Community-based counseling reaches and helps bereaved people living in low-income households.

OBJECTIVE: Poverty is related to increased grief-related mental health problems, leading some to suggest bereavement counseling should be tailored to income. However, information about accessibility and effectiveness of such counseling programs serving low-income households is scarce. This longitudinal study therefore investigated the association between poverty and complicated grief (CG), and the effectiveness of a community-based bereavement counseling program in serving low-income households. METHODS: Two hundred eighty-eight participants (75% female) were enrolled. Loss-related and demographic variables were assessed at baseline. Regression analyses were used to investigate household income as a predictor of CG, and examine bereavement counseling effectiveness by comparing CG symptom change across three household income categories across three time-points: baseline (T1), T1 + 12 months (T2), and T1 + 18 months (T3). RESULTS: Of all participants, 35.8% reported below poverty-threshold income, twice the general population's rate. Multiple regression analysis indicated poverty-threshold income was a predictor of CG symptoms over and above demographic and loss-related characteristics. Three-way interaction analysis detected a significant treatment effect for study condition across time, but no differences in treatment effects across income. CONCLUSION: Lower household income was associated with higher CG symptoms. Since income did not predict differential treatment response, community-based bereavement counseling appeared no less efficacious for members of low-income households. Clinical or methodological significance of this article: While previous research has indicated low income may be a risk factor for mental health problems after bereavement, and it has therefore been suggested bereavement counseling should be tailored to income, no study to date has investigated the need for such tailoring. This controlled, longitudinal treatment study fills this gap in knowledge. Main findings are that low income is a key predictor of complicated grief symptoms. The study also shows that the effectiveness of one-to-one bereavement counseling does not appear to differ according to income level.

Effectiveness of bereavement counselling through a community-based organization: A naturalistic, controlled trial.

This controlled, longitudinal investigation tested the effectiveness of a bereavement counselling model for adults on reducing complicated grief (CG) symptoms. Participants (N = 344; 79% female; mean age: 49.3 years) were adult residents of Scotland who were bereaved of a close relation or partner, experiencing elevated levels of CG, and/or risks of developing CG. It was hypothesized that participants who received intervention would experience a greater decline in CG levels immediately following the intervention compared to the control participants, but the difference would diminish at follow-up (due to relapse). Data were collected via postal questionnaire at 3 time points: baseline (T), post-intervention (T + 12 months), and follow-up (T + 18 months). CG, post-traumatic stress, and general psychological distress were assessed at all time points. Multilevel analyses controlling for relevant covariates were conducted to examine group differences in symptom levels over time. A stepwise, serial gatekeeping procedure was used to correct for multiple hypothesis testing. A main finding was that, contrary to expectations, counselling intervention and control group participants experienced a similar reduction in CG symptoms at postmeasure. However, intervention participants demonstrated a greater reduction in symptom levels at follow-up (M = 53.64; d = .33) compared to the control group (M = 62.00). Results suggest community-based bereavement counselling may have long-term beneficial effects. Further longitudinal treatment effect investigations with extensive study intervals are needed.

Telephone versus in-person intake assessment for bereavement intervention: Does efficiency come at a cost?

Standardized, evidence-based risk assessment is an important component in providing effective bereavement care. E-health intake assessments have been offered alongside or instead of in-person assessments, although evidence concerning the equivalence of assessment results is lacking. This article examines differences between a semistructured intake assessment for grief intervention conducted over the telephone (n = 330) and in-person (n = 115). Differences in scores and clinical implications were evaluated. Although composite assessment scores were lower in the telephone condition, further examination revealed this occurred in the semistructured assessment of risk of complications, not the structured grief symptom assessment. Implications for care provision are discussed.

Initial Validation of a Comprehensive Assessment Instrument for Bereavement-Related Grief Symptoms and Risk of Complications: The Indicator of Bereavement Adaptation-Cruse Scotland (IBACS).

OBJECTIVE: This study assessed the validity of the Indicator of Bereavement Adaptation Cruse Scotland (IBACS). Designed for use in clinical and non-clinical settings, the IBACS measures severity of grief symptoms and risk of developing complications. METHOD: N = 196 (44 male, 152 female) help-seeking, bereaved Scottish adults participated at two timepoints: T1 (baseline) and T2 (after 18 months). Four validated assessment instruments were administered: CORE-R, ICG-R, IES-R, SCL-90-R. Discriminative ability was assessed using ROC curve analysis. Concurrent validity was tested through correlation analysis at T1. Predictive validity was assessed using correlation analyses and ROC curve analysis. Optimal IBACS cutoff values were obtained by calculating a maximal Youden index J in ROC curve analysis. Clinical implications were compared across instruments. RESULTS: ROC curve analysis results (AUC = .84, p < .01, 95% CI between .77 and .90) indicated the IBACS is a good diagnostic instrument for assessing complicated grief. Positive correlations (p < .01, 2-tailed) with all four instruments at T1 demonstrated the IBACS' concurrent validity, strongest with complicated grief measures (r = .82). Predictive validity was shown to be fair in T2 ROC curve analysis results (n = 67, AUC = .78, 95% CI between .65 and .92; p < .01). Predictive validity was also supported by stable positive correlations between IBACS and other instruments at T2. Clinical indications were found not to differ across instruments. CONCLUSIONS: The IBACS offers effective grief symptom and risk assessment for use by non-clinicians. Indications are sufficient to support intake assessment for a stepped model of bereavement intervention.