丧葬仪式对丧亲者哀伤反应的影响

目的:本研究采用质性研究的方式,探讨未参加丧葬仪式的丧亲者哀伤反应的普遍性与特殊性,考察丧葬仪式对于丧亲者哀伤修复的功能。方法:采用质性研究方法,选取13名未参加亲友丧葬仪式的丧亲者进行半结构化访谈,采用主题分析法对资料进行分析。结果:丧亲者的哀伤反应体现在情绪、认知、行为、生理四个方面。情绪反应包括遗憾、愧疚与自责、恐惧、愤怒、失落、想念、伤心难过、烦躁、抑郁、震惊;认知反应包括不接受、不孝、重新理解死亡、转变对生者的态度、闯入性思维、迷信信念;行为反应包括哭、缅怀过去、精神自虐、暴力宣泄、绩效降低、家庭冲突增多、人际退缩、回避提示物、私下祭拜;生理反应包括浑身无力、身体不适、失眠、注意力难以集中、抑郁、多梦。结论:未参加丧葬仪式不利于丧亲者的哀伤平复,丧亲者表现出强烈的遗憾与自责;他们的哀伤反应具有普遍性与独特性。     

青少年多次丧友哀伤反应的定性研究

目的:探究青少年多次丧友的哀伤反应类型及特点,为有效心理介入提供参考依据。方法:在某高校进行公开招募,选取在青少年期经历过多次丧友事件的在校大学生3人,年龄为19~20岁,其分别在9岁、12岁以及15岁、17岁两次丧友。对3位入选者进行半结构化访谈,采用主题分析法对其丧友后的哀伤反应进行归类分析。结果:被访者在经历丧友后的常见哀伤反应主要有震惊、后悔、愤怒、否认、难以置信、害怕死亡、哭泣、寻找支持、回避,以及认知到死亡的残酷等;特有的及再次丧友的哀伤反应有:关心逝者亲朋、对朋友角色产生阴影、减少社交、寻求刺激与发泄、反抗学校、暴力倾向、努力学习等。结论:青少年在多次丧友后的哀伤反应具有多样性,并呈现青少年期的心理发展特点,须给予特别的关注与恰当心理介入。     

农村丧亲个体哀伤反应的质性研究

目的:研究中国农村丧亲个体的哀伤反应。方法:选取9名江西东北部某农村丧亲个体进行半结构化的访谈,采用主题分析法对资料进行分析。结果:丧亲者的哀伤反应主要为四个方面,情感反应有伤心、想念、舍不得、痛苦、愤怒、无助感、孤独感、内疚、后悔、失落感和平静,认知反应有不相信、不公平、羡慕、反事实思维、闯入性思想、感觉逝者存在和对生命和物质的态度的转变,行为反应有退缩、人际冲突增加或减少以及回避提醒物,生理反应有疲倦、记忆力减退、食欲不振和失眠。结论:农村丧亲者的哀伤反应有其普遍性和独特性。     

农村丧亲个体应对策略的定性研究:以江西省上饶县某农村为例

目的:初步研究中国农村丧亲个体的哀伤应对策略.方法:选取9名江西东北部某农村丧亲个体进行深入访谈,将访谈资料逐字转录,使用Nvivo 7.0管理资料,采用主题分析法对资料进行分析.结果:丧亲后的个体会经历强烈的哀伤,他们采用的应对策略包括葬礼仪式、处理遗物、归因、背鬼、压抑、回避、投身事物、社会交往、葬礼后仪式和保持联结.这些应对策略又可以归入到丽个更高级别——丧失指向的应对和恢复指向的应对——的分类中.每个丧亲者均会使用不同形式的丧失指向的应对和恢复指向的应对,随着时间的变化,丧失指向的应对变少,恢复指向的应对增多.丧亲者在两种应对之间有良好的摆动.结论:农村个体的哀伤应对策略有其独特性,对哀伤平复有良好的作用.仪式对哀伤平复有非常重要的作用.     

