"I lost so much more than my partner" - Bereaved partners' grief experiences following suicide or physician-assisted dying in case of a mental disorder.

BACKGROUND: There is a lack of existing research on grief following the intentional death of people suffering from a mental disorder. Our study aims to provide insight into grief experiences and social reactions of bereaved persons who lost their life partners, who were suffering from a mental disorder, to physician-assisted dying (PAD) or suicide. METHODS: For this mixed-methods research, we conducted a survey and in-depth interviews with 27 persons living in the Netherlands and bereaved by the death of their life partners. The deceased life partners suffered from a mental disorder and had died by physician-assisted dying (n = 12) or suicide (n = 15). Interviews explored grief experiences and social reactions. In the survey we compared self-reported grief reactions of partners bereaved by suicide and PAD using the Grief Experience Questionnaire. RESULTS: Compared to suicide, physician-assisted dying was associated with less severe grief experiences of the bereaved partners. Participants reported that others rarely understood the suffering of their deceased partners and sometimes expected them to justify their partners' death. Following physician-assisted dying, the fact that the partner's euthanasia request was granted, helped others understand that the deceased person's mental suffering had been unbearable and irremediable. Whereas, following suicide, the involvement of the bereaved partners was sometimes the focus of judicial inquiry, especially, if the partner had been present during the death. CONCLUSION: When individuals suffering from a mental disorder die by suicide or PAD, their bereaved partners may experience a lack of understanding from others. Although both ways of dying are considered unnatural, their implications for bereaved partners vary considerably. We propose looking beyond the dichotomy of PAD versus suicide when studying grief following the intentional death of people suffering from a mental disorder, and considering other important aspects, such as expectedness of the death, suffering during it, and partners' presence during the death.

Valid measurement of DSM-5 persistent complex bereavement disorder and DSM-5-TR and ICD-11 prolonged grief disorder: The Traumatic Grief Inventory-Self Report Plus (TGI-SR+).

INTRODUCTION: When grief reactions after bereavement are so intense that they impair daily functioning, a diagnosis of disturbed grief may apply. Slightly differing criteria-sets for disturbed grief are included in the ICD-11, the DSM-5, and its forthcoming text revision, DSM-5-TR. We examined psychometric properties of a new self-report measure, the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+), that assesses these criteria sets for Persistent Complex Bereavement Disorder (PCBD) as per DSM-5, and Prolonged Grief Disorder (PGD) as defined in ICD-11 and DSM-5-TR. MATERIAL AND METHODS: We examined the: i) factor structure, ii) internal consistency, iii) temporal stability, iv) convergent validity, v) known-groups validity, vi) probable caseness, and vii) optimal clinical cut-off scores in two Dutch bereaved samples. Sample 1 consisted of 278 adults, bereaved by various causes. Sample 2 included 270 adults who lost loved ones in a traffic accident. RESULTS: We found support for a 3-factor PCBD model, 1-factor DSM-5-TR model, and 1-factor ICD-11 PGD model. The DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD items demonstrated good internal consistency and temporal stability. Associations between disturbed grief symptoms and posttraumatic stress and depression levels supported convergent validity. Associations between demographic/loss-related variables and disturbed grief symptoms supported known-groups validity. Optimal clinical cut-offs for the TGI-SR+ total score were ≥ 75, ≥71, and ≥ 75 for probable caseness of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD, respectively. DISCUSSION: While replication of our findings in diverse bereaved samples is needed, we conclude that the TGI-SR+ is a reliable and valid measure to assess symptoms of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD.

[Chaplaincy care in psychotrauma care: an exploration]. / Geestelijke verzorging in de psycho-traumazorg; een plaatsverkenning.

BACKGROUND: The care for people with trauma- and stressor-related disorders is multidisciplinary. The place of chaplaincy care in multidisciplinary trauma care has received limited attention. AIM: Exploration of the place of chaplaincy care in relation to psychotrauma, moral injury, grief and palliative care and in time in relation to exposure to psychotrauma as a basis for a model of multidisciplinary collaboration. METHOD: Inventory and discussion of the position of chaplaincy care in the literature and guidelines for trauma- and stressor-related disorders. RESULTS: Chaplaincy care may support finding meaning and reconnection in people at risk of trauma and PTSD, moral injury, and traumatic grief. Chaplaincy care is increasingly available for palliative and multicultural care recipients. Most guidelines for trauma care recommend the availability of chaplaincy care or research into the effectiveness of complementary existential, spiritual or meaning-making interventions. CONCLUSION: Traumatic stressors represent limit experiences, whereby the quest for meaning, existential and moral orientation are pre-eminently at stake. The use of chaplaincy care supports finding meaning and reconnection and may thereby potentially contribute to the prevention of traumatic exposure to stressors, persistent symptoms after exposure, and worsening of chronic trauma- and stressor related symptoms.

