Perception of grief responses: Are maladaptive grief responses and the stages of grief considered normal?

Literature indicates laypeople hold strong opinions about how persons should grieve. This study examined how individuals perceive normal grief. Participants across two distinct samples (Study 1: N = 510 via MTurk; Study 2: N = 210 via Qualtrics panels) completed the Perception of Grief Scale and Grief Expectations Questionnaire. Findings indicated participants endorsed maladaptive grief responses as normal relative to other responses to loss. Endorsement of maladaptive grief responses as normal predicted endorsement of grief work beliefs. If social expectations deem maladaptive grief to be normal, as this study suggests, bereaved individuals might implicitly push themselves to grieve maladaptively.

Evaluating the empirical evidence for three transdiagnostic mechanisms in anxiety and mood disorders.

High co-morbidity among mental disorders indicates that common transdiagnostic mechanisms underlie various psychopathology, yet there has been little research effort to empirically explicate transdiagnostic processes. A few existing studies are limited in the number of transdiagnostic mechanisms and mental disorder categories explored. The current study addresses these limitations by examining the relationship between three transdiagnostic processes (experiential avoidance, rumination, and emotion dysregulation) and symptom severity of five mental disorders (generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobia, and depression) in a college sample (N = 266). Applying Structural Equation Modeling (SEM), three transdiagnostic models were evaluated, with the five latent variables of mental disorder regressed onto each transdiagnostic process. The results showed that all transdiagnostic models-except the emotion dysregulation model-generally fit the data well. Among the tested models, the strongest evidence was found for experiential avoidance as a transdiagnostic mechanism underlying multiple disorders, suggesting the need for further research effort to reduce experiential avoidance in diverse clinical populations.

An evaluation of common risk factors for prolonged grief disorder using the international classification of diseases-11 criteria.

OBJECTIVES: Inclusion of Prolonged Grief Disorder (PGD) in the ICD-11 warrants examination of risk factors using diagnostic criteria as there is a paucity of research that has examined risk factors of PGD using the diagnostic criteria. This study examines if the identified risk factors for prolonged grief predict PGD using the diagnostic criteria across three samples. METHODS: A cross-sectional survey design was used to assess risk factors and PG-13 in three distinct samples of bereaved adults. The PG-13 was either parsed dichotomously using the ICD-11 diagnostic criteria to indicate presence of PGD or summed to index general grief severity.Results: When using ICD-11 diagnostic criteria, only female gender and high levels of pre-loss contact were identified in separate samples as increasing risk of diagnosis. The most replicable results across samples were found when using the summed PG-13 symptom scores. When using the PG-13 total score, younger age and more pre-loss contact with the deceased were associated with higher symptom levels, which replicated in all three studies.Conclusions: This study provided evidence that the extant literature using summed scores to explore risk factors might not generalize to the ICD-11 diagnostic criteria.

"It may help you to know ": The Early-phase Qualitative Development of a Rheumatoid Arthritis Goal Elicitation Tool.

OBJECTIVE: Treatment guidelines for rheumatoid arthritis (RA) include a patient-centered approach and shared decision making, which includes a discussion of patient goals. We describe the iterative early development of a structured goal elicitation tool to facilitate goal communication for persons with RA and their clinicians. METHODS: Tool development occurred in 3 phases: (1) clinician feedback on the initial prototype during a communication training session; (2) semistructured interviews with RA patients; and (3) community stakeholder feedback on elements of the goal elicitation tool in a group setting and electronically. Feedback was dynamically incorporated into the tool. RESULTS: Clinicians (n = 15) and patients (n = 10) provided feedback on the tool prototypes. Clinicians preferred a shorter tool deemphasizing goals outside of their perceived treatment domain or available resources; they highlighted the benefits of the tool to facilitate conversation but raised concerns regarding current constraints of the clinic visit. Patients endorsed the utility of such a tool to support agenda setting and preparing for a visit. Clinicians, patients, and community stakeholders reported the tool was useful but identified barriers to implementation that the tool could itself resolve. CONCLUSION: A goal elicitation tool for persons with RA and their clinicians was iteratively developed with feedback from multiple stakeholders. The tool can provide a structured way to communicate patient goals within a clinic visit and help overcome reported barriers such as time constraints. Incorporating a structured communication tool to enhance goal communication and foster shared decision making may lead to improved outcomes and higher-quality care in RA.

Attributions About Bereaved Spouses: Testing the Myths of Coping With Loss.

Social expectations influence how we cope with loss and how people in our social networks respond to us. Wortman and Silver outlined Western cultural assumptions, or myths, about mourning, thought to influence judgments of one's grief response. In particular, the two myths hypothesized to affect social judgments about grievers' adjustment were related to (a) the intensities of the grief response and (b) the duration of the grief response. We assessed if these myths affected the attributions of potential support providers in a convenience sample of 510 Amazon Mechanical Turk community participants. The results indicated preheld expectancies that expressing and processing loss is important to recover from grief was related to attributions about the adjustment of spousally bereaved grievers in vignettes. However, any level of grief symptoms displayed in vignettes was associated with participants, indicating they would discourage expression of grief and distance themselves from the person grieving.

