Information-Processing Biases in Young Adults From Bereaved and Divorced Families.

Parental loss or divorce is associated with increased risk for affective disorders, potentially because of dysfunctional information processing. This study evaluated attentional biases to threat or loss-related cues in young adults from divorced, parental-loss, or intact families. Participants from intact families showed avoidance of supraliminal threat and loss cues, whereas those from divorced families showed vigilance toward loss cues. Those from bereaved families showed no pattern of bias. Abuse and poor family relationships were associated independently with vigilance toward negative cues. After controlling for abuse, group differences in threat bias were no longer apparent. Results suggest that parental death or divorce may increase risk of affective disorder owing to the loss of a "protective bias" away from negative stimuli. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Family Bereavement Program: Efficacy evaluation of a theory-based prevention program for parentally bereaved children and adolescents.

This article presents an experimental evaluation of the Family Bereavement Program (FBP), a 2-component group intervention for parentally bereaved children ages 8-16. The program involved separate groups for caregivers, adolescents, and children, which were designed to change potentially modifiable risk and protective factors for bereaved children. The evaluation involved random assignment of 156 families (244 children and adolescents) to the FBP or a self-study condition. Families participated in assessments at pretest, posttest, and 11-month follow-up. Results indicated that the FBP led to improved parenting, coping, and caregiver mental health and to reductions in stressful events at posttest. At follow-up, the FBP led to reduced internalizing and externalizing problems, but only for girls and those who had higher problem scores at baseline. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Minority stress predictors of HIV risk behavior, substance use, and depressive symptoms: Results from a prospective study of bereaved gay men.

Objective: Minority stress is the most frequently hypothesized risk factor for the increased rates of adverse behavioral and mental health outcomes among sexual minorities. However, there is a paucity of longitudinal research addressing this hypothesis. Design: Prospective, community-based cohort of 74 bereaved gay men. Participants were assessed before the partner or close friend died of AIDS and then at 1, 6, 13, and 18 months postloss. Main Outcome Measures: HIV risk behavior (unprotected anal intercourse), substance use and abuse symptoms, and depressive symptoms. Results: Hierarchical Linear Modeling analyses revealed that changes in internalized homophobia, discrimination experiences, and expectations of rejection were differentially associated with HIV risk behavior, substance use, and depressive symptoms, respectively. In contrast to the significant effects of minority stress, bereavement-related stressors (e.g., length of partner illness, quality of relationship with deceased) were largely unrelated to these outcomes. Conclusion: The results provide evidence for the predictive validity of minority stress, even in the context of a major life stressor, and suggest the importance of targeting minority stress experiences in HIV and mental health interventions with gay men. Future studies are needed to assess the mechanisms through which minority stress is associated with adverse health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effectiveness of psychotherapeutic interventions for bereaved persons: A comprehensive quantitative review.

Previous quantitative reviews of research on psychotherapeutic interventions for bereaved persons have yielded divergent findings and have not included many of the available controlled outcome studies. This meta-analysis summarizes results from 61 controlled studies to offer a more comprehensive integration of this literature. This review examined (a) the absolute effectiveness of bereavement interventions immediately following intervention and at follow-up assessments, (b) several of the clinically and theoretically relevant moderators of outcome, and (c) change over time among recipients of the interventions and individuals in no-intervention control groups. Overall, analyses showed that interventions had a small effect at posttreatment but no statistically significant benefit at follow-up. However, interventions that exclusively targeted grievers displaying marked difficulties adapting to loss had outcomes that compare favorably with psychotherapies for other difficulties. Other evidence suggested that the discouraging results for studies failing to screen for indications of distress could be attributed to a tendency among controls to improve naturally over time. The findings of the review underscore the importance of attending to the targeted population in the practice and study of psychotherapeutic interventions for bereaved persons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of the family bereavement program on multiple indicators of grief in parentally bereaved children and adolescents.

