Prevalence of Patient Suicide and Its Impact on Health Care Professionals: A Systematic Review.

OBJECTIVE: This review aimed to examine the impact of patient suicide on health care professionals (HCPs), assess available support resources, and evaluate postvention (i.e., activities designed to support HCPs after a patient suicide) efforts. METHODS: An integrative systematic review was conducted to evaluate the prevalence of patient suicide and its emotional and professional impacts on HCPs. Searches were conducted in MEDLINE, Embase, CINAHL Plus, and the Cochrane Library in October 2021 and August 2022. Index terms and keywords were related to suicide, patients, and clinicians. Each article was assessed for quality with the Mixed Methods Appraisal Tool. RESULTS: Sixty-six relevant articles were identified. Across studies, the mean±SD percentage of HCPs who experienced a patient suicide was 51%±<1%. Fifty-eight (88%) articles reported on the emotional impact of patient suicide, and 50 (76%) reported on the professional impact of patient suicide. Thirty-three articles described a change in practice habits, which occurred for 51%-100% of professionals in these samples. Perceptions of support ranged widely, with 11%-87% of HCPs feeling that they received sufficient support. HCPs wanted formal support, including referral to counseling (12%-82%), more suicide prevention or postvention training (4%-70%), debriefing or supervision (41%-75%), formal case review (18%-20%), time off (12%), and legal assistance (4%). CONCLUSIONS: HCPs can be affected by patient suicide, regardless of practice setting. More information is needed to better understand the implementation of postvention services after patient suicide and to create practical and universally deliverable support services to meet HCPs' needs.

Pathways between grief, depression, hopelessness, reasons for living, and suicidal ideation in bereaved individuals.

BACKGROUND: Associations between comorbid depression and grief with suicidal ideation (SI) have been inconsistent. To identify at-risk individuals, it is important to determine the role of symptom severity by examining both continuous and clinical-threshold grief and depression, in addition to other factors (i.e., hopelessness, reasons for living-RFL) associated with SI. METHODS: Participants (n = 216) bereaved by combat, accident, or suicide completed an online survey. Associations between depression, grief, SI, RFL, and hopelessness were examined by multivariable logistic regressions and structural equation modeling (SEM). RESULTS: Across the sample, hopelessness and RFL were associated with SI while continuous measures of grief and depression were not. In contrast, clinical-threshold grief, clinical-threshold depression, hopelessness, and RFL each were associated with SI. In addition, of the grief characteristics, yearning was the most robust correlate of SI, and Survival/Coping Beliefs (SCB) was the RFL most associated with SI. SEM indicated that direct paths between grief and SI, hopelessness and SI, and RFL and SI were significant, but not between depression and SI. Instead, depression had a strong direct effect on hopelessness, and hopelessness had a direct effect on SI. DISCUSSION: Results are consistent with previously-identified associations between SI and clinical levels of depression and grief. More nuanced findings suggest hopelessness, yearning, and SCB as additional targets for reducing risk for SI in bereaved individuals regardless of whether they meet clinical thresholds for grief or depression.

Family Members Grieving the Loss of a Person to Incarceration: A Scoping Review.

This scoping review examined grief related to the incarceration of a family member in order to establish a theoretical framework. A comprehensive search of PubMed, Social Sciences Citation Index, Embase, PsycInfo, Psychology & Behavioral Sciences, CINAHL, Cochrane Central Register of Controlled Trials & Cochrane Database of Systematic Reviews, PILOTS, and Psychiatry Online was conducted. We extracted data on sample characteristics, study design, purpose of the study, grief measure used, grief term and definition used, and key qualitative and quantitative findings. Twenty-five studies met inclusion criteria. Most studies used the terms 'ambiguous loss' (n = 15) and 'disenfranchised grief' (n = 12); however, grief terms and their definitions varied. The review identified 14 unique terms and more than 20 definitions. In several cases, the same term was defined and conceptualized differently between studies. This review also revealed shortcomings in existing theoretical frameworks for grief related to incarceration. Grief related to losing a family member to incarceration involves two distinct constructs: non-traditional losses and cascading losses. Non-traditional losses (measured on a continuum) capture elements of a loss to incarceration that are unique (compared to a loss via death) or may not be socially accepted, whereas cascading losses refers to the ongoing losses that one may experience related to the incarceration (e.g., loss of financial stability). This framework provides the field with consistent constructs and definitions that can be used to further advance research in incarceration-related grief and facilitates an improved ability to replicate findings between laboratories.

