseases, estimated to affect 1 in 10 bereaved people and causing significant distress and impairment. Maladaptive thoughts play an important role in PGD. We have previously validated the typical beliefs questionnaire (TBQ), which contains five kinds of thinking commonly seen in PGD: protesting the death, negative thoughts about the world, needing the person, less grief is wrong, and grieving too much. The current paper examines the role of maladaptive cognition as measured by the TBQ in PGD and its change with treatment.

Background Psychotherapy for Prolonged Grief Disorder (PGD), a condition characterized by an intense and persistent grief response, has received increased attention over the past decades. Evidence-based approaches to prevent PGD are currently scarce, and not always effective. This paper introduces a protocol for a clinical trial exploring the effectiveness of a Meaning Reconstruction psychotherapy approach (MR) assisted with ayahuasca, a traditional indigenous medicine. Method The outlined protocol is a three-arm, non-randomized controlled trial focused on reducing normal and pathological grief symptoms, comparing the effectiveness of Ayahuasca-assisted MR therapy (A-MR), MR therapy alone (MR) and No Treatment (NT). At least 69 people who lost a first-degree relative during the prior year, and with a Texas Revised Inventory of Grief score up 39 (TRIG ≥ 40), will participate in the trial. Participants will be allocated to an A-MR (n ≥ 23), MR (n ≥ 23) or NT (n ≥ 23) group. Those from the A-MR and MR therapy groups will undergo a therapeutic process involving 9 sessions of online psychotherapy. In addition, the A-MR condition involves 2 group sessions of ayahuasca. The primary outcomes will be normal and pathological grief severity as measured by the TRIG and Traumatic Grief Inventory Self-Report (TGI-SR), administered at baseline, post-treatment, and 3-month follow up. Measures of quality of life, post-traumatic growth, meaning-made, psychological flexibility, and self-belief consistency will be also included. In addition, subjective effects of ayahuasca and acceptance-avoidance promoting effects will be assessed following ayahuasca administration. Finally, we will analyze the potential mediating effect of meaning-made, psychological flexibility and self-belief consistency in grief symptoms (as measured by the TRIG and TGI). Discussion This trial is the first to empirically examinate the potential of psychedelic-assisted psychotherapy for grief, as well as the potential processes of change that may account for it. Clinical trial registration https://clinicaltrials.gov, identifier NCT06150859.

No abstract available

Objective The Lebanese people have endured through several disasters, such as the Beirut explosion, coronavirus pandemic, and cholera outbreak. However, volunteers who have tried to overcome such national disasters develop emotional stress after witnessing people’s death. This study was conducted to explore whether volunteers’ depression or anxiety mediates the relationship between grief response and post-traumatic stress disorder (PTSD) symptoms. Methods We conducted an anonymous online survey study and collected responses from 270 volunteers in Lebanon from March 20–26, 2023. Demographic information and responses to the questionnaires, which included the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5), Public Service Motivation scale (PSM scale), Connor-Davidson Resilience Scale-2, and Prolonged Grief Disorder (PG-13) were collected. Variables were compared between volunteers who did and did not witness people’s death. Furthermore, we explored the relationships among variables in volunteers who witnessed people’s death (n=72). Results Among 270 participants, 72 (26.67%) witnessed people’s death. The regression model demonstrated that scores for PG-13 (β= 0.31, p<0.001), PHQ-9 (β=0.21, p=0.011), and GAD-7 (β=0.44, p<0.001) were predictors of the PCL-5 score. Mediation analysis showed that grief reaction directly influenced PTSD symptoms (Z=6.19, p<0.001), whereas depression (Z=1.99, p=0.047) and anxiety (Z=2.79, p=0.005) individually mediated the relationship between grief reaction and PTSD symptoms. Conclusion Our study helps understand the mediating effects of volunteers’ depression or anxiety on the relationship between grief reactions and PTSD symptoms.