新冠肺炎疫情背景下丧亲者哀伤反应特点及哀伤咨询工作建议

新冠肺炎疫情中死亡人数持续增加,疫情中丧亲的人群急需心理卫生专业人员的关注和专业服务。本文在综述哀伤领域最新文献的基础上,分析疫情背景下丧亲者哀伤反应的特点,提出疫情背景下哀伤咨询服务模式及工作方法,为心理卫生专业人员哀伤咨询与服务提供建议。     

箱庭疗法应用于儿童哀伤咨询的临床实践和理论

为尝试将心理咨询与治疗实践和研究统一起来,首先对一名复杂哀伤儿童进行箱庭治疗实践,从中提取了研究的主题—箱庭疗法用于儿童哀伤咨询的机制;接着对复杂哀伤儿童进行箱庭治疗个案研究验证箱庭疗法与儿童哀伤咨询结合的可能性与可行性;最后将箱庭疗法和儿童哀伤咨询的理论背景进行梳理和总结获得箱庭疗法应用于儿童哀伤咨询的有效机制:①箱庭疗法的非言语特性可以提供安全表达哀伤的空间;②箱庭疗法为丧亲者提供过渡性客体;③箱庭制作能引发哀伤;④箱庭疗法能促进自我成长;⑤箱庭疗法与哀伤咨询的治疗理念相符;⑥箱庭疗法能促进家庭哀伤的完成。     

疫情一周年专题丧亲反应与哀伤处理

丧亲反应与哀伤应对 我们知道,丧失挚爱的亲人是生命历程中最痛苦的经历,个体在失去所依恋的对象之后常常会陷入哀伤情境. 突发的丧亲所导致的创伤性哀伤会使个体产生巨大的精神痛苦,甚至引发焦虑、抑郁,甚至伤害自己或他人等风险.因此,正确认识和了解经历疫情丧亲者的特殊表现,协助完成哀伤过程,显得十分必要和重要.     

重大疾病丧亲者的延长哀伤症状及预测因素

目的:考察重大疾病丧亲者的延长哀伤症状及其预测因素。方法:通过寻访和网络招募的方式对256名重大疾病丧亲者进行问卷测查。结果:所有丧亲者中没有完全符合延长哀伤障碍诊断的个体,但有4名丧亲者达到了临界标准。逝者离世时长、逝者离世时的年龄、与逝者的亲密程度与延长哀伤症状具有显著的相关性。丧亲者的延长哀伤症状得分在亲属级数、与逝者关系、教育程度和婚姻状况上存在显著差异。将所有因素纳入回归方程后发现:最能预测重大疾病丧亲者延长哀伤症状的因素包括:小学及以下的教育程度、逝者离世时长、逝者离世时的年龄。结论:相比于其他丧亲类型,重大疾病丧亲者的延长哀伤障碍的患病率较低,其延长哀伤症状受到部分人口学特征和丧失相关特征的影响。     

论农村殡葬礼俗的心理治疗价值——以汉族为例北大核心CSCDCSSCI

殡葬礼俗指安葬、祭奠死者的一系列礼仪和习俗。农村的殡葬礼俗尽管带有一些迷信色彩,但同时也具有一定的心理治疗价值。表现为:哭丧使丧亲者的负面情绪得以充分宣泄;闹丧活动转移了注意力,冲淡阴森、压抑氛围的同时也避免了丧亲者沉溺于哀伤;众人聚集对死者共同进行悼念发挥了团体心理辅导的功效;各种仪式和习俗使丧亲者不断体验丧失的现实感,在心理上逐步完成与逝者的分离;各种祭祀活动帮助丧亲者重建与逝者的情感联系,为丧亲者提供了精神上的慰藉,激励其重拾生活的信心;通过"尽礼"以达"尽心",减轻了丧亲者的自责与愧疚。     

大学生失恋哀伤过程的定性研究

目的:了解大学生失恋后哀伤反应及由此体现的哀伤阶段特征,为相关心理服务提供依据。方法:运用定性研究方法,招募并筛选谈恋爱分手1年以上的11名在校大学生进行半结构化访谈,对访谈录音做誊录编码后进行分析。结果:失恋的哀伤阶段分为初分手时情绪、行为反应强烈,情绪低落、行为减少或转移注意痴迷其他事情,寻找与分手者的连接,放下感情、适应和准备开始新的生活4个阶段;在分手初期男、女在反应方式上会有不同,且恋爱主动分手者在此阶段存在轻松、愧疚等情绪反应;如果分手对方找到新的男/女朋友易再次引发较强烈情感反应;因客观原因分手者其哀伤反应中对未来有明显的期待。结论:大学生失恋后具有明显的哀伤反应和呈现一定的阶段性,同时性别、分手过程中主客观因素也会引发的一些特定哀伤反应需要予以关注。     

Treatment gap in bereavement care: (Online) bereavement support needs and use after traumatic loss

