Dementia spousal caregivers and past transgressions: Measuring and understanding forgiveness experiences.

The transition from "wife" to "caregiver" for a cognitively impaired husband can be an overwhelming experience. Communication patterns change and small conflicts can grow, at times bringing angry feelings and new burdens. Engagement with forgiveness processes may benefit wives by lowering resentment over past tensions, restoring trust, and enhancing the overall caregiving experience. This study examined the utility of the Enright Forgiveness Inventory (EFI) within a sample of caregiving wives. Our intent was to better understand this population's experience with forgiveness when other contextual factors were likely to influence this process. Forgiveness scores on the EFI were positively related to the cognitive status of the care recipient, a particularly important finding for clinical intervention, and inversely related to marital distress and state anxiety.

Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11.

BACKGROUND: Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. METHODS AND FINDINGS: A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. CONCLUSIONS: The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for Editors' Summary.

Posttraumatic growth in bereaved parents.

The Posttraumatic Growth Inventory (PTGI), Revised Grief Experience Inventory, and World Assumptions Scale were administered to 111 bereaved parents. The PTGI scores indicate that many bereaved parents report personal growth in domains outlined by L.G. Calhoun and R. G. Tedeschi (2001). Grief intensity was inversely correlated with growth scores. Self-worth was a strong predictor of growth scores, whereas assumptions about the benevolence and meaningfulness of the world were not correlated with growth.

Assessing pre-death grief in cancer caregivers using the Marwit-Meuser Caregiver Grief Inventory (MM-CGI).

The Marwit-Meuser Caregiver Grief Inventory (MM-CGI) was developed and initially validated with caregivers of persons with Alzheimer's disease, and subsequently evaluated with caregivers of persons with brain injury. The present study examined MM-CGI psychometric and validity properties in 75 caregivers of persons with cancer. As with previous studies, high internal consistency reliability of MM-CGI Total Grief and subscale scores (Personal Sacrifice and Burden, Heartfelt Sadness and Longing, and Worry and Felt Isolation) was demonstrated. Construct validity of the subscale scores was supported by differential associations with other caregiver measures of depression, strain, well-being, and family support. Based on these preliminary results, the MM-CGI appears useful for assessing pre-death grief in caregivers of persons with cancer.

Caregiver grief in end-stage dementia:using the Marwit and Meuser Caregiver Grief Inventory for assessment and intervention in social work practice.

Caregivers of individuals with end-stage dementia experience increased grief reactions; however, their grief is too often over-looked by health professionals. Regardless of their practice setting, social workers must assess and intervene with caregivers dealing with grief. This article provides information on the Marwit and Meuser Caregiver Grief Inventory (MM-CGI) that was designed to measure the grief of caregivers of individuals with progressive memory loss. Through the use of case examples, key areas of assessment are highlighted, as well as initial areas for helping caregivers cope and heal from their experiences of grief.

An investigation of the relationship of personality, coping, and grief intensity among bereaved mothers.

A mediational model of grief intensity (Meuser & Marwit, 2000) was examined in a population at risk for complicated grief. Coping strategies (emotion-oriented, task-oriented, and avoidance-oriented coping) were hypothesized to mediate the influence of personality factors (neuroticism and extraversion) on grief. Bereaved mothers (N = 138) completed the Eysenck Personality Questionnaire, Coping Inventory for Stressful Situations, and Revised Grief Experiences Inventory. Coping strategies partially mediated the influence of personality factors on grief. However, compared to prior findings among bereaved spouses, coping played a weaker mediating role, and neuroticism had a stronger direct influence on grief among bereaved mothers. Results suggest that personality and coping factors may function differently across different loss circumstances.

Measuring grief in caregivers of persons with acquired brain injury.

PRIMARY OBJECTIVE: To investigate the psychometric and validity properties and applicability of a modified version of the Marwit-Meuser Caregiver Grief Inventory (MM-CGI) for use with caregivers of patients with acquired brain injury (ABI). RESEARCH DESIGN: Replicate Marwit and Meuser's original psychometric study assessing grief in caregivers of dementia patients. METHODS AND PROCEDURES: The MM-CGI was administered to 28 ABI caregivers along with standardized measures of caregiver strain, depression, well-being and family support. MAIN OUTCOMES AND RESULTS: Results for ABI caregivers were similar to those for dementia caregivers with the instrument demonstrating excellent internal consistency reliability for total and sub-scale grief scores and strong divergent validity. Results also parallel those of a recent study of cancer caregivers. CONCLUSIONS: The MM-CGI is as useful for diagnosing and treating grief in ABI caregivers as it is for those caring for persons with other serious illnesses.