After years of debate, a new diagnosis called prolonged grief disorder (PGD) was finally included in the 11th edition of the International Classification of Diseases (ICD-11; World Health Organization). The pathologization of grief has been controversial and caused quite a stir among researchers, practitioners, and the general public. Recently, Bergsmark and Ramsing (2023) have addressed some considerations that they believe are lost in the ensuing debate, and they call for a positive response to the diagnosis among psychologists. In this reply, I argue that we have good reasons to maintain a critical stance both toward the specific grief diagnosis and toward the general pathologization of human suffering.

There are multiple well-established evidence-based treatments for posttraumatic stress disorder (PTSD). However, recent clinical trials have shown that combat-related PTSD in military populations is less responsive to evidence-based treatments than PTSD in most civilian populations. Traumatic death of a close friend or colleague is a common deployment-related experience for active duty military personnel. When compared with research on trauma and PTSD in general, research on traumatic loss suggests that it is related to higher prevalence and severity of PTSD symptoms. Experiencing a traumatic loss is also related to the development of prolonged grief disorder, which is highly comorbid with depression. This study examined the association between having traumatic loss-related PTSD and treatment response to cognitive processing therapy in active duty military personnel. Participants included 213 active duty service members recruited across two randomized clinical trials. Results showed that service members with primary traumatic loss-related PTSD (n = 44) recovered less from depressive symptoms than those who reported different primary traumatic events (n = 169), B = -4.40. Tests of mediation found that less depression recovery suppressed recovery from PTSD symptoms in individuals with traumatic loss-related PTSD, B = 3.75. These findings suggest that evidence-based treatments for PTSD should better accommodate loss and grief in military populations.

In this response, Lars Petter Sødal Bergsmark and Frida Ramsing address the arguments and criticism made by Svend Brinkmann (2023) concerning their carefully optimistic presentation of the psychiatrization of pathological grief in the article “Which Considerations Are Lost When Debating the Prolonged Grief Disorder Diagnosis?” (Bergsmark & Ramsing, 2023). Overall, they argue that Brinkmann (2023) presents intriguing perspectives on this controversial topic, but he does not capture the complex case of prolonged grief disorder adequately, partly because of faulty premises in his argument. Contrary to the perspective put forth by Brinkmann, the authors remark on the possibilities and promises of integrating critical cultural psychology with the developments in psychiatric nosology, and in conclusion provide three standpoints for the future of psychiatry.

The experience of the loss of the relatives, which is naturally one of the most stressful events in a person’s life, has turned into a new concept and challenge for survivors and mental health professionals during the coronavirus era. We discussed how restrictions caused by social distancing potentially increase the likelihood of a phenomenon called complicated grief or prolonged bereavement disorder and multilayer response by case finding to increase the access to public education to manage this complicated situation.

Background: Satisfaction with care is an important outcome measure in end-of-life care. Validated instruments are necessary to evaluate and disseminate interventions that improve satisfaction with care at the end of life, contributing to improving the quality of care offered at the end of life to the Portuguese population. The purpose of this study was to perform a cross-cultural adaptation and psychometric analysis of the Portuguese version of the CANHELP Lite Bereavement Questionnaire. Methods: Methodological research with an analytical approach that includes translation, semantic, and cultural adaptation. Results: The Portuguese version comprised 24 items. A panel of experts and bereaved family members found it acceptable and that it had face and content validity. A total of 269 caregivers across several care settings in the northern region of Portugal were recruited for further testing. The internal consistency analysis of the adapted instrument resulted in a global alpha value of 0.950. The correlation between the adapted CANHELP questionnaire and a global rating of satisfaction was of 0.886 (p < 0.001). Conclusions: The instrument has good psychometric properties. It was reliable and valid in assessing caregivers’ satisfaction with end-of-life care and can be used in both clinical and research settings.

No abstract available

No abstract available

No abstract available

No abstract available

No abstract available

No abstract available

Health care communication is a skill that is critical to safe and effective medical practice; it can and must be taught. Communication skill influences patient disclosure, treatment adherence and outcome, adaptation to illness, and bereavement. This article provides a review of the evidence regarding clinical communication in the pediatric setting, covering the spectrum from outpatient primary care consultation to death notification, and provides practical suggestions to improve communication with patients and families, enabling more effective, efficient, and empathic pediatric health care.