A Latent Class Analysis on Indicators of Early Prolonged Grief Disorder and Well-Being Among Dutch Adults Bereaved During the First Year of the COVID-19 Pandemic.

Most studies examining prolonged grief disorder (PGD) in people bereaved during the COVID-19 pandemic are focused on psychopathology. However, mental health encompasses both absence of psychopathology and presence of well-being. This is the first study examining symptom profiles of early PGD and subjective mental well-being in 266 Dutch adults recently bereaved during the pandemic. Early PGD and well-being indicators were assessed with the Traumatic Grief Inventory-Self Report Plus and the World Health Organization-Five Well-Being Index, respectively. Latent class analysis identified four classes: low PGD/high well-being (32%), low PGD/moderate well-being (24%), moderate PGD/high well-being (23%) and high PGD/low well-being class (21%). People in the poorer mental health classes were more likely to be female, lower educated, suffering from a mental disorder, have a poor health status, closer kinship to the deceased, and higher risk of severe COVID-19. Classifying adults according to symptom profiles of negative and positive outcomes provides a more complete picture of mental health in bereaved people and offers potential intervention targets.

Is pregnancy loss (that) disenfranchised? Evidence from a vignette study.

Background: Perceiving that society disregards grief after pregnancy loss (disenfranchised grief) elevates bereaved parents' psychological burden.Objective: In this research, we aimed to compare the disenfranchisement of pregnancy loss with four other loss types considering the bereaved's gender.Method: We collected data from Turkish participants (N = 1,280) using a 5 (loss type) x 2 (gender) between-subjects design with randomly assigned vignettes. Participants reported their expected grief and behavioural tendencies toward the bereaved. We conducted MANOVA and ANOVA analyses.Results: Results revealed that participants expected higher grief for pregnancy loss than two other disenfranchised grief types (former colleague's death, grandfather's diagnosis with Alzheimer's). Expected grief for pregnancy loss was higher than or similar to the level for the best friend's loss across examinations but lower than the level for the one-year-old child's loss. Behaviour tendencies were alike across vignettes, and their results did not paint a coherent picture. Findings did not differ by the bereaved's gender.Conclusion: Pregnancy loss might be less disenfranchised than bereaved parents perceive it, and parents' perceptions could be targeted in therapeutic interventions.

We investigated whether pregnancy loss is more disenfranchised by society than four other loss types considering the bereaved's gender.We collected data from a large sample in Turkey.Pregnancy loss might be less disenfranchised than argued in the literature.

COVID-19 Deaths in Transnational Settings: Disrupted Bereavement and Pandemic-Related Prolonged Grief Disorder in the Latinx Immigrant Population.

The Latinx immigrant population experienced one of the highest COVID-19 death rates. Those left behind have exhibited rising rates of mental illness, particularly, pandemic-related prolonged grief disorder. The Latinx immigrant population is uniquely vulnerable to this disorder as a result of disrupted culturally appropriate bereavement practices, constrained social support, and concurrent COVID-19 stressors and immigration-related trauma. Despite a rising call for research on pandemic-related prolonged grief disorder, little is known about the true prevalence, cause, and appropriate treatment protocol behind this disorder in the Latinx immigrant population. Four areas of research critical to the identification and understanding of pandemic-related prolonged grief disorder in this population are recommended: 1) death and bereavement in transnational settings, 2) immigrant social networks and disrupted bereavement, 3) COVID-19 stressors and grieving, and 4) prolonged grief disorder and mental illness comorbidities. An understanding of these four contributing areas to Latinx immigrants' vulnerability to prolonged grief disorder is imperative to providers' development of assessments and treatment protocols needed to identify and treat prolonged grief disorder in this population.

Proposed nursing care plan for women who suffer a perinatal loss, according to Watson's theory.

