Understanding gender differences in bereavement following the death of an infant: Implications of or treatment.

The death of an infant confronts parents with a multitude of difficult challenges. Bereaved parents often experience a grief that is unexpectedly pervasive, intense and enduring. Support from family, friends, and medical professionals is often limited, and most parents rely predominantly on their partner or spouse for sustained support and understanding over time, partners often experience increased difficulties in supporting each other due to gender differences in grief and coping, strained communication, and characteristic patterns of misunderstandings. This article discusses research findings regarding gender similarities and differences in grief and coping following perinatal loss or loss from sudden infant death syndrome (SIDS), and regarding marital difficulties associated with incongruent grieving. Also discussed are the impact of social support on the experience of bereavement, typical patterns of misunderstandings underlying many grief-related marital difficulties, and treatment recommendations for psychotherapists working with individual clients or bereaved couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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

The vast majority of bereavement research is conducted after a loss has occurred. Thus, knowledge of the divergent trajectories of grieving or their antecedent predictors is lacking. This study gathered prospective data on 205 individuals several years prior to the death of their spouse and at 6- and 18-mo postloss. Five core bereavement patterns were identified: common grief, chronic grief, chronic depression, improvement during bereavement, and resilience. Common grief was relatively infrequent, and the resilient pattern most frequent. The authors tested key hypotheses in the literature pertaining to chronic grief and resilience by identifying the preloss predictors of each pattern. Chronic grief was associated with preloss dependency and resilience with preloss acceptance of death and belief in a just world. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective Patterns of Resilience and Maladjustment During Widowhood.

Using prospective longitudinal data on an older sample beginning prior to the death of a spouse, G. A. Bonanno et al. (2002) distinguished 5 unique trajectories of bereavement outcome: common grief, chronic grief, chronic depression, depression followed by improvement, and resilience. These trajectories having been identified, the aims of the current study were to examine differences in how respondents in each group reacted to and processed the loss. Specific hypotheses were tested regarding differences in coping, meaning making, context, and representations of the lost relationship. Results suggest that chronic grief stems from the upheaval surrounding the loss of a healthy spouse, whereas chronic depression results from more enduring emotional difficulties that are exacerbated by the loss. Both the resilient and the depressed-improved groups showed remarkably healthy profiles and relatively little evidence of either struggling with or denying/avoiding the loss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who suffers more? Sex differences in health risks of the widowed.

Explores whether differences in health risks after conjugal bereavement vary systematically with the sex of the widowed spouse. A review of the literature shows that differences in the effects of loss are substantial. Whereas some people recover from grief on the death of a partner relatively unscathed, for others bereavement is associated with extremely debilitating mental and physical effects that may persist for years. Opinions differ greatly on the relation of these effects to sex. The empirical evidence reviewed covers investigations of all major manifestations of normal and pathological grief: psychological distress and depression, mental illness, physical illness, mortality, and suicide. Evidence from both cross-sectional and longitudinal studies is considered. Although few studies are really strong, there is a convergence of evidence from both types of investigations across all areas reviewed: If there is a sex difference in conjugal bereavement reactions, it is the men who suffer more. Interpretations of these findings in terms of selectivity, stress theory, role theory, and interpersonal protection theory are discussed. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The sociobiology of bereavement: A reply to Littlefield and Rushton.

This article offers a critique of Littlefield and Rushton's (1986) application of sociobiological principles to bereavement following the death of a child. The following general issues are considered: (a) whether behavior is always adaptive and (b) the distinction between proximate and ultimate explanations. It is argued that grief is a maladaptive by-product of another, adaptive feature and that hypotheses about the severity of grief are best derived from proximate considerations rather than genetic relatedness. The use of a single-item rating scale to measure grief is questioned, and it is noted that interspouse reliabilities reported in the article were low, a problem not solved (as claimed) by aggregation. Criticisms are made of the specific hypotheses, notably in terms of their origins in sociobiological theory. It is argued that functional hypotheses are not alternatives to proximate mechanisms, but enable some proximate mechanisms to be viewed from the perspective of evolutionary biology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An exploration of anticipatory grief: the lived experience of people during their spouses' terminal illness and in bereavement