No abstract available

Background Internet interventions for mental disorders and psychological problems such as prolonged grief have established their efficacy. However, little is known about how internet interventions work and the mechanisms through which they are linked to the outcomes. Objective As a first step in identifying mechanisms of change, this study aimed to examine emotion regulation and loss-related coping self-efficacy as putative mediators in a randomized controlled trial of a guided internet intervention for prolonged grief symptoms after spousal bereavement or separation or divorce. Methods The sample comprised older adults who reported prolonged grief or adaptation problems after bereavement, separation, or divorce and sought help from a guided internet intervention. They were recruited mainly via newspaper articles. The outcome variables were grief symptoms assessed using the Texas Revised Inventory of Grief and psychopathology symptoms assessed using the Brief Symptom Inventory. A total of 6 module-related items assessed loss-focused emotion regulation and loss-related coping self-efficacy. In the first step, path models were used to examine emotion regulation and loss-related coping self-efficacy as single mediators for improvements in grief and psychopathology symptoms. Subsequently, exploratory path models with the simultaneous inclusion of emotion regulation and self-efficacy were used to investigate the specificity and relative strength of these variables as parallel mediators. Results A total of 100 participants took part in the guided internet intervention. The average age was 51.11 (SD 13.60) years; 80% (80/100) were separated or divorced, 69% (69/100) were female, and 76% (76/100) were of Swiss origin. The internet intervention increased emotion regulation skills (β=.33; P=.001) and loss-related coping self-efficacy (β=.30; P=.002), both of which correlated with improvements in grief and psychopathology symptoms. Path models suggested that emotion regulation and loss-related coping self-efficacy were mediators for improvement in grief. Emotion regulation showed a significant indirect effect (β=.13; P=.009), whereas coping self-efficacy showed a trend (β=.07; P=.06). Both were confirmed as mediators for psychopathology (β=.12, P=.02; β=.10; P=.02, respectively). The path from the intervention to the improvement in grief remained significant when including the mediators (β=.26, P=.004; β=.32, P≤.001, respectively) in contrast to the path from the intervention to improvements in psychopathology (β=.15, P=.13; β=.16, P=.10, respectively). Conclusions Emotion regulation and loss-related coping self-efficacy are promising therapeutic targets for optimizing internet interventions for grief. Both should be further examined as transdiagnostic or disorder-specific putative mediators in internet interventions for other disorders. Trial Registration ClinicalTrials.gov NCT02900534; https://clinicaltrials.gov/ct2/show/NCT02900534 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-016-1759-5

No abstract available

Communication influences patient disclosure, treatment adherence, and outcome, adaptation to illness, and bereavement. Different cancer patients and caregivers communicate their various experiences in unique ways. These distinctive experiences are necessary to be told, because it empowers both the teller and everyone who hears and shares that experience. However, there is little research documenting the experiences of cervical cancer patients and caregivers in Kenya and the rest of Africa. This study therefore sought to assess the communication experience among cervical cancer patients and their caregivers. This study was a qualitative study employing the phenomenological method to obtain data from cervical patients and caregivers. It was carried out in Uasin Gishu County, Kenya, where a range of in-depth interviews were held with eight patients and eight caregivers purposively sampled. Data from the interviews were analysed thematically and presented in narrative form using paraphrases and quotations. Ethical issues such as informed consent, confidentiality and official authorisation were observed at all levels. To enrich this study, hermeneutic theory, which explains more about the individual's experience, was used. The findings of the study indicated that communication is therapeutic, although most of the patients and the caregivers were reluctant to talk about their illness. The findings of this study will be of interest to scholars, policy-makers and caregivers of terminally ill patients.