Losing a newborn is for many mothers a painful end in which death occurs when life is expected, which makes them live a time of loneliness, personal doubt and feeling of failure. After carrying out a previous qualitative study analyzing the experiences of 25 women who suffered a spontaneous perinatal loss at any time during pregnancy and a systematic review of the factors that affect the emotional response after perinatal losses, a nursing care proposal is presented based on Watson's Theory of Transpersonal Human Care to respond to the needs of women who experience this loss process. This care plan proposal is intended to achieve individualized care for women who suffer perinatal losses adapted to their needs, not only physical but also emotional.

Ethical and Psychological Considerations for Posthumous-Assisted Reproduction for Adolescents and Young Adults With Poor Cancer Prognosis in the Context of Grief.

Objective: Families or loved ones of adolescents and young adults (AYA) with a poor cancer prognosis who preserved fertility and did not survive treatment may choose to pursue posthumous assisted reproduction (PAR; i.e., use of preserved reproductive material for future family-building attempts). Decisions about PAR may be occurring in the context of grief and bereavement, which is associated with ethical and psychological considerations because grief can complicate a person's capacity for informed decision-making. Methods: Through the use of a five-step ethical decision-making model, the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct, and a blended case example, the ethical and psychological considerations for families of AYA with poor prognosis who pursue PAR is discussed with an ethical analysis. Results: Ethical and psychological considerations included assessing the potential for harm to involved parties, navigating PAR decision-making with responsibility and honesty, examining the accessibility of PAR, and considering informed consent/assent and autonomy. Conclusions: Clinical recommendations for supporting families and loved ones exploring PAR in the context of grief were discussed, with considerations for improving clinicians' comfort and competence with PAR, incorporating grief into informed consent conversations, standardizing conversations about PAR, and promoting an interdisciplinary approach to PAR-related decisions.

Controversies in trauma- and stress-related disorders.

The release of ICD-11 has resulted in an expansion of diagnostic entities for trauma- and stress-related disorders. This resulted, at least temporarily, in discrepancies with the DSM-5. This situation is outlined and a look is taken at the potential diagnosis of 'continuous traumatic stress reaction'.

Toward Centrality Evaluation of Yearning Symptoms for Prolonged Grief Disorder: A Cross-Cultural Approach.

BACKGROUND: The new ICD-11 diagnosis of prolonged grief disorder (PGD) is characterized by the prominent role of yearning as hallmark symptom. A secondary analysis of eight international datasets on PGD was conducted to evaluate this assumption. Additionally, cross-cultural comparison explored whether the centrality of yearning differs across world regions. METHODS: Primary studies originated from German-speaking countries (n = 4 samples), other European countries and Israel (n = 3 samples), as well as China (n = 1 samples). Different PGD measures were used, including yearning and longing as symptoms. For the centrality assessment of yearning, PGD symptoms were ranked by their factor loadings from confirmatory factor analyses, followed by statistical testing to determine significant differences between yearning and other symptoms of PGD in their factor loading estimates. Subsequently, ranking positions of yearning in three world regions (German-speaking, other Europe-Israel, and China) were compared. Finally, proxy thresholds for individuals at high-risk states for PGD were defined for the different datasets, and sensitivity-specificity analyses of yearning were performed. RESULTS: Yearning was ranked high in five out of 12 models tested. In the German-speaking region, it was predominantly ranked among the most central symptoms; in the other Europe-Israel region as well as China, it tended to fall into the middle or lower rankings of symptom centrality. Sensitivity values were consistently high, while specificity values indicated moderate levels. DISCUSSION: In line with previous research on the general outcomes of grief, the present study showed that yearning may be subject to a culture-specific distribution. Other central symptoms such as feeling as if a part of oneself died have also been shown to potentially play a central role in PGD across world regions. On the other hand, the sensitivity-specificity analyses revealed that yearning can be considered a significant (diagnostically highly sensitive) symptom for individuals in high-risk states for PGD, although it has only moderate specificity (i.e., its absence does not necessarily indicate individuals experiencing normative grief). Nonetheless, a culture-sensitive approach to psychopathology should consider the cultural differences in the centrality of this symptom group. More research is needed to better understand the role of yearning and its determinants across world regions.

Adapting Complicated Grief Therapy for Use With People With Intellectual Disabilities: An Action Research Study.

