Efectos de la educación emocional en el duelo por la pérdida de un ser querido en la infancia y la adolescencia: una revisión sistemática guiada por las directrices PRISMA / Effects of grief education programs in children and adolescents facing the loss of a loved one: a prisma-driven systematic review

Introducción: Diferentes estudios surgidos desde el año 2020 indican que 5,2 millones de niños y niñas han perdido al menos un progenitor o cuidador como consecuencia de la pandemia de COVID-19. Estos datos ponen de manifiesto la importancia de educar en el duelo a los niños y adolescentes y protegerlos de posibles complicaciones en la elaboración del duelo.Objetivo: Analizar si hasta el momento se han realizado investigaciones que avalúen los efectos de los programas de educación emocional en la elaboración del duelo por la pérdida de un ser querido.Método: Se ha realizado una revisión sistemática siguiendo las directrices PRISMA que ha permitido identificar 8 estudios localizados en las bases de datos PsycInfo, Pubmed, ERIC y Dialnet que cumplían con los criterios de inclusión. Resultados y conclusiones: Los resultados indican que la educación emocional sí influye en la relación que los niños y adolescentes establecen con el duelo, la pérdida y la muerte. Asimismo, la falta de claridad en algunos resultados y el uso de instrumentos no específicos para avaluar el duelo, hace que estos deban ser valorados con precaución y hace aconsejable más investigación que supere las limitaciones de la actual.(AU)

Introduction: Several studies published since 2020 claim that about 5.2 million children have lost at least one parent or parental figure to COVID-19. These data support the importance of grief psychoeducation with children and adolescents as this may be an effective intervention to protect them from eventual complications, such as prolonged grief disorder, posttraumatic stress disorder, or others. Aim: To analyse whether research has been conducted up to date on the effects of grief psychoeducation or emotional education programs on grief processes following the death of a parent or another loved one in children and adolescents. Materials and Methods: A PRISMA-driven systematic review has been carried out using databases PsycInfo, Pubmed, ERIC and Dialnet. 8 studies meeting all inclusion criteria have been identified and analysed.Results and conclusions: Results suggest that emotional education significantly impacts grieving processes in children and adolescents, besides shaping their relationships with bereavement, loss and death. Nonetheless, some of the located study results lack clarity and many studies did not use specific instruments to evaluate grief. This calls for prudence when interpreting positive results and encourages future research that hopefully overcomes limitations identified in previous studies.(AU)

Experience of loss and grief among people from Germany who have lost their relatives during the pandemic: the impact of healthcare professionals' support.

Background: Due to public restrictions during the early stages of the COVID-19 pandemic, many people were unable to visit and bid a proper farewell to their dying loved ones. This study aimed to address the loss-oriented aspects of grief and bereavement of relatives and relate these to the support they may have received from their dying relative's caring professionals. Materials and methods: People from Germany who experienced bereavement during the COVID-19 pandemic were enrolled in a cross-sectional study between July 2021 and May 2022, using standardized questionnaires (i.e., ICG, Inventory of Complicated Grief; BGL, Burdened by Grief and Loss scale; WHO-5, WHO-Five Wellbeing Index; and 5NRS, perception of burden related to the pandemic). Results: Most participants (n = 196) had the opportunity to visit their relatives before death (59%). When this was not possible, being burdened by grief and loss was significantly higher (Eta2 = 0.153), while this had no significant influence on complicated grief or psychological wellbeing. Furthermore, 34% of participants felt well-supported by the treatment/care team. Their own support was moderately correlated with BGL scores (r = -0.38) and marginally with ICG scores (r = -15). Regression analyses showed that complicated grief symptoms as the dependent variable were predicted by (low) psychological wellbeing, relational status, and the perception of COVID-19-related burden (R2 = 0.70). In contrast, BGL as the dependent variable can be best explained by the perception of emotional affections because of restricted visits shortly before their death, by the (short) duration of visits before death, and by the relational status (R2 = 0.53). Although both were interconnected (r = 0.44), their predictor pattern was different. Conclusion: Being able to visit dying relatives was important for the mourning and bereavement processes. This emotional aspect was more relevant to the normal, non-pathological grief and loss processes than to complicated grief processes. Support from their dying relatives' treatment/care team was highly relevant to the mourning process, but the visiting relatives often lacked information about additional resources such as psychologists or pastoral care professionals or had limited access to them.