No abstract available

ABSTRACT Objective To investigate any association between expressions of parents’ continuing bond with their stillborn baby and bereavement adaptation. Background Continuing bonds theory suggests that bereaved parents adapt to the loss of their child by sharing and transforming mental representations of the child, allowing them to be integrated into parents’ everyday lives. Little is known about the mental health benefits of expressing continuing bonds following stillbirth. This study examined any association between aspects of parents’ relationship with their stillborn baby, social support for the relationship, and bereavement adaptation. Methods Cross-sectional questionnaire study. Parents of stillborn babies (N=170) completed an online questionnaire examining engagement in continuing bonds expressions; characteristics of parents’ relationship with their stillborn baby and their experience of sharing it; social support, and meaning-making. Measures of mental health were included to quantify bereavement adaptation. Results Regression analyses showed that time since death, meaning-making, engaging with nature, and legacy building are positively linked to bereavement adaptation. Risk factors included inadequate social support for the relationship, a greater desire to share it more freely, an increased sense of integration with baby, and societal pressure to move on. Conclusion Key aspects of parents’ ongoing relationship with their stillborn baby and the social context are related to bereavement adaptation.

ABSTRACT Background and Objectives Maladaptive emotion regulation strategies increase prolonged grief and depressive symptoms following bereavement. However, less is known about the role of adaptive emotion regulation strategies in adaptation to loss. Therefore, we examined the concurrent and longitudinal associations of three putative adaptive emotion regulation strategies (cognitive reappraisal, emotional expression, and mindfulness) with prolonged grief and depression symptoms. Design A two-wave longitudinal survey. Methods A sample of 397 bereaved Dutch adults (89% female, mean age 54 years) completed validated questionnaires to assess trait cognitive reappraisal, emotional expression, mindfulness and prolonged grief and depression symptoms at baseline (T1) and 344 participants completed symptom measures again six months later (T2). Results Zero-order correlations demonstrated that mindfulness, cognitive reappraisal and emotional expression relate negatively to T1 and T2 prolonged grief and depression symptoms. In multiple regression analyses, controlling for relevant background variables, all emotion regulation strategies related negatively to T1 prolonged grief and depression symptoms. In multiple regression analyses, controlling for T1 symptoms and background variables, mindfulness predicted lower T2 depression symptoms. Conclusions Adaptive emotion regulation strategies relate negatively to post-loss psychopathology symptoms, yet only mindfulness longitudinally predicts lower depression symptoms. Dispositional mindfulness may be a protective factor in psychological adaptation to bereavement.

Limited longitudinal studies have hindered the understanding of family adaptation after loss of a loved one in an intensive care unit (ICU). Based on the Double ABCX Model, this study examined changes in adaptation to bereavement for family members in the first year after the ICU death, with special attention to the effects of race/ethnicity. A repeated-measures design was used to conduct the investigation using 3 time points (1-3, 6, and 12 months) after the ICU death. Data were analyzed using linear mixed modeling. Family members (n = 30) consisted of 60% non-Hispanic Whites and 40% African Americans (AAs). During the first 1 to 3 months, moderate to severe symptoms of posttraumatic stress disorder, depression, anxiety, and stress were found (60%, 40%, 30%, and 26.7%, respectively). Initially, non-Hispanic Whites had higher depression scores than African Americans. The change in depression and posttraumatic stress disorder symptoms over 1 year differed by race/ethnicity. Many family members tended to be at risk of psychological sequelae in the early months after a patient's death in an ICU. Racial/ethnic differences in bereavement process need further exploration to understand the broader context within family members grieve and effectively offer support over the course of the first year.

The loss or death of a beloved pet creates a grief reaction comparable to that of the loss of a family member and may lead to the development of symptoms consistent with a diagnosis of persistent complicated grief disorder. Nevertheless, society does not always recognize it as a significant loss, which may contribute to bereaved owners feeling isolated and ashamed when coping with it, as well as not resorting to mental health professionals when necessary. The development of instruments to assess these reactions may contribute to improving the understanding of this suffering. This study aimed to adapt the Pet Bereavement Questionnaire for European Portuguese speakers. A non-probabilistic convenience sample of 169 adults who had a pet that died answered a battery of questionnaires, which included the Portuguese version of the Pet Bereavement Questionnaire. This version resulted from a consensus translation prepared by two translators and subsequently subjected to a cognitive debriefing. The Portuguese version of the instrument demonstrated good reliability (good internal consistency for the total questionnaire and for its subscales) and good external validity (negative correlation with well-being measures and positive correlation with psychopathology measures), as well as reasonable internal validity and sensitivity.