BACKGROUND: There is established evidence of complicated grief among people with an intellectual disability. This paper describes the process of adapting complicated grief therapy (CGT) for this population. METHOD: Action research documented the adaptation of CGT. Qualitative methods included analysing meeting notes, reflective interviews with two members of the team involved in adapting the materials, and interviews with six professionals working in disability settings who reviewed the adapted materials. RESULTS: Key processes included adapting the standardised tools that form part of CGT and developing adapted approaches to abstract concepts related to death, dying and bereavement. Key therapeutic components such as imaginal revisiting and the role of significant others required adaptation for implementation with people with intellectual disabilities. CONCLUSION: The importance of adapting evidence-based therapies for people with intellectual disabilities is emphasised. This research provides an adapted form of an established therapy for piloting with this population.

How to support caregivers in general practice: development of the Caregiver Care Model.

Background: Caring for a family member can be demanding, particularly when caregivers experience profound distress. Supportive interventions may help prevent mental and physical illness in the caregiver. General practice plays a key role by regularly engaging with patients and caregivers, thereby being able to identify their support needs, offer talk therapy and refer to care initiatives. Objective: This study aimed to develop and pilot-test the Caregiver Care Model to mitigate grief reactions among caregivers in general practice. Design: A participatory intervention development study. Methods: A prototype was developed in a workshop with healthcare professionals. The prototype was refined based on a pilot-test among 40 caregivers from 5 general practice clinics and a workshop with general practitioners. The data were obtained from workshops, feedback questionnaires completed by healthcare professionals, and interviews with caregivers and general practitioners. The analysis focused on model development and mechanisms of impact. Results: The prototype was refined by focusing the dialogue questionnaire, minimising the grief facilitation tools and expanding the target group. The prototype seemed to accommodate the needs among caregivers by acknowledging their situation. The final model includes up to seven caregiver consultations in general practice. A dialogue questionnaire filled in by the caregiver serves as a fixed starting point and preparation for the first consultation. If needed, talk therapy in general practice or referrals to other services are used. Conclusion: The model offers promising support for caregivers. Its flexible structure allows for customisation. The viability of the model should be further tested.

Nursing Interventions in Primary Care for the Management of Maladaptive Grief: A Scoping Review.

Grief is a natural and self-limited adaptation process to a new reality that emerges after a significant loss (whether real or perceived), with a broad variety of manifestations that exert an impact on a grieving person's health. The study aim was to synthesize the evidence available about the interventions carried out by Primary Health Care nurses, by means of an individual approach to reduce maladaptive grief or maladaptive grief risk. A scoping review was conducted (November and December 2023) through searches in Medline, Cinahl, Web of Science, ProQuest and Scopus using MeSH terms combined with Booleans. Primary research of any design in adult people undergoing grief situations and receiving professional assistance by nurses in the primary, home and community care contexts published after 2009 in English, Spanish or Portuguese languages were included. Excluded publications were those conducted in in-hospital clinical settings and which did not correspond to research designs or the gray literature. The screening process was carried out by two reviewers using the appropriate JBI critical appraisal tools for each design and discrepancies were resolved by a third reviewer. A total of n = 10 studies were included (n = 4 qualitative, n = 2 RCTs, n = 1 quasi-experimental, n = 2 cross-sectional observational, and n = 2 mixed methods). The qualitative studies identified topics and subtopics of professionals' and families' experiences of grief. The observational studies analyzed symptoms and factors associated with the grieving process. Interventions consisted of cognitive-behavioral therapies delivered by psychological specialists who assessed the severity of grief in a range of cultural contexts using different instruments. The evidence retrieved from the studies that address the reduction in maladaptive grief or maladaptive grief risk is not conclusive. There is a need to increase both the number and the methodological quality of studies assessing the effectiveness of Nursing care in Primary Health Care for individuals experiencing maladaptive grief or maladaptive grief risk. Further research should focus on experimental studies, developing specific interventions conducted by nurses to address individual's grief and prevent maladaptive grief.

Feeling Connected to Nature Attenuates the Association between Complicated Grief and Mental Health.

