Experiences of widows with children: A qualitative study about spousal death in Iran

The experience of the spousal bereavement of widows who are single parents has been largely neglected in the literature. This qualitative study provides insight into how such women grieved over their spouse's death in Iran. In‐depth interviews with 24 participants were held and field notes were written. The generated data were analyzed by using the constant comparative method. The results indicated four main categories: “intense grief”, “becoming hopeless”, “internalizing bereavement and continuing bonds”, and “the contexts of experience of spousal death”. The fourth category consisted of two subcategories: “the unexpected nature of death” and “full dependence”. The findings suggested that hopelessness related to spousal death changed the lifestyles of the participants, which led to health risks in these women. We conclude that it is the duty of health‐care professionals, especially nurses, to first identify widows at risk, with the help of the contexts of experience of spousal death and the symptoms presented in this study, and then to provide hope therapy, which can facilitate positive bereavement outcomes for healthier living after spousal death.     

The impact of complicated grief on mental and physical health at various points in the bereavement process

The purpose of this cohort sequential study was to determine whether the presence of complicated grief (CG) measured at various points in the spousal bereavement process is associated with an increase in mental and physical health problems 18 months later. One hundred twelve participants provided data at four points in time. CG was measured with the Inventory of Complicated Grief (ICG), and mental health was measured with the Integra Outpatient Tracking Assessment, Mental Health Index (MHI), and illnesses by self-report. Twenty-nine participants were identified as experiencing CG. Beginning at 6 months after the death, MHI scores were significantly lower for the CG group and those results were persistent. The CG group experienced more additional life stressors, perceived less social support, and achieved less clinically significant change in MHI than the NCG group. Identification of CG at any point at 6 months or later in bereavement indicates a need for professional intervention. Implications for establishing CG as a DSM diagnosis are discussed.     

THE IMPACT OF COMPLICATED GRIEF ON MENTAL AND PHYSICAL HEALTH AT VARIOUS POINTS IN THE BEREAVEMENT PROCESS

The purpose of this cohort sequential study was to determine whether the presence of complicated grief (CG) measured at various points in the spousal bereavement process is associated with an increase in mental and physical health problems 18 months later. One hundred twelve participants provided data at four points in time. CG was measured with the Inventory of Complicated Grief (ICG), and mental health was measured with the Integra Outpatient Tracking Assessment, Mental Health Index (MHI), and illnesses by self-report. Twenty-nine participants were identified as experiencing CG. Beginning at 6months after the death, MHI scores were significantly lower for the CG group and those results were persistent. The CG group experienced more additional life stressors, perceived less social support, and achieved less clinically significant change in MHI than the NCG group. Identification of CG at any point at 6 months or later in bereavement indicates a need for professional intervention. Implications for establishing CG as a DSM diagnosis are discussed.     

Measuring Meaning: Searching for and Making Sense of Spousal Loss in Late-Life

Despite much recent theorizing, evidence regarding the temporal relationship of sense-making to adjustment following bereavement remains relatively sparse. This study examined the role of searching for and making sense of loss in late-life spousal bereavement, using prospective, longitudinal data from the Changing Lives of Older Couples (CLOC) project (N = 250). Searching at 6 and 18 months post-loss predicted both contemporaneous and subsequent grief. Sense-making was not related to grief for this sample. In contrast, sense-making at 6 months and 18 months predicted positive affect at 48 months, although searching had no prospective effect on this outcome. Searching at 6 months predicted depression at 18 months. Results are interpreted in terms of meaning-oriented theories of bereavement and processes promoting both adaptive and maladaptive outcomes.     

Hope, counselling and complicated bereavement reactions

Hope, counselling and complicated bereavement reactions This paper examines the relationship between hope and complicated bereavement, and then considers if current bereavement counselling theory addresses this issue. Bereavement can be considered to have a number of phases or stages which need not occur in a linear fashion, but this does not make bereavement a mechanistic process. Whilst there are commonalities in people's experience of bereavement and loss, the experience of bereavement is unique to each individual. A person needs to reach a state of acceptance, to resolve conflicts related to grieving in order to complete the bereavement. Yet all individuals do not achieve this resolution naturally. Some individuals appear to experience delay in this process, and this can be described as a complicated grief reaction. Unequivocally bound up with bereavement are hope and hopelessness, with a completed bereavement process being bound up with the re-emergence of hope and complicated bereavement process being bound up with continued hopelessness. There are many theories of bereavement counselling, and commonalities exist between these theories. Whilst the theories indicate implicitly the re-emergence of hope in the bereft individual as a result of the counselling, there is a dearth of specific reference to how this inspiration occurs. Since the re-emergence of hope appears to be linked to a person's movement towards a completed bereavement reaction, and this movement is facilitated by means of bereavement counselling, this paper concludes that there is a clear need to examine how this resolution occurs.     