Psychological and religious coping strategies of mothers bereaved by the sudden death of a child.

The authors examined the associations of 3 types of psychological coping (task-based, emotion-based, avoidance), 2 types of religious coping (positive, negative), and their interactions with grief of 57 mothers bereaved by the sudden death of a child. Results indicated that mothers who use emotion-based coping report significantly higher levels of grief, whereas mothers who use avoidance coping report lower levels of grief. The interaction of task coping and positive religious coping was also associated with lower self-reported grief. The findings support the differential utility of various coping styles on mothers' grief reactions to the sudden death of a child.

Development of a short form inventory to assess grief in caregivers of dementia patients.

This article describes the derivation of a short-form of the Marwit-Meuser Caregiver Grief Inventory (MM-CGI), an inventory designed to measure grief in caregivers of persons with progressive dementia. It presents initial reliability and validity data and describes ways to use the inventory both clinically and scientifically. The resulting MM-CGI Short Form, presented here in its entirety, is comprised of 18 items and, like its full-form relative, is self-scoring and yields a Total Grief score and sub-scale scores measuring factors representing Personal Sacrifice Burden, Heartfelt Sadness and Longing, and Worry and Felt Isolation.

Complicated grief and the trend toward cognitive-behavioral therapy.

Recently, considerable attention has been given to the cognitive processes entailed in mourning. There has been a growing understanding that the death of a loved one forces individuals to restructure and rebuild previously held assumptions about the self and the world. On the basis of this conceptualization of grief as a period of meaning reconstruction, cognitive-behavioral therapy seems a fitting intervention mechanism for treating individuals with complicated grief. The purpose of this article is to provide an overview of the theory, intervention mechanisms, and research on the application of cognitive-behavioral therapy to grief, in general, and to non-normative grief, in particular.

Development and initial validation of an inventory to assess grief in caregivers of persons with Alzheimer's disease.

PURPOSE: The purpose of this study was to develop an empirically based, psychometrically sound instrument for the assessment of grief in caregivers of persons with Alzheimer's disease. DESIGN AND METHODS: A total of 184 statements addressing personal grief reactions were obtained from 45 adult child and 42 spouse caregivers in 16 focus groups representing early, middle, late, and postdeath stages. These were presented to a second sample of 83 adult child and 83 spouse caregivers, who rated them according to their current experience. Also administered were the Beck Depression Inventory, the Anticipatory Grief Scale, the Caregiver Strain Index, the Caregiver Well-Being Scale-Basic Needs, and the Perceived Social Support-Family Questionnaire. RESULTS: Factor analysis resulted in a 50-item scale containing three factors: Personal Sacrifice Burden, Heartfelt Sadness and Longing, and Worry and Felt Isolation. Cronbach's alpha scores ranged from.90 to.96, indicating high internal consistency reliability for each factor as well as for their combined total. Correlations of each factor with other measures provide evidence of validity, especially when assessed in the context of the caregiver grief model. IMPLICATIONS: Results suggest that caregiver grief is neither a unitary nor a static construct and that a scale such as this may be appropriate for use in supportive, clinical, and research settings.

Diagnosing complicated grief: a closer look.

Over the past decade, a number of researchers have proposed a separate DSM category for complicated grief. Recently, there have been attempts to determine empirically the number and nature of variables comprising the complicated-grief syndrome. The present research addresses one such procedure for defining these variables. Combining a past methodology that demonstrated the relative utility of one classification of complicated grief (Worden, 1991) with dimensional concepts derived from other classifications, the present research concludes that a relatively small number of variables account for the concept. These findings are discussed not only in terms of previous research on Worden's categorization and more recent classifications, but, more importantly, in terms of the more global theoretical and methodological issues surrounding the definition(s) of complicated grief.

Disclosure preferences about terminal illness: an examination of decision-related factors.

Twenty-six male and 86 female, predominantly White, non-terminal cancer patients addressed preferences for disclosure of terminal prognosis, should their disease advance to that stage. Specific inquiries were made about desired levels of disclosure (full, partial,or non-disclosure) and desired pathways of disclosure (from physician to patient only, from physician to patient in the presence of a loved one, or from physician to loved one only). Gender, previous experience with death, and trait anxiety were associated with level preference. Education, previous experience with death, and trait anxiety were associated with pathway preference.Variables predictive of level and pathway preference were identified, benefits to physicians and patients were explored, and sampling limitations were discussed.