Abstract Objectives Personal reminiscence styles are known to influence a person’s well-being, but research regarding their impact on bereavement outcomes is limited. Based on previous findings, we assumed ruminative and reflective reminiscence styles to be associated with feelings of grief and personal growth, and that meaning-making efforts and the degree of having meaning-made of losing a loved one potentially mediate these relationships. Methods The final study sample consisted of 198 participants aged between18 and 75 years (Mage = 40.58, SD = 39.0), 83.3% were female. In a first step, we ran separate mediation models to examine the associations between reminiscence styles, processes of making meaning of the loss and bereavement. Based on these results, we build a parsimonious, inclusive pathway model. Results Our findings indicate that a ruminative reminiscence style is related to feelings of grief and personal growth through its associations with meaning-made. A reflective reminiscence style, in contrast, is associated with feelings of grief through its relation to meaning-making efforts. Moreover, a reflective reminiscence style is directly related to personal growth. Conclusion Findings are discussed regarding their implications for both areas of research — autobiographical remembering and adaptation to bereavement, as well as their applicability in clinical settings.

Objective This study assessed the validity of the Indicator of Bereavement Adaptation Cruse Scotland (IBACS). Designed for use in clinical and non-clinical settings, the IBACS measures severity of grief symptoms and risk of developing complications. Method N = 196 (44 male, 152 female) help-seeking, bereaved Scottish adults participated at two timepoints: T1 (baseline) and T2 (after 18 months). Four validated assessment instruments were administered: CORE-R, ICG-R, IES-R, SCL-90-R. Discriminative ability was assessed using ROC curve analysis. Concurrent validity was tested through correlation analysis at T1. Predictive validity was assessed using correlation analyses and ROC curve analysis. Optimal IBACS cutoff values were obtained by calculating a maximal Youden index J in ROC curve analysis. Clinical implications were compared across instruments. Results ROC curve analysis results (AUC = .84, p < .01, 95% CI between .77 and .90) indicated the IBACS is a good diagnostic instrument for assessing complicated grief. Positive correlations (p < .01, 2-tailed) with all four instruments at T1 demonstrated the IBACS' concurrent validity, strongest with complicated grief measures (r = .82). Predictive validity was shown to be fair in T2 ROC curve analysis results (n = 67, AUC = .78, 95% CI between .65 and .92; p < .01). Predictive validity was also supported by stable positive correlations between IBACS and other instruments at T2. Clinical indications were found not to differ across instruments. Conclusions The IBACS offers effective grief symptom and risk assessment for use by non-clinicians. Indications are sufficient to support intake assessment for a stepped model of bereavement intervention.

The topic of bereavement (i.e., the death of someone significant) has long been a neglected area of study in the organizational sciences. The most common outcome of bereavement is grief. Currently, we have little knowledge about relationships among bereavement grief, bereavement leave, other organizational policies and practices, and work-related outcomes (job behaviors, work engagement, perceived organizational support). Using a survey with 388 bereaved employees, results showed that bereavement grief had a significant negative relationship to job behaviors, work engagement and perceived organizational support (POS). Bereavement leave was positively related to POS but unrelated to other work outcomes. Several organizational offerings and practices (e.g., the opportunity to talk about workplace accommodations) were positively related to certain work outcomes while other results were mixed. These findings are discussed, along with implications and future research directions, as well as practical guidance for organizational decision makers.