Complicated grief (CG) predicts decreased mental health over time. Furthermore, feeling connected to nature (CN) is positively associated with beneficial mental health outcomes, such as psychological wellbeing and perceived psychological resilience. Thus, we hypothesized that CN moderates the association between general grief or CG and negative mental health for bereaved people. Further, we hypothesized that one's physical exposure to nature-that is, estimated time spent in nature and greenness (i.e., vegetation) surrounding one's residential area-might moderate the association between general grief or CG and negative mental health for bereaved people. To test these hypotheses, we conducted a cross-sectional study. We sampled 153 participants who experienced the death of a close other by COVID-19 infection. Participants reported CG, general grief, anxiety symptoms, depression symptoms, CN, estimated time spent in nature, and residential area postal code via a single online survey. We estimated greenness surrounding participants' residential areas using their self-reported five-digit U.S. postal code. Cross-sectional analyses indicated that, as predicted, CN attenuated the association between CG and depression, trended toward moderating the association between CG and anxiety, and did not moderate the associations between general grief and depression or anxiety. Other variables related to the experience of nature-the estimated time an individual spends in nature and the greenness surrounding one's residential area-did not moderate the association between general grief or CG and depression or anxiety. We thus conclude that a sense of feeling connected to nature-not simply spending more time in nature or being surrounded by nature-may serve an important role in the mental health status of people experiencing complicated grief, perhaps because CN replenishes general belonging when someone significant has passed away.

Redemption or Manipulation? Revisiting the Art of a Serial Killer-A Dialogue.

This article revisits an ongoing dialogue between the co-authors, examining their divergent perspectives on whether the art of serial killers was used to perpetuate their psychopathic cycles after their murderous sprees were interrupted, or whether the art-particularly a piece done by one serial killer, Glen Rogers-reflects remorse and redemption. The two art therapists draw from their own clinical and professional experiences to argue their respective outlooks. After explaining what art therapy is, re-examining the concept of murderabilia, and underscoring psychopathy, this article provides an in-depth evaluation of two art pieces done by the serial killer through both of their viewpoints. Ultimately, while neither author completely changed their overall conclusions, elements from both sides of the argument were found relevant. Ultimately, this article emphasized the chaotic and messy connections between art and violence, yet through new perspectives explored on the complexities and motivations within the mayhem, mutual understandings emerged.

Grief on pain and quality of life in combat veterans with PTSD.

Background: Persistent Complex Bereavement Disorder (PCBD) comprises a set of grief symptoms that are often linked to other psychological conditions such as PTSD and depression, may be prevalent in Veterans with combat experience, and may also impact general health.Objective: This study investigated the association between grief and sleep, pain, PTSD, and depression, among Veterans participating in a clinical trial for PCBD treatment.Method: Data from 155 Veterans receiving treatments for PCBD were analysed to explore the association between PCBD and symptoms of sleep pain, PTSD, and depression. Veterans experiencing grief reported symptoms related to physical health, emotional problems, energy, and fatigue, emotional well-being, social functioning, presence of pain, and general health. PCBD appeared to have a specific association with pain and physical functioning, independent of other variables.Conclusions: This study examined the potential independent association of PCBD on physical and mental health in Veterans with PTSD. PCBD appeared to have a very specific and significant association with pain and physical functioning. In other words, the pain of grief was related to ratings of physical pain. Future research on PCBD should address the potentially bidirectional association with bodily pain, particularly chronic pain, in relation to loss, with specific attention to potential mechanisms underlying this relationship.

This study explored the distinct relationship of PCBD on aspects of physical, as well as mental health among Veterans with Persistent Complex Bereavement Disorder (PCBD).Findings underscore the importance of addressing comorbid conditions of PCBD, such as PTSD, emphasising the need for tailored approaches that consider this intricate interaction between grief and other mental health and even physical health conditions.This study calls for further research into the mechanisms underlying the relationship between PCBD and bodily pain and physical functioning as the most affected areas associated with PCBD.

A protocol for a pilot randomised controlled trial of unguided internet cognitive behaviour therapy for grief in adolescents.

Grief is highly prevalent in adolescents, however, there have been no studies investigating internet delivered cognitive behaviour therapy for grief in adolescents (ICBT-G-A). In this paper, the co-design of an unguided ICBT-G-A intervention is described, and a protocol outlined for a pilot randomised controlled trial of the intervention. Participants will be randomised to the intervention (delivered via eight modules over a four-week period) or a four-week waitlist control. Intervention participants will complete a follow-up assessment at one-month post-intervention (eight weeks from the pre-intervention assessment). The intervention outcomes assessed at pre-intervention, post-intervention and follow-up include wellbeing and symptoms of anxiety, depression, post-traumatic stress, and prolonged grief. User feedback on experiences and acceptability of the intervention will be sought and feasibility assessed via programmatic data on recruitment and attrition.