Pandemic grief.

The author expresses themselves with a poem about their experiences with COVID-19. They talk about how the about the lack of connection and grief during the pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Inferring China's excess mortality during the COVID-19 pandemic using online mourning and funeral search volume.

We construct a mourning and funeral index, using online search volume for "wreath and elegiac couplet", "obituary", "mortuary house", "cinerary casket", "cremation" and "pass away", to infer excess cases of mortality in China during the COVID-19 pandemic. During the 3-month period (December 2022-February 2023) after China ended its Zero-COVID policy, there were around 712 thousand excess cases of mortality. These excess cases of mortality, bench marked against the 2-year period preceding the pandemic, could be directly or indirectly related to COVID-19. During the 35-month Zero-COVID regime (January 2020-November 2022), the excess death toll was a negative 1480 thousand. Overall, by delaying the surge in infections, China might have saved 767 thousand lives. While these estimates are based on various assumptions and can be imprecise, China's COVID-19 experience could reasonably be characterized by a sharp surge in deaths after its departure from Zero-COVID and a steady pattern of lives saved during the Zero-COVID regime.

Migrant women caregivers' experiences in end-of-life formal care.

OBJECTIVE: To describe and understand the experience of Latin American migrant women as caregivers of elderly people in situations of advanced illness and end of life. METHOD: Qualitative study using Gadamer's hermeneutic phenomenology. Data were collected in 2019 through 9 semi-structured interviews with Latin American women caregivers, who had cared for people at the end of life, in the Province of Granada (Spain). RESULTS: Two themes emerged: "Migrant caregiver at the end of life" and "And now, what should I do?": the impact of the loss at the economic, emotional and labor level. CONCLUSION: Care during the end of life of the cared person generates an additional overload to the situation of migrant women. The experience of this stage is related to the bond with the persons cared and their families, which may affect the development of complicated grief and personal problems related to the loss of employment and the absence of economic support.

Duelo anticipado en familiares de personas con demencia. Variables psicosociales asociadas y su impacto sobre la salud del cuidador. Una revisión de literatura / Anticipatory grief in family caregivers of persons with dementia. Psychosocial correlates and impact on caregiver's health: A literature review

Introducción Cuidar de un familiar con demencia puede suponer consecuencias negativas en el bienestar del cuidador. Uno de los procesos que se pueden vivenciar es el duelo anticipado, que se define como los sentimientos de dolor y pérdida que aparecen en el cuidador previamente al fallecimiento de la persona cuidada. Objetivos La revisión tuvo como objetivos conceptualizar el duelo anticipado en esta población, estudiar las variables psicosociales relacionadas, y conocer las repercusiones para la salud del cuidador. Método Se realizó una búsqueda sistemática siguiendo las directrices PRISMA en las bases de datos ProQuest, PubMed, Web of Science (WOS) y Scopus, incluyendo los estudios publicados en los últimos 10 años (2013-2023). Resultados Se obtuvo un total de 160 artículos, seleccionándose 15 finalmente. Se observa que el duelo anticipado se define como un proceso ambiguo al aparecer antes de la muerte del familiar enfermo. Ser cuidadora mujer, cónyuge del familiar con demencia, tener una relación más cercana con él y/o tener una importante responsabilidad en el cuidado se asocian a una mayor probabilidad de experimentar duelo anticipado. Respecto a la persona cuidada, si esta se encuentra en una fase severa de la enfermedad, es más joven y/o presenta comportamientos problemáticos, también se observa un mayor duelo anticipado en el cuidador. El duelo anticipado tiene un impacto significativo en la salud física, psicológica y social de los cuidadores, asociándose con una mayor sobrecarga, sintomatología depresiva y aislamiento social. Conclusiones El duelo anticipado resulta un concepto relevante en el contexto de las demencias, siendo necesario incluirlo en programas de intervención para esta población (AU)