Objectives: This article reports on results from a randomized experimental trial of the effects of the Family Bereavement Program (FBP) on multiple measures of grief experienced by parentally bereaved children and adolescents over a 6-year period. Method: Participants were 244 youths (ages 8–16, mean age = 11.4 years) from 156 families that had experienced the death of a parent. The sample consisted of 53% boys and 47% girls; ethnicity was 67% non-Hispanic White and 33% ethnic minority. Families were randomly assigned to the FBP (N = 135) or a literature control condition (N = 109). Two grief measures, the Texas Revised Inventory of Grief and the Intrusive Grief Thoughts Scale (IGTS) were administered at 4 times over 6 years: pretest, posttest, and 11-month and 6-year follow-ups. A 3rd measure, an adaptation of the Inventory of Traumatic Grief (ITG) was administered only at the 6-year follow-up. Results: Compared with the control group, the FBP group showed a greater reduction in their level of problematic grief (IGTS) at posttest and 6-year follow-up and in the percentage at clinical levels of problematic grief at the posttest. The FBP also reduced scores on a dimension of the ITG, Social Detachment/Insecurity, at 6-year follow-up for 3 subgroups: those who experienced lower levels of grief at program entry, older youths, and boys. Conclusion: These are the first findings from a randomized trial with long-term follow-up of the effects of a program to reduce problematic levels of grief of parentally bereaved youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Jungian family sandplay with bereaved children: Implications for play therapists.

Jungian family sandplay (JFS) with bereaved clients, especially young children, may assist family members in communicating their intrapersonal world of grief through symbolic methods. Specifically, play therapists using JFS provide the opportunity for children to share feelings with caretakers that may be developmentally difficult to verbalize. With JFS, children use nonthreatening images to portray feelings and struggles associated with the death of a loved one. The focus of this article is the importance of including caretakers and family members in bereaved children’s sandplay. In addition, we include a clinical vignette to illuminate the potential benefits of incorporating JFS with bereaved children. We conclude with implications for play therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attachment in Coping With Bereavement: A Theoretical Integration.

Researchers have deplored shortcomings in theoretically based models of coping with bereavement. Integration of cognitive stress with attachment theory is proposed to predict adjustment to bereavement, describe different forms of effective coping, and resolve ongoing debates about continuing versus relinquishing bonds. These 2 generic approaches are integrated within a bereavement-specific perspective, the dual-process model of coping (Stroebe & Schut, 1999). Accordingly, (a) different coping styles are adopted by, and are differentially efficacious for, bereaved people according to their style of attachment; (b) bereaved people's ways of continuing bonds differ according to their attachment style; and (c) grief complications are associated with insecure attachment styles. The authors conclude that it is better for some bereaved individuals to work toward retaining ties and for others to work toward loosening ties. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Helping Bereaved Children, Second Edition: A Handbook for Practitioners.

Reviews the book, Helping Bereaved Children, Second Edition: A Handbook for Practitioners edited by Nancy Boyd Webb (see record 2002-02276-000). When health policy decision-makers understand the greater societal benefits of providing evidence-based bereavement support to children and adolescents, our country will have coordinated, accessible, and comprehensive Loss Support programs for every family member. Until then, we are fortunate to have this guide to educate us on how to best support our most vulnerable family members when someone loved dies. Although the title specifically targets practitioners, I believe that the plain language and holistic approach would assist parents and other adults in supporting these children and teens. I am pleased to endorse this book as an excellent resource for professionals and lay people alike as we all strive to ensure that our children receive the best support for the grief they experience in their young lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does disclosure of emotions facilitate recovery from bereavement? Evidence from two prospective studies.

Two longitudinal studies assessed whether disclosure of emotions facilitates recovery from bereavement. Study 1 tested prospectively over a 2-year period whether the extent to which bereaved persons talked about their loss to others and disclosed their emotions was associated with better adjustment to the loss of a marital partner. There was no evidence that disclosure facilitated adjustment. Study 2 randomly assigned recently bereaved individuals either to the Pennebaker writing task (J. W. Pennebaker & S. K. Beall, 1986) or to no-essay control conditions. The writing task did not result in a reduction of distress or of doctors visits either immediately after the bereavement or at a 6-month follow-up. Beneficial effects were not demonstrated for bereaved persons who had suffered an unexpected loss or who at the time of the study still expressed a high need for emotional disclosure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bereavement care in general practice: a survey in South Thames Health Region