Anticipatory grief has been the subject of much debate since Lindemann first coined the term to describe premature mourning. Much of the research in this area takes a positivist approach focusing on the effect of anticipatory grief on bereavement. In contrast, this study, explores anticipatory grief through a Heideggerian phenomenological approach to elicit the experience of anticipatory grief. Unstructured interviews were conducted with four participants. The resulting data were interpreted using hermeneutics and evaluated using the criteria identified by Madison. The themes arising from this interpretation identify the change the participants experienced. Although these findings are limited to four participants, they are offered to raise awareness of the impact of multiple role loss and the impact of diagnosis on supporting partners. The findings also raise ways in which nurses might support people experiencing loss.     

Grief in Freud's life: reconceptualizing bereavement in psychoanalytic theory.

Presents a critique of Freud's drive-based theory of grief, which emphasizes decathexis as the resolution of normal bereavement, using a social developmental model (SDM) of bereavement applied to Freud's own lifelong experiences with grief. Freud's grief at his father's death has been extensively discussed as a creative stimulus to his writing, but most biographers remain loyal to Freud's interpretation of death and grief in his own development. Other close family deaths strongly influenced Freud's life and work. An SDM of grief emphasizes the role of relationships in creating life structure at any age and stage of development, and the growth-sustaining, lifelong bonds that are recreated but are not severed by death. Freud's experiences with death illustrate the usefulness of an SDM of bereavement integrated with relational psychoanalytic perspectives, which view the resolution of grief as the recreation of a new, enduring relational bond. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Factorial validity of the Texas Revised Inventory of Grief—Present scale among bereaved older adults.

The Texas Revised Inventory of Grief—Present scale (TRIG–Present) is one of the most widely used grief measures; however, researchers have only empirically examined the validity and underlying factor structure of TRIG–Present scores in a few studies. Hence, in the present investigation, we sought to examine the factorial validity of the TRIG–Present (those scores that index current grief) among 2 samples of bereaved older adults—a community-dwelling sample of 162 individuals who experienced a diverse set of losses in terms of relationship to the deceased and time since loss, and a recently widowed sample of 212 individuals who were assessed at 2-months and 12-months postloss. Across both samples, we found support for a 3-factor model, composed of clusters of items representing Emotional Response, Thoughts, and Nonacceptance regarding a loss. Additionally, this 3-factor model exhibited significant invariance from 2-months to 12-months postloss in the recently widowed sample. Analyses examining the convergent validity of these 3 factors also suggest that this conceptualization of the TRIG–Present could have practical advantages and potentially influence the way in which clinicians and/or researchers assess grief and evaluate bereavement interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward an integrative perspective on bereavement.

For nearly a century, bereavement theorists have assumed that recovery from loss requires a period of grief work in which the ultimate goal is the severing of the attachment bond to the deceased. Reviews appearing in the 1980s noted a surprising absence of empirical support for this view, thus leaving the bereavement field without a guiding theoretical base. In this article, the authors consider alternative perspectives on bereavement that are based on cognitive stress theory, attachment theory, the social functional account of emotion, and trauma theory. They then elaborate on the most promising features of each theory in an attempt to develop an integrative framework to guide future research. The authors elucidate 4 fundamental components of the grieving process—context, meaning, representations of the lost relationship, and coping and emotion-regulation processes—and suggest ways in which these components may interact over the course of bereavement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive Aspects of Caregiving and Adaptation to Bereavement.

This study examined how positive aspects of caregiving affect adaptation to bereavement among older adults who cared for a family member with dementia. The sample consisted of 217 caregivers who were part of the Resources for Enhancing Alzheimer's Caregiver Health Study. Using pre- and postloss data, hierarchical regressions were carried out to examine the effects of positive aspects of caregiving (caregiving benefit) on postloss depression and grief. Findings show that preloss caregiving benefit was associated with higher levels of postloss depression and grief, even after controlling for caregiver demographic characteristics, contextual factors, and caregiving burden. This effect was particularly strong for the relation between benefit and grief. Results demonstrate the importance of studying both positive and negative aspects of caregiving and their relation to bereavement outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comprehensive approach to bereavement