Introduction Taking care of a relative with dementia may be linked to negative consequences for the caregiver. One of the processes that can be experienced is anticipatory grief, that is defined as the feelings of pain and loss that appear in the caregiver before the death of the person cared for. Objectives The review aimed to conceptualize anticipatory grief in this population, to study the related psychosocial variables, and to know the repercussions for the health of the caregiver. Method A systematic search was made under the directives of PRISMA statement in the ProQuest, PubMed, Web of Science (WOS), and Scopus databases, including studies published in the last 10 years (2013–2023). Results A total of 160 articles were obtained, 15 being finally selected. It is observed that anticipatory grief is defined as an ambiguous process since it appeared before the death of the sick family member. Being a female caregiver, spouse of a family member with dementia, having a closer relationship with him and/or having an important responsibility in care, are associated with a greater chance of experiencing anticipatory grief. In relation to the person cared for, if he or she is in a severe phase of the disease, is younger, and/or presents problematic behaviours, there is also greater anticipatory grief in the family caregiver. Anticipatory grief has a significant impact on caregivers’ physical, psychological, and social health, being associated with greater burden, depressive symptomatology, and social isolation. Conclusions Anticipatory grief turns out to be a relevant concept in the context of dementia, being necessary to include it in intervention programs for this population (AU)

Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study.

AIMS: To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an increased risk of self-harm and suicide around dates of (i) anniversaries of the death and (ii) the deceased's birthday, compared with intervening periods. METHODS: We conducted a self-controlled case series study using national register data on all individuals living in Denmark from 1 January 1980 to 31 December 2016 and who were bereaved by the suicide of a first-degree relative or partner (spouse or cohabitee) during that period, and who had the outcome (any episode of self-harm or suicide) within 5 years and 6 weeks of the bereavement. We compared relative incidence of suicidal behaviour in (i) the first 30 days after bereavement and (ii) in the aggregated exposed periods (6 weeks either side of death anniversaries; 6 weeks either side of the deceased's birthdays) to the reference (aggregated unexposed intervening periods). As an indirect comparison, we repeated these models in people bereaved by other causes. RESULTS: We found no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased's birthdays in people bereaved by suicide (adjusted incidence rate ratio [IRRadj] = 1.00; 95% confidence interval [CI] = 0.87-1.16) or other causes (IRRadj = 1.04; 95% CI = 1.00-1.08) compared with intervening periods. Rates were elevated in the 30 days immediately after bereavement by other causes (IRRadj: 1.95, 95% CI: 1.77-2.22). CONCLUSIONS: Although people bereaved by suicide are at elevated risk of self-harm and suicide, our findings do not suggest that this risk is heightened around emotionally significant anniversaries. Bereavement care should be accessible at all points after a traumatic loss as needs will differ over the grief trajectory.

The Nurse in the Waiting Room: In Grief and Abandoned.

Finding no guidance or support at a vulnerable moment.

Exploring the phenomenon of intrusive mental imagery after suicide bereavement: A qualitative interview study in a British sample.