Abstract Meaning reconstruction is a central process in bereavement adaptation. However, clinical measures or means for identifying individuals whose struggles with meaning making have become dysfunctional have yet to be developed for clinicians to readily use in practice. Therefore, the objective of this study was to evaluate the diagnostic effectiveness of the Integration of Stressful Life Experiences Scale-Short Form (ISLES-SF) for measuring clinically significant struggles with meaning making of loss. The results of this study of 118 bereaved adults support the diagnostic use of the ISLES-SF (sensitivity of 83% and specificity of 73%), as well as an identified cut-score (≥ 14) that researchers and clinicians can employ to accurately and efficiently identify those whose difficulties with making meaning of loss have become debilitating. The results also showed that those who scored in the clinical range of the ISLES-SF displayed higher levels of anxiety, depression and prolonged grief than those not struggling with meaning making.

Abstract This work provides psychometric data on the validity and reliability of the Spanish adaptation of the Pet Bereavement Questionnaire (PBQ), as well as information on the intensity of bereavement in the Spanish population. The study evaluated 333 Spanish participants of legal age (M = 31.5; SD = 11.6), mostly women (76.3%). Confirmatory factor analysis (CFA) tested the adequacy of three different structures present in literature, finding better fit indexes for a model that kept the original three-factor structure (grief, guilt, and anger) but rearranged 2 of the 16 items. Around 70% of participants reported signs of intense bereavement on the grief scale, with higher means among women. The results confirm adequate psychometric qualities of the PBQ, offering healthcare professionals a tool to evaluate bereavement intensity after the loss of a companion animal in Spanish samples.

Background The global refugee population has significantly increased, with Syrian refugees being one of the largest displaced groups. Bereavement represents a major challenge. However, access to mental health care is limited by structural and cultural barriers. Internet-based interventions (IBIs) offer a promising solution, but most are developed in Western contexts, limiting their cultural relevance. This study aimed to evaluate the acceptability, feasibility, and preliminary efficacy of a culturally adapted self-help IBI for bereaved Syrian refugees in Switzerland. Methods In a mixed-methods pilot randomized controlled trial (RCT), 30 bereaved Syrian refugees were randomly assigned to a 5-week app-based intervention or a waitlist control group. Semi-structured interviews with the intervention group provided qualitative insights on feasibility and acceptability and were analyzed with framework analysis. Quantitative data assessed treatment satisfaction, adherence, and preliminary efficacy on grief, depression, posttraumatic stress disorder (PTSD), anxiety, well-being, disability, post-migration difficulties, and social support. Descriptive statistics were used for feasibility and acceptability, while linear mixed-effects models assessed efficacy. Results High treatment satisfaction, a low dropout rate and adherence of 40 % were found. Qualitative interviews indicated the intervention was relevant and beneficial, further adaptations were suggested. No significant group differences were found on bereavement or secondary outcomes. However, trends indicated reduced grief, anxiety, PTSD, and depression, with improved well-being and social support in the intervention group. Conclusions The results suggest that this culturally adapted IBI is both feasible and acceptable for Syrian refugees. While trends are promising, a larger RCT is needed to investigate efficacy. This intervention shows potential as meaningful support for bereaved Syrian refugees.

ABSTRACT This research examined the effect of marital status and gender on various indicators of psychological adaptation, namely depressive symptoms, loneliness, and life satisfaction. It further explores the role of trait resilience, marital history, and context of death for predicting these outcomes in bereaved individuals. Four hundred eighty widowed individuals aged between 60 and 89 were compared with 759 married peers. Main effects were found for marital status and gender for all indicators. The regression analyses illustrate the multifaceted structure of psychological adaptation. Trait resilience is a key factor in adapting to spousal bereavement, whereas marital history and the context are secondary.

In recent decades, there has been increased advocacy for death education as well as grief literacy. Simultaneously, digital learning has been extensively integrated into higher education, particularly post-COVID-19. The study's aim was to explore the use of digitally-delivered death education training, related to childhood bereavement, to gain insight into participants' learning outcomes and the contribution of the digital platform. Employing a qualitative approach, data collection included open-ended reflections, a focus group, and semi-structured interviews with 32 pre-service teachers (PSTs), all of which were analyzed using inductive thematic analysis. Findings revealed three themes (values, knowledge, skills), each of which was divided into two categories (self-oriented, other-oriented), and nine subthemes denoting PSTs' learning outcomes. The analysis also indicated four aspects of the digital platform that facilitated these learning outcomes. The study provides theoretical insights alongside practical implications of using digitally-delivered death education to teach wide-scale best practices to support grieving children.