Bereavement is associated with significant mental and physical health consequences, and risk factors for illness associated with bereavement have been demonstrated. Although bereavement cannot be eliminated as a health risk, primary care providers can screen for it, facilitate the normal grief process, and mitigate risks for bereavement complications and health deterioration. Considering the time constraints in today's fast-paced health care environment, this article offers a clear and comprehensive framework for primary care of grieving people. The framework presented here includes (1) empirically shown risk factors for health deterioration in bereavement; (2) an assessment and screening patient history format suitable for primary bereavement care; (3) primary care guidelines for differential diagnosis of bereavement; and (4) principles of primary care for the bereaved. This article also addresses primary care for bereaved children, parents, and other specific bereaved populations, and discusses pharmacotherapy and multicultural considerations in bereavement.     

Review of Handbook of bereavement research and practice: Advances in theory and intervention.

Reviews the book, Handbook of bereavement research and practice: Advances in theory and intervention, edited by Margaret S. Stroebe, Robert O. Hansson, Henk Schut, and Wolfgang Stroebe (see record 2008-09330-000). The goal of this book is to provide a state-of-the-art overview of the field of bereavement research and practise. To achieve this goal, the editors have enlisted the collaboration of several well-known grief and bereavement researchers. This latest effort tries to relate bereavement research more explicitly to contemporary society and practise issues than was done in the two earlier volumes. The handbook is to be commended for fairly presenting multiple, and at times contradictory, points of view on some of the more controversial issues in the field. This results in a fascinating, well-written book, with many thought-provoking chapters that will challenge some of the persistent misconceptions that psychologists may have about bereavement and the nature of grief work. This book will help guide students who want to pursue clinical work or research in this field. Seasoned researchers will likely also find this book very helpful in terms of its conceptual clarification of terms that are often poorly defined. Readers who are looking for practical advice on how best to help their clients grieve may, however, be disappointed. As the editors indicate, this is not a sourcebook for clinicians looking for practical tips. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The crucial importance of empirical evidence in the development of bereavement theory: Reply to Archer (2001).

In his commentary, J. Archer (2001a) argued that G. A. Bonanno and S. Kaltman's (1999) review and integration of the bereavement literature failed to consider evolutionary theory or other approaches to the origins of grief. Archer also argued that Bonanno and Kaltman had merely replaced the traditional grief work perspective with cognitive restructuring, thereby ignoring the processes related to avoidance and distancing from the loss. In this reply, the author first explains that although it was compelling to do so, Bonanno and Kaltman did not emphasize an evolutionary approach to the origins of grief reactions because in their current form these theories lack empirical and theoretical clarity. Second, the author shows that, contrary to Archer's reading, Bonanno and Kaltman's article viewed cognitive restructuring as a mechanism used primarily by extremely grieved persons and only in some cognitive domains. Last, the author shows that Bonanno and Kaltman have championed rather than ignored avoidant or distancing processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Elbow arthroscopy in trauma and reconstruction

Grief and bereavement following the death of a loved one present clients with significant challenges to the physical, emotional, and spiritual health and well-being. The grieving process for the person with HIV infection may be compounded by shame, stigma, and lack of social support. For communities with the highest prevalence of HIV infection, AIDS-related losses have resulted in mounting, and often overlapping, bereavements. Addressing the impact of these bereavements on the physical and emotional health of clients and their survivors is imperative to designing appropriate interventions to alleviate the potential adverse health outcomes associated with epidemic loss. Facilitating the grief work of HIV positive persons and their loved ones serves to assuage unhealthy sequelae, promote effective coping skills, and provide opportunities for personal growth.     

Death of One's Partner: The Anticipation and the Reality.

The loss of a chosen partner is, for many people, one of the most tragic events that can occur. The severity of the sense of loss and grief is contingent on length of marriage/relationship, age of partner and of their children, whether the partner's death was sudden or followed a long illness, socioeconomic status, existence of a support network, and whether the relationship was predominantly happy or discordant. This article explores the fear about and reactions to death of a partner. It is based on over 35 years of clinical practice and draws on myriad observations about how family, friends, and patients perceive and cope with this life-altering event. Case illustrations are used, and interventions are highlighted to provide a possible template for clinicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective predictors of positive emotions following spousal loss.