Randomized controlled trial protocol for project BRIDGE: A telephone-administered motivational interviewing intervention targeting risky sexual behavior in older people living with HIV.

PURPOSE: By 2020, 70% of people living with HIV in the United States will be greater than 50 years of age. As many as 37% of sexually active older people living with HIV (OPLWH) engage in HIV transmission sexual behaviors. In spite of repeated calls for secondary prevention interventions to reduce condomless sex in OPLWH, no age-appropriate, evidence-based secondary prevention interventions exist for this group. Furthermore, many OPLWH face barriers to engaging in face-to-face secondary prevention services because of HIV- and age-related stigma, comorbid mental and physical health conditions that complicate travel, or geographic isolation. High rates of depression in OPLWH may further complicate engagement in interventions intended to reduce HIV transmissions. Telephone-administered motivational interviewing may be a feasible and efficacious intervention for this population. METHODS: This randomized controlled trial will test the efficacy of a 5-session telephone-administered motivational interviewing plus behavioral skills training (teleMI+BST) intervention versus a 5-session telephone-administered coping effectiveness training (teleCET) control intervention to reduce condomless sex in OPLWH. A diverse sample of 336 OPLWH will be recruited across the U.S. The primary analysis will test the efficacy of teleMI+BST to reduce occasions of non-condom protected anal and vaginal intercourse with HIV serodiscordant sex partners. Secondary analyses will examine the efficacy of teleMI+BST to reduce depressive symptoms in mildly depressed OPLWH. CONCLUSION: This is the first large-scale RCT intended to reduce HIV sexual transmission risk behavior in OPLWH and will add to the literature on secondary prevention telehealth interventions for people living with HIV. ClinicalTrials.gov Identifier: NCT03004170. This trial has been conducted by the approval of the Institutional Review Board. Participants provided verbal consent to participate in this trial.

Commonalities in grief responding across bereavement and non-bereavement losses.

BACKGROUND: Despite implications for theory and treatment, commonality in responding to non-bereavement and bereavement losses are not well explicated. METHOD: This study identified the factor structure of the three most common responses to bereavement, prolonged grief, posttraumatic stress, and major depression in a bereaved community sample (n=151, 59% female, 68% white) from the U.S. recruited from Amazon's MTurk using a cross-sectional survey design, then cross-validated the structure in samples where people had lost other potentially self-defining roles; one's employment (n=157, 47% female, 69% white) and one's marriage (n=116, 62% female, 80% white). RESULTS: Results indicated that symptoms of prolonged grief, posttraumatic stress, and major depression were distinct factors in the bereaved sample, the three-factor solution was a good fit for the job-loss and divorce samples, and levels of grief in each sample appeared to be best predicted by time since loss and centrality of the loss to one's identity. LIMITATIONS: Limitations include potential sample bias due to convenience sampling, and the cross-sectional design did not allow examination of the stability of factors over time. CONCLUSIONS: These results suggest that grief is not a unique response to loss of loved one but instead may be a common phenomenology across types of loss. This implies that facilitating meaningful engagement in self-defining activities that compensate for the disrupting loss might be efficacious in promoting grief resolution without the need for working through individuals' emotional attachment to a specific individual or processing one's emotional responses to the loss.

Prevalence and correlates of complicated grief in adults who have undergone a coronary artery bypass graft.

BACKGROUND: Complicated grief (CG) is a recently described mental health condition that follows bereavement. CG is often comorbid with depression and may also be associated with poor health outcomes. However, CG has not been studied in depressed medically ill populations. This study examined the prevalence, correlates, and impact of CG in depressed post-coronary artery bypass graft surgery (CABG) patients. METHODS: A 5-item CG screen was administered to 302 depressed post-CABG patients participating in a comparative effectiveness intervention trial at 7 Pittsburgh-area hospitals from March 2004 to September 2007. Eligible patients were randomly assigned to either a telephone-delivered collaborative care intervention for depression or their primary care physicians' usual care. Measures examined depression, physical and mental health-related quality of life, and physical functioning over 8 months. RESULTS: Compared to CG screen-negative patients, CG screen-positive patients were younger, more likely to: be female, non-White, have lost a partner or child, and to have used tobacco or antidepressants. At baseline, they had significantly higher depression and lower mental health scores. At 8 months, screen-positives had poorer physical functioning and marginally higher depression scores. LIMITATIONS: The study lacked a definitive measure of CG. Moreover, the CG-positive group was relatively small, reducing the power to detect differences between groups or control for the possible influence of other variables on identified results. CONCLUSIONS: CG in depressed post-CABG patients is associated with negative health and mental health outcomes. These results underscore the importance of identifying and treating CG in depressed medically ill populations.