Family members bereaved by their loved ones’ suicidal death normally undergo a complicated and lengthy bereavement process. In this qualitative case study, we explored longitudinal changes in the suicide bereavement process by applying assimilation analysis, based on the Assimilation Model (AM) and the Assimilation of Problematic Experiences Scale (APES), to longitudinal interview data collected from two Chinese suicide-bereaved individuals within the first 18 months after their loss. The results showed that over time the participants both progressed in adapting to their traumatic losses. Assimilation analysis both effectively elaborated the difference in the inner world of the bereaved and clearly demonstrated development in their adaptation to the loss. This study contributes new knowledge on the longitudinal changes in suicide bereavement experiences and demonstrates the applicability of assimilation analysis to suicide bereavement research. Professional help and resources need to be tailored and adapted to meet the changing needs of suicide-bereaved family members.

OBJECTIVE Following the Jishishan earthquake in China, the demand for bereavement support for affected individuals has increased. This study aimed to test the efficacy of a Confucian-adapted, dual process model (DPM)-based group intervention. METHOD A cluster randomized controlled trial was conducted. Six sites were randomized to either the experimental group (Confucian-based dual-process bereavement group intervention, C-DPBGI, n = 30) or the control group (Confucian-based loss-oriented bereavement group intervention, C-LOBGI, n = 30). Participants received 12 sessions over 6 weeks. Assessments of posttraumatic stress symptoms (PTSS, measured by Impact of Event Scale-Revised) and general mental health (GHQ-12) were conducted at baseline, postintervention, and 8-week follow-up. Linear mixed models (LMM) were used for intention-to-treat analysis (N = 60). RESULTS LMM analyses revealed significant reductions over time in both PTSS and general mental health distress for both groups (p < .001). A significant Time × Group interaction was found for PTSS, F(2, 116) = 5.71, p = .004, indicating a greater reduction in PTSS in the C-DPBGI group compared to the C-LOBGI group, particularly from baseline to postintervention (between-group Cohen's d = 0.64) and baseline to follow-up (between-group Cohen's d = 0.79). No significant Time × Group interaction was found for general mental health, F(2, 116) = 0.31, p = .733, suggesting similar improvement trajectories for both groups on this outcome. CONCLUSIONS Both Confucian-adapted interventions showed efficacy in improving mental health among earthquake-bereaved individuals. The DPM-based C-DPBGI, incorporating both loss- and restoration-oriented components, demonstrated a significant advantage over the loss-oriented C-LOBGI in reducing PTSS, supporting the utility of the full DPM framework and cultural adaptation in this context. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Abstract Aims To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an increased risk of self-harm and suicide around dates of (i) anniversaries of the death and (ii) the deceased’s birthday, compared with intervening periods. Methods We conducted a self-controlled case series study using national register data on all individuals living in Denmark from 1 January 1980 to 31 December 2016 and who were bereaved by the suicide of a first-degree relative or partner (spouse or cohabitee) during that period, and who had the outcome (any episode of self-harm or suicide) within 5 years and 6 weeks of the bereavement. We compared relative incidence of suicidal behaviour in (i) the first 30 days after bereavement and (ii) in the aggregated exposed periods (6 weeks either side of death anniversaries; 6 weeks either side of the deceased’s birthdays) to the reference (aggregated unexposed intervening periods). As an indirect comparison, we repeated these models in people bereaved by other causes. Results We found no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased’s birthdays in people bereaved by suicide (adjusted incidence rate ratio [IRRadj] = 1.00; 95% confidence interval [CI] = 0.87–1.16) or other causes (IRRadj = 1.04; 95% CI = 1.00–1.08) compared with intervening periods. Rates were elevated in the 30 days immediately after bereavement by other causes (IRRadj: 1.95, 95% CI: 1.77–2.22). Conclusions Although people bereaved by suicide are at elevated risk of self-harm and suicide, our findings do not suggest that this risk is heightened around emotionally significant anniversaries. Bereavement care should be accessible at all points after a traumatic loss as needs will differ over the grief trajectory.