Differential psychological reactions to grief: The role of childhood adversity for depression symptoms among bereaved and non-bereaved adults

Abstract

Childhood maltreatment dysregulates an individual’s physiological response to stress, increasing reactivity to stressors across the lifespan. Given the prevalence and impact of bereavement, we examined whether the association between childhood maltreatment and depression was exacerbated by spousal bereavement. We identified an interaction between childhood maltreatment and bereavement using linear regression analysis (B?=?0.79, p?<?.001). A simple slopes test indicated a positive association between childhood maltreatment and depressive symptoms among those who were bereaved (B?=?0.86, p?<?.001), but such association did not emerge among those who were not bereaved (B?=?0.06, p?=?.60).     

An interdisciplinary a pproach to clinical intervention for childhood bereavement

The impact of the death of a parent has long been emphasized in the literature concerning childhood bereavement, yet little has been written about preventive intervention strategies that may facilitate positive adaptation to parental loss. One strategy that appears to have promise is creative arts therapy groups for children offered in conjunction with companion parent groups. The goal of creative arts in short-term bereavement counseling is to provide social sanction for juvenile grief through the use of activities that extend a child's understanding and expressive skills regarding parental loss. The companion parent group provides didactic and open-ended discussion focused on the members' spousal loss as well as their adjustment to the role of widowed parent.

Such a bereavement intervention program has been in existence at Hospice, Inc. since 1984. A registered art therapist conducts the creative arts groups for children and a social worker facilitates the companion groups. Both parental evaluations and clinical observations sugfest that a creative arts approach may effect a productive mourning experience for children. However, the power of this approach appears diluted when a child does not have a parent in the companion group. This implies that the child in grief must be considered within the context of the famii) system and that the value of the therapy is redoubled when offered as part of an interdisciplinary interuention.     

Doctor and grief.]

In Germany approximately 1% of the population dies each year. This indicates that at least 2-3% of the population will be bereaved every year. Consequently, approximately 2 million people will experience severe loss in Germany each year. This has not only strong psychosocial implications, but is also linked to a broad range of health risks, including increased mortality. Given these statistics it is surprising that loss, grief and bereavement are not given more attention within undergraduate, postgraduate and continuing professional medical education across Germany. This article aims to provide doctors with some suggestions for meaningful and practical support for the bereaved within medical practice. After a short introduction on how current bereavement research is influencing thinking relating to bereavement processes, the article focuses on specific medical options. The role of the doctor in bereavement is discussed, highlighting that this role is not one of a bereavement counselor. However, doctors do encounter bereavement in practice and should be able to provide direction, which enables people to move through the grieving process, allowing them - in the words of J.W. Worden - to move the deceased emotionally to a new place and reengage with their own life.     

Psychological adaptation to spousal bereavement in old age: The role of trait resilience,marital history,and context of death

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.     

“The deceased has left; the alive has to move on”: Experiences of Chinese Widows in the UK

Relatively little is known about the experiences of Chinese widows, especially those living outside China. This qualitative study examines the experiences of eight Chinese or Hong Kong-born widows living in the UK. Using a semistructured approach to interviewing, participants were asked about their lives before, during, and after their spousal bereavement. Five major themes emerged: (1) complexity of marital lives; (2) experiences around the time of the death including fate; (3) loneliness and isolation; (4) the challenges of practical tasks; and finally, (5) current life. The implications of the findings for social policy and practice are briefly discussed.     

Bereavement and the brain: invitation to a conversation between bereavement researchers and neuroscientists

A recent development by neuroscience is neuroimaging, a method of looking into the "black box" of the brain while people are feeling, doing, and thinking in real time. The first fMRI study of bereavement has recently been published, and the present article summarizes it in non-specialist language, focusing on its theoretical and clinical applications. In an attempt to bridge the gap between bereavement researchers and neuroscientists, the author discusses how these two fields could assist each other in forwarding both fields. Three current debates in the field of bereavement research are outlined, including (a) adaptation in the normal grief process, (b) complicated grief vs. resilience, and (c) meaning-making vs. return-to-baseline models of bereavement. The potential contribution of neuroscientific data to these debates is discussed in several hypothetical examples. These examples stimulate thinking about the reciprocity between 2 questions: What can bereavement teach us about the brain? and What can the brain tell us about bereavement? This article is designed to provide enough background for investigators who are primarily concerned with the brain and those primarily concerned with bereavement to open a dialogue between both of these fields.     

Can a Function-Based Therapy for Spousally Bereaved Seniors Accrue Benefits in Both Functional and Emotional Domains?

Late-life spousal bereavement has detrimental effects in daily functioning and emotional distress. This study tested the hypothesis that a therapy based exclusively upon functioning issues (sleep and daily lifestyle regularity) would accrue benefits in both functional and emotional domains. A comparison was made with a control therapy that concentrated on emotional issues, and specifically avoided discussing sleep or lifestyle regularity. Thirty-eight spousally bereaved seniors were randomly assigned to either functional or control therapy. Assessments were made before, during, and after a 6-month, 10-session individual therapy. The functional therapy assisted in both functional and emotional domains and the hypothesis was confirmed.     