People bereaved through road traffic accidents (RTAs) are at risk for severe and disabling grief (i.e., pathological grief). Knowledge about needs and use of bereavement care, including psychotherapy, pharmacotherapy, and support groups, is limited. This study charted (correlates of) the needs and use of bereavement care in RTA bereaved people. Furthermore, although online grief treatment seems effective, it is unknown whether it is perceived as acceptable. Accordingly, we examined the acceptability of online treatment. Dutch RTA bereaved adults (N = 273) completed self-report measures about needs and use of bereavement care, acceptability of online grief treatment, and pathological grief. Regression analyses were used to identify correlates of care needs and use and acceptability of online treatment. The majority (63%) had received help from psychotherapy, pharmacotherapy, and/or support groups. One in five participants had not used bereavement care services, despite reporting elevated pathological grief levels and/or expressing a need for care, pointing to a treatment gap. Use of psychological support before the loss was the strongest predictor of bereavement care needs and use following the loss. A minority (35%) reported being inclined to use online grief treatment if in need of support. More openness towards online services was related to greater acceptability of online treatment. In conclusion, 20% of RTA bereaved people with pathological grief or care needs had not received care. This treatment gap may be reduced by improving accessibility of online treatments. However, as only 35% was open to using online treatments, increasing the acceptability of (online) treatments appears important.     

Improve your hospital autopsy rate to 40-50 per cent, a tale of two towns.

In the light of medical audit, all pathology departments are scrutinizing their hospital autopsy rate. In most countries, the rate has fallen over the last few decades to between 10 and 20 per cent. However, it is still possible to achieve a much higher rate. We compare two neighbouring District General Hospitals (DGHs): Northampton, with the more usual autopsy rate of 11 per cent, and Kettering, with a higher rate of 40-50 per cent. These hospitals are comparable in almost every way except for the system used to request permission for an autopsy. These differences were evaluated and the following factors were found to be of importance in achieving a high rate: (1) centralization of death certificates within the mortuary and personal contact between the certifying doctor and the relatives within the bereavement room; (2) mortuary pathology technicians are designated as bereavement officers and act as coordinators between relatives, clinicians, and pathologists; and (3) regular clinico-pathological meetings and a positive attitude to autopsies by clinicians.     

Bereavement Interventions,End‐of‐Life Cancer Care,and Spousal Well‐Being: A Systematic Review

Recent comprehensive reviews have concluded that there is little evidence for the effectiveness of bereavement interventions. These reviews have not been limited to investigations of bereavement services for spouses of patients with cancer. This systematic review examined the evidence from 10 articles reporting on eight studies examining outcomes of bereavement interventions and adjustment to bereavement following specialized end‐of‐life patient care for spouses of patients with cancer. Patient end‐of‐life interventions may positively influence bereavement outcomes for spouses, but based on the available evidence, it is difficult to draw definitive conclusions about the effectiveness of bereavement group interventions for spouses of patients with cancer. Methodologically rigorous studies with larger sample sizes are required to determine the effectiveness of these interventions.     

Grief and bereavement issues and the loss of a companion animal: People living with a companion animal,owners of livestock,and animal support workers

Companion animals play various roles in people's lives and these roles can impact on loss, grief, bereavement and mourning when the animal has been lost, whether that is through death, when missing, or when relinquished. This paper considers not only companion animal owners, but also those who own farm animals and those who work in animal service occupations. The focus is on adult clients, not children. Practical strategies are offered for the counsellor who is working with a bereaved pet owner, farmer, and service provider.     

The “Ins” and “Outs” of the Depressive Disorders Section of DSM‐5

In this article, we review and evaluate changes in the depressive disorders section from DSM‐IV to DSM‐5. We describe characteristics of three new depressive disorders: disruptive mood dysregulation disorder, premenstrual dysphoric disorder, and persistent depressive disorder. We also discuss the controversial decision in DSM‐5 to remove the bereavement exclusion from the criteria for major depressive disorder. Next, we review the decision to replace the diagnosis of depressive disorder not otherwise specified with two new diagnoses: other specified depressive disorder and unspecified depressive disorder. Finally, we discuss the inclusion of two novel specifiers in the DSM‐5 depressive disorders section: “with anxious distress” and “with mixed features.” For each of these changes, we examine the relevant research and discuss implications of the changes for research and clinical practice.     