BACKGROUND: Studies have shown that bereaved individuals suffer increased rates of physical and mental ill health. Bereavement support has recently been advocated as an area of prevention in primary care, with suggestions that general practitioners (GPs) should adopt protocols for the active follow-up of their bereaved patients, which relies on the early notification of deaths by hospitals and hospices. Little is known about the routine care currently provided by GPs and primary health care teams (PHCTs) to support their bereaved patients. AIMS: To explore GPs' perceptions of patient death notifications by hospitals and hospices. To describe practice policies relating to patient deaths and the provision of bereavement support. METHOD: Postal questionnaires were sent to senior partners of a random sample of 500 general practices in South Thames Health Region. RESULTS: Three hundred and fifty-three practitioners responded (71%). Hospitals were perceived to be significantly slower than hospices in notifying deaths (P < 0.0001). One hundred and ninety-six practices (56%) kept death registers, 230 (65%) discussed deaths together, and 142 (40%) identified bereaved relatives. One hundred and thirty-seven practices (39%) routinely offered bereaved relatives contact with a PHCT member; while 133 (38%) supported only those who asked for help. Routine support was significantly more likely to be provided by practices that kept a death register, discussed deaths together, identified bereaved relatives, and had a special interest in palliative care. CONCLUSIONS: GPs perceive hospitals to be slower than hospices at notifying deaths, particularly in the first 24 hours. They are divided over whether bereavement support should be proactive or reactive. Keeping a practice death register, discussing deaths together, and identifying newly bereaved relatives are activities related to providing routine bereavement care.     

Retrospective assessment of marital adjustment and depression during the first 2 years of spousal bereavement.

Two hundred twelve bereaved elders rated marital adjustment using items drawn from the H. J. Locke and K. M. Wallace (1959) Marital Adjustment Test and completed the Beck Depression Inventory 2 months, 12 months, and 30 months after the loss of their spouses. Their responses were compared with those of 162 nonbereaved individuals of comparable age who were tested at the same times. More positive ratings of marital adjustment were made by bereaved subjects than by nonbereaved subjects. Among nonbereaved elders, more severe ratings of depression were associated with lower ratings of marital adjustment. In the bereaved sample, however, the opposite was found: More severe ratings of depression were associated with higher ratings of marital adjustment. This pattern of results changed only slightly over the 2.5-year course of bereavement and was not influenced by gender. These results are discussed in terms of cognitive processes (e.g., idealization) that influence retrospective assessments of marital adjustment during bereavement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional and cardiovascular sensitization to daily stress following childhood parental loss.

Adverse childhood events can influence the development of emotional and physiological self-regulatory abilities, with significant consequences for vulnerability to psychological and physical illness. This study evaluated stress sensitization and inoculation models of the impact of early parental death on stress exposure and reactivity in late adolescence/young adulthood. Ambulatory blood pressure (BP) and diary reports of minor stress were collected every 30 min during waking hours over a 24-hr period from 91 late adolescents/young adults (43 early bereaved, 48 nonbereaved). Across the sample, minor stressors were associated with elevated BP and negative affect. The bereaved group had lower BP than did the nonbereaved group. Within the bereaved group, higher perceived caring from the surviving parent was associated with fewer reports of minor stress and lower stress-related negative affect. Higher perceived parental caring during childhood was associated with lower BP across the sample and more frequent hassles in the nonbereaved group. Findings support both the stress inoculation and sensitization models, suggesting that childhood parental loss and parental caring exert important influences on children's development of stress sensitivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Regret resolution, aging, and adapting to loss.

Both theory and empirical evidence suggest that people who have unresolved regrets experience lower levels of well-being than do those who resolve their regrets. In this study, the authors examined the role of regret resolution during bereavement by assessing whether (a) regret resolution would aid in adapting to the death of a loved one and (b) older adults would be more successful at resolving their bereavement-related regrets than would younger adults. Mixed models were run with longitudinal data from an age-heterogeneous sample of 147 men and women who were eventually bereaved after providing care for a loved one through a hospice. As expected, regret resolution contributed to adjustment as indicated by postloss patterns of depressive symptoms, well-being, and rumination; further, older adults were more likely to resolve their regrets than were younger adults. Implications for encouraging regret resolution early in bereavement are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The balance of give and take in caregiver–partner relationships: An examination of self-perceived burden, relationship equity, and quality of life from the perspective of care recipients following stroke.

Purpose: We examined the sense of being a burden to others or self-perceived burden (SPB) in people with stroke. Method: A mail survey was completed by 57 former inpatients and their partner caregivers. The care recipient survey included measures of functional status, quality of life, marital satisfaction, equity in the relationship, and psychological distress, as well as SPB using the Self-Perceived Burden Scale (SPBS; Cousineau, McDowell, Hotz, & Hébert, 2003). The caregiver survey included similar measures in addition to a caregiver burden measure. Results: SPB was found to be a prevalent and distressing concern. SPBS scores correlated with measures of functional status and mood; however, the correlations were highest for measures of family roles and work/productivity. Using equity theory as a basis to examine the SPB construct, care recipients who perceived themselves as overbenefiting from the relationship had significantly higher SPB scores than those whose relationship was viewed as equitable or underbenefiting. Conclusions: For some receiving care from a partner after stroke is associated SPB. This sense of burden is related to changes in help-seeking behavior, quality of life, and distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postbereavement depressive mood and its prebereavement predictors in HIV+ and HIV– gay men.