Perinatal Grief Counseling and Its Effect on Grief Levels in Women Who Underwent Pregnancy Termination: A Comparative Experimental Study.

This study was designed as a two-group pre-test post-test comparative experimental study to examine the effects of grief counseling on perinatal grief levels in women who underwent pregnancy termination before discharge from the clinic. This study was conducted with 70 women who underwent medical termination of pregnancy. The intervention group (n = 35) received perinatal grief care, while the control group (n = 35) received only routine hospital care. In this study, the Introductory Information Form, Perinatal Grief Scale, and evaluation form of the care received were completed. While the perinatal grief level of the intervention group decreased after the application of grief care, a significant difference between the groups was detected only in women with a history of medical termination according to obstetric characteristics (p < .05). The findings obtained from this study showed that perinatal grief care support decreased grief scores on perinatal grief instruments and their sub-dimensions in the intervention group.

Bereavement due to COVID-19 pandemic among school-going adolescents - A cross-sectional study in district Dehradun.

BACKGROUND: Millions of people lost their loved ones due to the COVID-19 pandemic; this dire situation had an impact on almost every aspect of the daily life of every person. However, most of the individuals adapted to their losses nearly 2-10% of the population experienced dysfunctional grief in which adolescents were also affected. Aims and Objectives: Prime objective of the study was to assess dysfunctional grief due to loss from COVID-19 Pandemic among adolescents and to find out the coping strategies used by them to overcome this grief. MATERIALS AND METHODS: The study was conducted among school-going adolescents of District Dehradun. A pre-designed, pre-tested, self-administered, semi-structured questionnaire including socio-demographic details, COVID-19-related questions and Pandemic Grief Scale (Cronbach alpha-0.77) was used in the offline survey. RESULTS: Out of 690 study participants, a total of 151 (21.8%) adolescents lost their loved ones due to the COVID-19 pandemic. Of these, 9.93% were facing dysfunctional grief due to their loss. To overcome this grief, coping strategies used by study participants were mainly phone and internet usage (78%) followed by watching TV (73.8%) and sleeping (68.1%). CONCLUSION: Adolescents who experienced loss and were grieved are more at high risk of developing psychological disorders, particularly depression, anxiety, and physical illness, that might affect their education and overall development. Though to tackle the mental health crisis in the country Tele-Mental Health Assistance and Networking Across States (Tele-MANAS) has been initiated, still there is a lack of clarity regarding the structure and range of services provided by Tele-MANAS centers set up under the National Tele-Mental Health Program (NTMHP). Timely intervention and research to take solid steps to diminish the potential adverse effects of bereavement on adolescents' mental health is necessary.

"That Is What We Have Left of Her": The Significance of Transitional Objects After the Death of an Infant in a Norwegian Context.

When an infant dies in a neonatal intensive care unit in Norway, healthcare professionals provide bereaved parents with objects intended to help them processing their loss. Such objects can be clothes, blankets, soft animal toys, hand- and footprints, hair, as well as scrapbooks where the short life is documented through text and photo. By interviewing bereaved parents in three focus groups, we investigated the parents' use of these objects. Applying the method of reflexive thematic analysis, we developed three themes from the data material: (i) the importance of preserving objects, (ii) the approach to the objects, and (iii) the ambivalence concerning the objects. Pertinent to all themes was the parents' feeling of ambivalence toward the objects. On the one hand, the parents experienced the objects to affirm parenthood and manifest that the infant existed as a family member. Further, the objects were important in ritualization while according the child its status as deceased. Also, the objects helped the bereaved establish and keep continuing bonds with the deceased and to integrate their traumatic experience of losing a child. On the other hand, the bereaved parents shared that they were ambivalent toward the objects as they stirred up both good and painful emotions. The objects reminded them of their shocking and traumatic loss and the bereaved did not want to be confronted with this all the time. Therefore, through a preference for some objects and indifference toward others as time passed, the parents worked on transforming their bonds with the lost infant.