Whereas theoreticians are interested in modeling how bereavement contributes to health, the bulk of research on spousal bereavement is conducted after a loss has occurred. Using prospective longitudinal data, this study examined the extent to which positive emotion following spousal loss varies on the basis of preloss characteristics of the bereaved spouse and the marital relationship prior to loss. Analyses are based on the National Survey of Midlife Development (MIDUS), a 2-wave panel survey of adults in the contiguous United States. Results indicate that compared with continuously married controls, widowed participants experienced a significant decline in positive emotion within 3 years following loss. Conversely, no significant declines in positive emotion were evident among widowed persons with greater preloss trait resilience or greater marital strain. Results provide support for the notion that adjustment to loss may be linked to factors that precede actual loss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Short-term psychotherapy for perinatal loss.

Suggests that psychotherapy with victims of perinatal loss provides an opportunity to facilitate the mourning process as well as further resolution of long-standing conflicts in pregnancy and its tragic aftermath. Two cases illustrate psychotherapy for recent perinatal loss and for unresolved grief. While a psychodynamic orientation is used, it is argued that interpersonal resources and family styles of coping are important factors in the outcome of perinatal bereavement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When avoiding unpleasant emotions might not be such a bad thing: Verbal-autonomic response dissociation and midlife conjugal bereavement.

It has been widely assumed that emotional avoidance during bereavement leads to either prolonged grief, delayed grief, or delayed somatic symptoms. To test this view, as well as a contrasting adaptive hypothesis, emotional avoidance was measured 6 months after a conjugal loss as negative verbal- autonomic response dissociation (low self-rated negative emotion coupled with heightened cardiovascular activity) and compared with grief measured at 6 and 14 months. The negative dissociation score evidenced reliability and validity but did not evidence the assumed link to severe grief. Rather, consistent with the adaptive hypothesis, negative dissociation at 6 months was associated with minimal grief symptoms across 14 months. Negative dissociation scores were also linked to initially high levels of somatic symptoms, which dropped to a low level by 14 months. Possible explanations for the initial cost and long-term adaptive quality of emotional avoidance during bereavement, as well as implications and limitations of the findings, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of bereavement outcomes in families of patients with cancer: a literature review

The purpose of this paper is to review the literature on predictors of bereavement outcomes in family caregivers of persons who have died of cancer. The literature has been divided into common themes of predictors: characteristics of the deceased person, characteristics of the bereaved person, comparisons of bereaved and non-bereaved persons, well-being of the bereaved person prior to the death, prior interpersonal relationships, characteristics of the illness, characteristics of the caregiving experience, and characteristics of terminal care. A number of recurring patterns point the way to identifying persons who may be at increased risk for poor adjustment during bereavement. It is apparent that men and women express their grief somewhat differently. Whether men or women are at greater risk for poor adjustment, however, remains to be determined. There is some empirical evidence to suggest that lower socioeconomic status and linguistic barriers interfere with adjustment during bereavement. There is a dearth of culturally relevant services to help palliative-care patients and their family members make the required adjustments. The literature makes apparent the need for open awareness of the impending death and for careful and thoughtful planning for where and how the death ought to occur. The regular and frequent presence of professional caregivers contributes to family caregivers' satisfaction with care. Discrepant findings point to the need to explore the issues that underline them. Older bereaved caregivers appear to have some advantages over younger ones, but this finding is not universally found in the results of these studies. Methodological problems include small sample sizes and large variations in the particular bereavement outcomes studied.     

Mourning in prison: mission impossible?

The author's interest in the issue of mourning in prison is twofold. As an active hospice volunteer, she became involved with bereavement work, which sensitized her to the issues of loss encountered upon joining the staff at the Maine State Prison. More often than not, the inmates with whom she met had unresolved issues of loss. The impetus for a grief support group came from an inmate who had experienced the death of five relatives during his period of incarceration; he commented on how difficult it is to mourn in prison, and he worried about how he would deal with all his losses when confronted with them upon his release. The author raised the possibility of a support group and the inmate offered to help organize it. This article describes the author's experience with such a prison-based support group and what she has learned, through this experience, about mourning in prison.