['They're still adding more pain on me': psychological effects of immigration detention]. / They're still adding more pain on me'; psychische klachten na vreemdelingendetentie.

BACKGROUND: In the Netherlands, people without a valid residence permit can be detained in immigration detention in order to keep them available for repatriation. International literature shows that immigration detention has a negative impact on psychological health, but little is known about the experience of people in Dutch immigration detention centers. AIM: In this qualitative study we describe the experience of people who have been detained in immigration detention in the Netherlands and the impact it has had on their psychological health. METHOD: We interviewed 9 patients who were treated for posttraumatic stress disorder at ARQ Centrum'45 and who had previously been detained in immigration detention. Interviewed were transcribed, coded and analyzed thematically. RESULTS: The following themes emerged: not knowing what to expect, being treated as a criminal, the expectation of protection in the Netherlands, and retraumatization. These perceptions led to fear, hopelessness, shame, anger, and suicidality. Many participants had been in solitary confinement during detention, which had worsened their psychological health. CONCLUSION: Immigration detention was described as extremely disruptive and caused psychological harm. The circumstances of immigration detention should be improved by using clearer communication about the reason and duration of detention, a less prison-like approach, and by eliminating solitary confinement.

Responding to the new International Classification of Diseases-11 prolonged grief disorder during the COVID-19 pandemic: a new bereavement network and three-tiered model of care.

The field of bereavement research and care is at a tipping point. The introduction of prolonged grief disorder (PGD) in the International Classification of Diseases (ICD-11) has ignited clinical interest in this new disorder, along with debate over challenges in validating and implementing these new criteria. At the same time, the global COVID-19 pandemic has launched several local and international efforts to provide urgent support and comfort for individuals and communities suffering from grief. Recently, grief experts have called for a collective response to these complicated bereavements and possible increase in PGD due to COVID-19. Here we outline a new European network that aims to unite a community of grief researchers and clinicians to provide accessible, evidence-based support particularly during times of unprecedent crisis. The Bereavement Network Europe (BNE) has been developed with two main aims. Firstly, to develop expert agreed, internationally acceptable guidelines for bereavement care through a three-tiered approach. Secondly, to provide a platform for researchers and clinicians to share knowledge, collaborate, and develop consensus protocols to facilitate the introduction of PGD to diverse stakeholders. This article outlines the current status and aims of the BNE along with the plans for upcoming network initiatives and the three-tiered bereavement care guidelines in response to the COVID-19 pandemic.

[Toward cultural assessment of grief and grief-related psychopathology]. / Culturele evaluatie van verlies en rouw.

Ways of dealing with bereavement and grief are influenced by the norms of one's cultural identity. Cultural assessment of bereavement and grief is therefore needed for a comprehensive evaluation of grief-related psychopathology and for negotiating appropriate treatment. Cultural aspects of bereavement and grief include cultural traditions related to death, bereavement, and mourning as well as help seeking and coping. To facilitate clinical exploration of cultural aspects of bereavement and grief, the authors propose a set of brief, person-centered, and open-ended questions as a draft supplementary module to the DSM-5 Cultural Formulation Interview. Three case vignettes show how cultural assessment of bereavement and grief may contribute to diagnosis, treatment, and enhancing rapport in patients who seek help following the loss of loved ones.

Stress sensitization following a disaster: a prospective study.

BACKGROUND: According to the stress sensitization hypothesis, prior exposure to extreme stressors may lead to increased responsiveness to subsequent stressors. It is unclear whether disaster exposure is associated with stress sensitization and, if so, whether this effect is lasting or temporary. This study aimed to investigate the occurrence and duration of stress sensitization prospectively following a major disaster. METHOD: Residents affected by a fireworks disaster (n=1083) participated in surveys 2-3 weeks (T1), 18-20 months (T2) and almost 4 years (T3) after the disaster. Participants reported disaster exposure, including direct exposure, injury and damage to their home at T1, and also stressful life events (SLEs) at T2 and T3. Feelings of anxiety and depression, concentration difficulty, hostility, sleep disturbance, and intrusion and avoidance of disaster-related memories were used as indicators of distress. RESULTS: Residents whose home was completely destroyed responded with greater distress to SLEs reported 18-20 months following the disaster than residents whose home was less damaged. There were no differences in stress responsiveness almost 4 years after the disaster. CONCLUSIONS: During the first years after a disaster, stress sensitization may occur in disaster survivors who experienced extreme disaster exposure. Stress sensitization may explain the persistence or progression of distress over time following extreme stressor exposure.