Predictors of grief following the death of one's child: the contribution of finding meaning

This study examined the relative contribution of objective risk factors and meaning-making to grief severity among 157 parents who had lost a child to death. Participants completed the Core Bereavement Items (CBI; Burnett, Middleton, Raphael, & Martinek, 1997), Inventory of Complicated Grief (ICG; Prigerson et al., 1995), questions assessing the process and degree of sense-making and benefit-finding, and the circumstances surrounding their losses. Results showed that the violence of the death, age of the child at death, and length of bereavement accounted for significant differences in normative grief symptoms (assessed by the CBI). Other results indicated that the cause of death was the only objective risk factor that significantly predicted the intensity of complicated grief (assessed by the ICG). Of the factors examined in this study, sense-making emerged as the most salient predictor of grief severity, with parents who reported having made little to no sense of their child's death being more likely to report greater intensity of grief. Implications for clinical work are discussed.     

Preclinical student reactions to dissection,death, and dying

The objective of the present study was to determine the reactions of preclinical medical students to dissection; cognate issues. A questionnaire was administered to a class of 148 students: the stimulus items inquired about the frequency of mental and physical symptoms, causes of stress, degree of upset occasioned by dissection, previous encounters with death, mental preparedness at the commencement of the course, reactions to dissecting room activities, coping strategies, and the desirability of a course on death and dying. Nearly a quarter of the sample reported an increase in the frequency of mental and physical symptoms. A third of the students identified the dissecting room as a “very important” stressor. Only for female respondents were “dissecting room” and “great difficulty of work” significantly associated as causes of stress. Over three-quarters of the students were upset at the beginning of dissection and about a third remained disturbed after 101.5 hours. Sixty students had seen a dead body previously and 30 students had been bereaved within the 2 years preceding the study. However, neither prior exposure to a dead body nor bereavement was a safeguard against persistent upset by dissection. The initial reactions were mostly negative, but neutral and positive attitudes later supervened. The coping strategies cited did not suggest any significant distortion attributable to the unseemly origins of the cadavers. A compulsory formal course on death and dying during both preclinical and clinical stages was considered desirable by the majority of respondents, more for personal and clinical reasons than for dissection-related ones. © 1996 Wiley-Liss, Inc.     

Human dissection and attitudes of preclinical students to death and bereavement

Two questionnaires were used to gather information about preclinical education concerning death and bereavement. One was mailed to Heads of Anatomy Departments of 26 UK medical schools. The other was distributed to 220 first- and 210 second-year preclinical students in Cambridge. Among curricular organizers (77% response rate), the motivation for giving such education was primarily to improve knowledge about dissection, and only secondarily and infrequently to prepare students for clinical practice or to address their attitudes or feelings. In contrast, the primary concern of students (response rate 54%) was preparation for encounters with death in clinical practice (61–85%), lesser concerns being to address their own fears and feelings (30–40%) or knowledge about the dissecting room, cadavers, etc. (23–37%). Students were also asked about their reactions to dissection in order to determine whether the dissecting room might provide an opportunity for teaching about death. Most (66%) admitted experiencing moderate to extreme apprehension in advance of dissection. Apprehension was associated, on starting dissection, with very strong reactions, which in some cases interfered with learning. Some (27%) dealt with this by depersonalization. The only previous experiences that showed a significant association with the occurrence during dissection of interfering and/or non-task-related thoughts and feelings were (i) for both men and women the occurrence and quality of handling of death experience(s) at school, and (ii) for a group of male students the experience of the death of more than one close non-family friend. A strategy for effective use of the dissecting room in studies on death is outlined. © 1994 Wiley-Liss, Inc.     

Bereavement care in primary care: a systematic literature review and narrative synthesis

Background

Over half a million people die in Britain each year and, on average, a GP will have 20 patients die annually. Bereavement is associated with significant morbidity and mortality, but the research evidence on which GPs and district nurses can base their practice is limited.

Aim

To review the existing literature concerning how GPs and district nurses think they should care for patients who are bereaved and how they do care for them.

Design

Systematic literature review.

Method

Searches of AMED, BNI, CINAHL, EMBASE, Medline and PsychInfo databases were undertaken, with citation searches of key papers and hand searches of two journals. Inclusion criteria were studies containing empirical data relating to adult bereavement care provided by GPs and district nurses. Information from data extraction forms were analysed using NVivo software, with a narrative synthesis of emergent themes.

Results

Eleven papers relating to GPs and two relating to district nurses were included. Both groups viewed bereavement care as an important and satisfying part of their work, for which they had received little training. They were anxious not to ‘medicalise’ normal grief. Home visits, telephone consultations, and condolence letters were all used in their support of bereaved people.

Conclusion

A small number of studies were identified, most of which were >10 years old, from single GP practices, or small in size and of limited quality. Although GPs and district nurses stated a preference to care for those who were bereaved in a proactive fashion, little is known of the extent to which this takes place in current practice, or the content of such care.