No abstract available

Bereavement by suicide is a traumatic and life-changing experience. However, little is known about the lived experiences of people bereaved by suicide themselves, and older people’s voices are notably absent from the current suicide prevention and intervention strategies. This paper seeks to understand the different individual experiences and pathways arising from the suicide research for people in later life who have been bereaved by suicide through the lens of transformational learning. Using a qualitative paradigm, we explored the critical themes and features evident in the meaning making, coping, and adaptation needs of 24 people aged 66 – 92 years who were bereaved by suicide. In-depth interviews led by researchers with lived experience generated two themes on the centrality of experience: Critical reflection and meaning making in later life following suicide trauma; and the journey of discovery and how this interacted with social and political rights. Findings suggest that further research is necessary to generate practice-based evidence, which identifies the impact of bereavement by suicide on people in later life and how their needs for support might be unique when being assessed and identified; and how to respond more holistically to older people with psychosocial problems, which stem from these learning experiences. Recommendations consider the potential for developing more service user-led social, community-based, and therapeutic interventions, which utilizes the authentic knowledge of older people with lived experiences.

A recent national survey of bereaved partners found high levels of complicated grief and psychological distress, with evidence that loneliness and isolation may contribute to these outcomes. However, the mechanisms of action for this have not been explored. To advance grief theory this paper reports analysis of the survey free-text data to examine the relationship between social support and emotional responses to bereavement. Individuals bereaved of a civil partner or spouse 6-10 months previously were identified through death registration data. 569/1945 (29 %) completed surveys were received. Of those, 311 participants (55 %) provided responses to two free-text questions which asked about their 'feelings since the death of their partner or spouse', and 'about the support around' them. Data were analysed using corpus-assisted discourse analysis and the discourse dynamics approach for figurative language. Participants described diverse emotional responses to the bereavement (e.g. sadness, anger, denial, acceptance), and the value of formal and informal bereavement support. Although many of the experiences described are accounted for in existing grief theory, some participants described a liminal experience not recognised within these theories. They felt trapped, unable to engage with loss or restoration, and unable to move forward as their planned future no longer existed. They sought out 'communitas' (solidarity in experiences), but often found support from their social networks had diminished. Metaphors were used to describe this liminality, with partner grief expressed as a dark agentic force, a monster, an abyss, and as water. The findings of this study offer original insights into experiences and trajectories of bereavement, and our understandings of prolonged or complicated grief. A novel model 'Between Loss and Restoration' is presented to include these experiences. Recognition of the place for liminality within the spectrum of grief experiences could enhance grief literacy and improve formal and informal bereavement support provision.

BackgroundThe aim of the current study is to determine the effects of caregiving on bereavement outcome. The study will address two important gaps in the research literature: (1) the relationship between pre-death distress and post-death outcomes and (2) family caregivers’ anticipation and preparation of the death of the person for whom they care.Methods/DesignWe will conduct a longitudinal, prospective study of adult family caregivers of adult patients receiving palliative care. All participants will complete a questionnaire administered at four points – approximately 4–8 weeks prior to bereavement, and 3–4, 6–7, and 9–10 months post-bereavement. The questionnaire includes measures of multidimensional caregiving experiences (strain, distress, positive appraisals, and family wellbeing), caregiver prolonged grief, multidimensional grief responses (despair, panic behaviour, blame and anger, detachment, disorganisation, and personal growth), prolonged grief, quality of life, general health (psychological and physical) and demographics. These caregivers’ data will be compared to a comparison group matched for age, sex, and postcode, allowing the caregivers’ general health and quality of life to be compared to a normative group. The caregivers will also be invited to participate in a semi-structured interview about preparing for impending bereavement.DiscussionThis is the first study to address the methodological limitations in the current literature and will likely make a significant contribution to both our understanding of caregiving on bereavement outcome and to bereavement care offered in palliative and hospice settings.