Predictors of prolonged grief in an internet-based grief therapy for people bereaved by suicide.

Internet-based cognitive-behavioural grief therapy (ICBGT) has proven to be effective for people bereaved by suicide, however the extent to which patients can benefit from therapy seems to differ. This study investigates predictors of initial grief as well as change in grief severity following treatment in an ICBGT for people bereaved by suicide. Data was gathered from a randomized control trial including 57 people participating in a 5-week intervention. Change in grief symptoms was calculated using absolute change scores of grief. In order to examine best overall combination of independent variables, best subset regressions were conducted. Higher levels of pre-test grief were associated with worse sleep quality (ß = 0.32, p = .002), lower self-esteem (ß = -0.37, p = .002), lower support seeking (ß = -0.38, p = .006), and a higher need for social support (ß = 0.28, p = .028). A greater reduction in grief severity was associated with higher self-efficacy (ß = -0.49, p = .001), higher attachment anxiety (ß = -0.31, p = .017) and higher pre-test grief symptoms (ß = -0.39, p = .006). Attention should be paid to the intensity of grief, the attachment style and a positive self-image, as these variables seem to influence the extent, to which patients' symptoms of PGD subside following ICBGT. To specifically target factors of patients that require improvement, further studies are needed.

Efficacy of an Internet-based cognitive-behavioural grief therapy for people bereaved by suicide: a randomized controlled trial.

Background: The loss of a loved one due to suicide can be a traumatic event associated with prolonged grief and psychological distress. Objective: This study examined the efficacy of an Internet-based cognitive-behavioural grief therapy (ICBGT) specifically for people bereaved by suicide. Methods: In a randomized controlled trial, 58 participants with prolonged grief disorder (PGD) symptoms who had lost a close person to suicide were randomly allocated either to the intervention group (IG) or waitlist-control group (WCG). The 5-week intervention comprised ten writing assignments in three phases: self-confrontation, cognitive restructuring, and social sharing. Symptoms of PGD, common grief reactions after suicide, depression, and general psychopathology were assessed at pre-, post-test and follow-up. Results: Between-group effect sizes were large for the improvement of PGD symptoms in treatment completers (dppc2 = 1.03) and the intent-to-treat analysis (dppc2 = 0.97). Common grief reactions after suicide and depressive symptoms also decreased in the IG compared to the WCG (moderate to large effects). The results are stable over time. Only for general psychopathology, there was no significant time by group interaction effect found. Conclusions: The ICBGT represents an effective treatment approach for people suffering from PGD symptoms after bereavement by suicide. Considering the effect sizes, the small treatment dose, duration, and the stability of the results, the ICBGT constitutes an appropriate alternative to face-to-face grief interventions.

Antecedentes: La pérdida de un ser querido por suicidio puede ser un evento traumático asociado con el duelo prolongado y el malestar psicológico.Objetivo: Este estudio examinó la eficacia de una terapia cognitivo conductual de duelo basada en el internet (ICBGT en su sigla en inglés), específicamente para las personas en duelo por suicidio.Métodos: En un ensayo controlado aleatorizado, 58 participantes con síntomas de trastorno de duelo prolongado (PGD en su sigla en inglés) que han perdido una persona cercana por suicidio fueron asignados al grupo de intervención (IG en su sigla en inglés) o grupo de control de lista de espera (WCG en su sigla en inglés). La intervención de 5 semanas incluye diez tareas escritas en tres etapas: auto-confrontación, reestructuración cognitiva, y compartir social. Fueron evaluados antes y después de la intervención y al seguimiento, los síntomas de PGD, reacciones de duelo comunes luego de un suicidio, depresión, y psicopatología general.Resultados: Los tamaños de los efectos entre los grupos fueron grandes para la mejoría de los síntomas de PGD en quienes completaron el tratamiento (dppc2=1.03) y el análisis del intento-de-tratar (dppc2=0.97). Las reacciones de duelo comunes luego de suicidio y los síntomas depresivos también disminuyeron en IG en comparación con WCG (efectos moderados a grandes). Los resultados fueron estables a lo largo del tiempo. Solo en psicopatología general no se encontró un efecto significativo de tiempo por grupo.Conclusiones: ICBGT representa una forma de tratamiento efectiva para las personas que sufren de síntomas PGD luego de una pérdida por suicidio. Considerando los tamaños de los efectos, la dosis pequeña de tratamiento, la duración, y la estabilidad de los resultados, ICBGT constituye una alternativa apropiada para las intervenciones en duelo presenciales.

Subtypes of Personality and 'Locus of Control' in Bariatric Patients and their Effect on Weight Loss, Eating Disorder and Depressive Symptoms, and Quality of Life.

The present study subdivided personality types in a bariatric sample and investigated their impact on weight loss and psychopathology 6 and 12 months after surgery. One hundred thirty participants answered questionnaires on personality (NEO-FFI), 'locus of control' (IPC), depression severity (BDI-II), eating disorder psychopathology (EDE-Q), and health-related quality of life (HRQoL; SF-12). K-means cluster analyses were used to identify subtypes. Two subtypes emerged: an 'emotionally dysregulated/undercontrolled' cluster defined by high neuroticism and external orientation and a 'resilient/high functioning' cluster with the reverse pattern. Prior to surgery, the first subtype reported more eating disorder and depressive symptoms and less HRQoL. Differences persisted regarding depression and mental HRQoL until 12 months after surgery, except in the areas weight loss and eating disorders. Personality seems to influence the improvement or maintenance of psychiatric symptoms after bariatric surgery. Future research could elucidate whether adapted treatment programmes could have an influence on the improvement of procedure outcomes. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Predictors of Changes in Health-Related Quality of Life 6 and 12 months After a Bariatric Procedure.

BACKGROUND: Bariatric surgery is an effective method for treating morbid obesity and improving patients' health-related quality of life (HRQoL). As research on predictors that contribute to the amelioration of HRQoL is sparse, our prospective study was conducted to examine the predictive value of demographic, psychological and physiological variables on physical and mental HRQoL 6 and 12 months after surgery. METHODS: We surveyed 154 participants who had undergone either a laparoscopic Roux-en-Y gastric bypass (LRYGB) or a laparoscopic sleeve gastrectomy (LSG). Prior to surgery and both 6 and 12 months after the procedure, patients completed questionnaires concerning their demographic data, height and weight, co-morbid conditions, HRQoL (Short Form Health Survey-12), depression severity (Beck Depression Inventory-II), and eating psychopathology (Eating Disorder Examination-Questionnaire). Multiple linear regression analyses were conducted to detect predictors of physical and mental HRQoL 6 and 12 months post-operation. RESULTS: The predictors included within the models explained 50 to 58% of the variance of post-operative physical and mental HRQoL, respectively. Higher baseline depression severity was associated with reduced HRQoL after surgery, whereas changes from pre- to post-surgery in BDI-II scores positively predicted HRQoL values, especially mental HRQoL. The persistence of somatic co-morbid disorders had a negative effect on physical HRQoL. CONCLUSIONS: Depression severity before surgery and changes in depression scores were found to be major predictors of HRQoL after bariatric surgery. Therefore, we recommend screening patients regularly for depression both before and after bariatric surgery and offering them adequate psychotherapeutic and/or psychopharmacologic support.