The risk assessment of bereavement in a palliative care setting

An effective bereavement risk assessment document used in a palliative care setting was identified which could ensure bereavement support for those in need, be it a family or carer group. The nursing team were used as assessors with a system to indicate carers' and relatives' immediate need following the death of a patient. The aim of this bereavement risk assessment system was to lessen the possible long-term effects of unresolved grief for family and carers of patients who died within a hospice setting. The assessment document is a useful education tool for nurses, allied support professionals and bereavement support volunteers in their work with grief and loss.     

Exploring parental reactions to the diagnosis of cleft lip and palate

The birth of an infant with a facial cleft evokes a range of emotions and reactions in parents. During acceptance of a child's disability, parents are said to progress through several stages similar to those responses reported in the bereavement process. This paper describes the process of adapting in terms of personal construct theory, and reports a pilot of the repertory grid technique as a therapeutic tool to elicit parental reactions following diagnosis of cleft lip and palate. Two mothers compared other significant life events to their reactions to the diagnosis of cleft lip and palate. This pilot supported the use of the repertory grid technique as a means to facilitate exploration of parental responses. Comparisons to the bereavement process were evident, although individual reactions or perceptions may differ from those expected. Recommendations are made for a wider research study within cleft lip and palate.     

New Evidence for Anticipatory Grief

This exploratory study was designed to learn more about the needs of the survivors of hospice patients. A transitions framework is proposed as a way to conceptualize both hospice care and anticipatory grief, and a new clinical tool—the 10-Mile Mourning Bridge—is presented for survivors’ assessments of their progress in bereavement. Survivors perceived that the routine pre-death work of the hospice team had a positive impact on their subsequent wellbeing in bereavement.     

Widowhood and other demographic associations of pain in independent older people

OBJECTIVES: To determine if psychosocial factors, as suggested by the demographic variables of widowhood and living alone, are associated with pain, particularly severe pain, in a representative sample of independent older people. DESIGN: One thousand older people (65+) randomly selected from independent residents living in a major city were surveyed about their health status (Health Status of Older People Study). Demographic characteristics, including age, gender, education, income, living alone, widowhood, and childlessness, were analyzed by logistic regression for their association with pain report of differing severity. Path analysis was used to confirm the association with pain severity and further define the role of mood disturbance in mediating this relationship. RESULTS: The prevalence of any pain report for the preceding 12 months was 56.3%. This was reduced when using more restrictive criteria, such that moderate-to-severe pain "at worst" and "at present" was found in 48.7% and 4.1% of the sample, respectively. After adjusting for type 1 error rate, the status of living alone was primarily associated with moderate-to-severe pain at worst, and being a widow(er) was associated with moderate-to-severe pain at present. The latter association had an estimated odds ratio greater than 3 and was characterized by more recent bereavement. Using path analysis, the model that severe pain was secondary to mood disturbance of widowhood, particularly recent bereavement, was tested and confirmed. The model explained 17% of the variance of pain severity in widow(er)s. CONCLUSION: The mood disturbance related to spousal bereavement aggravates pain in older people. This lends support to the biopsychosocial model of pain.     

Identification of spouses at high risk during bereavement: a preliminary assessment of Parkes and Weiss' Risk Index

The Risk Index developed by Parkes and Weiss (1983) is a brief structured assessment tool for identifying bereaved spouses who may be at high risk for developing complications during bereavement. The present study was undertaken to evaluate the utility of the Risk Index in predicting outcome during the first year of bereavement in spouses of deceased hospice patients. Professional staff at the hospice completed the Risk Index shortly after the spouse died and outcome was then assessed after 1, 3, 6, and 12 months. High-risk bereaved were younger than low-risk bereaved. Number of young children at home, existence of close relationships, and financial status were important predictors of outcome during the first year of bereavement. The findings suggest that the Risk Index may serve as a cost-effective means of assessing risk for complications during the first year of bereavement.     

Trauma and bereavement: conceptual and clinical issues revolving around relationships

The article re-examines trauma and bereavement and the category of loss considered to be traumatic bereavement. It is argued that the perspective of the relation to the deceased is an insufficiently acknowledged source of traumatic disruption following bereavement.The significance of the relational aspect in bereavement is present in the paradigm of the Two-Track Model of Bereavement (S. Rubin, 1981, 1999). The implications of this approach are examined in the case of a soldier exposed to trauma and death.The case is examined from a traditional trauma perspective stressing exposure to life threat and again from a perspective stressing the significance of the relationship to the deceased. An examination of the different intervention strategies and their outcome lends support to the importance of the relational aspects in this case of trauma and supports the use of the Two-Track Model of Bereavement.The location of trauma as basic to the experience of all bereavement for its impact on the reorganization vis a vis the representation of the loved one now deceased is considered as fundamental to the trauma of all bereavement. The additional contribution of bereavement occurring under conditions of life threat (traumatic situations) is an important feature potentially impacting the bereavement process, but it is not what makes bereavement traumatic per se. An additional source of trauma in bereavement, occurring when the previous representation or introject of the deceased is shattered, is considered for its status as an additional source of complication in the traumas of bereavement.