Prebereavement predictors of the course of postbereavement depressive mood were examined in 110 gay men who were their partner's caregiver until the partner's death of AIDS. In all, 37 HIV+ and 73 HIV– bereaved caregiving partners were assessed bimonthly throughout a 10-month period beginning 3 months before and ending 7 months after the partner's death. Throughout the 10 months, mean Centers for Epidemiology Scale-Depression (CES-D) scores on depressive mood were above the cutoff for being at risk for major depression. CES-D scores decreased for 63% of bereaved caregivers over the 7 postbereavement months, and 37% showed little change from high CES-D scores or increasing CES-D scores. High prebereavement CES-D scores and finding positive meaning in caregiving predicted diminishing depressive mood; HIV+ serostatus, longer relationships, hassles, and use of distancing and self-blame to cope predicted unrelieved depressive mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caregiver models of self and others, coping, and depression: Predictors of depression in children with chronic pain.

In a sample of 59 chronically ill pediatric patients and their maternal caregivers, both child-reported pain and caregiver-reported depression predicted child-reported depression. Results further suggested that the association between pain and depression in children is ameliorated by caregiver coping strategies and that how caregivers cope is a function of their attachment-related representations of the self and others. Caregivers with a negative model of the self were more depressed, and those with a negative model of others were more prone to use avoidant coping strategies, and, in turn, to be more depressed. However, the extent to which caregivers with negative models of self used more avoidant and less approach coping appeared to depend on whether they perceived that others were likely to respond to their needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A co-twin--control study of response to widowhood

The effects of long-term and recent conjugal bereavement were investigated in a sample of 2,104 Swedish twins followed between 1984 and 1993. In co-twin-control analyses, the bereaved twin experienced significantly more depressive symptoms, more loneliness, and less life satisfaction than the married co-twin. This association existed for recently widowed (< 3 years) of both sexes. Long-term widowed (> 5 years) reported more loneliness than married individuals, and for women there was also a difference in life satisfaction. There were no effects of bereavement on perceived physical health. Individual analyses, which included all respondents regardless of the co-twin's bereavement status, showed the same pattern of results. There was also evidence for an anticipation effect of widowhood indicated by elevated depressive symptoms prior to the spouse's death. Finally, longitudinal analyses showed that it is more stressful to be bereaved when young-old than old-old, but revealed no age differences in adaptation.     

Complicated grief and deficits in emotional expressive flexibility.

There is growing evidence that deficits in emotion regulation may be at the heart of maladaptive reactions after bereavement. Expressive flexibility, or the ability to flexibly enhance or suppress emotional expression, appears to be especially important for adjustment in the aftermath of highly aversive events (Bonanno, Papa, Lalande, Westphal, & Coifman, 2004). In this study, we compared expressive flexibility in a sample of bereaved adults who lost their spouse 1.5–3 years earlier and a comparable sample of married adults. Approximately half of the bereaved adults had Complicated Grief (CG) and half were asymptomatic. Using a within-subjects design, we asked all participants to either enhance or suppress their expressions of emotion or to behave normally while viewing evocative pictures at a computer screen. Observer ratings of expressiveness made blind to condition showed no group differences in overall emotion. However, bereaved adults suffering from CG exhibited deficits in expressive flexibility. Specifically, the CG group was less able to enhance and less able to suppress emotional expression relative to asymptomatic bereaved and married adults. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A safe haven: An attachment theory perspective on support seeking and caregiving in intimate relationships.

This study used an attachment theoretical framework to investigate support-seeking and caregiving processes in intimate relationships. Dating couples (N?=?93) were videotaped while one member of the couple (support seeker) disclosed a personal problem to his or her partner (caregiver). Results indicated that when support seekers rated their problem as more stressful, they engaged in more direct support-seeking behavior, which led their partners to respond with more helpful forms of caregiving. Responsive caregiving then led seekers to feel cared for and to experience improved mood. Evidence for individual differences was also obtained: Avoidant attachment predicted ineffective support seeking, and anxious attachment predicted poor caregiving. Finally, couples in better functioning relationships engaged in more supportive interactions, and participants' perceptions of their interaction were biased by relationship quality and attachment style. (PsycINFO Database Record (c) 2010 APA, all rights reserved)