INTRODUCTION: Each year an estimated 48 million people are bereaved by suicide internationally. Following traumatic events, experiencing intrusive mental imagery relating to the trauma is not uncommon. This phenomenological study aimed to explore the nature, experience and impact of intrusive mental imagery after suicide bereavement. METHODS: Semi-structured interview transcripts with 18 adults bereaved by the suicide of a close contact were analysed using thematic analysis to explore patterns and themes within the data, with particular consideration of the content of images, how people experience and relate to the imagery, and the impact that the imagery has on the bereaved. RESULTS: Thematic analysis identified common characteristics in the experience of intrusive mental imagery following suicide loss, summarised under two main themes capturing: 1) the descriptive characteristics and 2) the emotional experience of intrusive mental imagery following suicide loss. The majority of participants found the experience of intrusive imagery distressing, but most also described positive aspects, including help in making sense of the death and retaining memories of the deceased. CONCLUSION: Findings inform our understanding of the distressing experience of intrusive imagery after suicide loss, also revealing perceived value in processing the death.

The longitudinal contribution of prolonged grief to depression and suicide risk in the aftermath of suicide loss: The moderating role of self-criticism.

BACKGROUND: Suicide-loss survivors (SLSs)-individuals who lost family member to suicide, have been recognized as at risk for several mental health complications, including depression and suicide. Recent studies have emphasized the contribution of prolonged grief (PG) symptoms and suicide-related shame as facilitators of depression and suicide risk in the aftermath of suicide loss. In this six-year longitudinal design study, we examined self-criticism as a moderator of the link between PG and depression and suicide risk, with suicide-related shame mediating these links. METHOD: Participants were 152 SLSs (130 females) aged 18-70 who completed questionnaires assessing prolonged grief, depression, and suicide risk as well as trauma-related shame and self-criticism. RESULTS: A moderated mediation model shows that high self-criticism intensified the relations between PG and shame and between shame and depression and suicide risk, above and beyond the contribution of the longitudinal PG trajectory. Importantly, the indirect effects of PG on both depression and suicide risk via shame levels were found only among SLSs with high levels of self-criticism. CONCLUSION: The findings highlight the critical longitudinal role of self-criticism in facilitating depression and suicide risk among SLSs with higher levels of PG. Theoretical implications relating to healing processes and focused clinical recommendations are discussed, including interventions for addressing self-criticism and suicide-related shame in the aftermath of suicide loss.

Con E de enfermera Unidad de Acompañamiento al Duelo / With E for nurse... Grief Accompaniment Unit

Sonia López Luque es responsable de Enfermería y coordinadora de la Unidad de Acompañamiento en el Duelo en el Hospital SanJuan de Dios de Córdoba, un servicio impulsado desde el Área de Humanización del centro para ayudar a superar las posiblessituaciones de pérdida que se produzcan tanto en los familiares como en los propios pacientes. Está compuesta por un equipomultidisciplinar y trabajan bajo un protocolo específico. ¡Nos cuenta todos los detalles!.(AU)

Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review.

BACKGROUND: People with an advanced progressive illness and their caregivers frequently experience anxiety, uncertainty and anticipatory grief. Traditional approaches to address psychological concerns aim to modify dysfunctional thinking; however, this is limited in palliative care, as often concerns area valid and thought modification is unrealistic. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy aimed at promoting acceptance and valued living even in difficult circumstances. Evidence on its value in palliative care is emerging. AIMS: To scope the evidence regarding Acceptance and Commitment Therapy for people with advanced progressive illness, their caregivers and staff involved in their care. DESIGN: Systematic scoping review using four databases (Medline, PsychInfo, CINAHL and AMED), with relevant MeSH terms and keywords from January 1999 to May 2023. RESULTS: 1,373 papers were identified and 26 were eligible for inclusion. These involved people with advanced progressive illness (n = 14), informal caregivers (n = 4), palliative care staff (n = 3), bereaved carers (n = 3), and mixed groups (n = 2). Intervention studies (n = 15) showed that Acceptance and Commitment Therapy is acceptable and may have positive effects on anxiety, depression, distress, and sleep in palliative care populations. Observational studies (n = 11) revealed positive relationships between acceptance and adjustment to loss and physical function. CONCLUSION: Acceptance and Commitment Therapy is acceptable and feasible in palliative care, and may improve anxiety, depression, and distress. Full scale mixed-method evaluation studies are now needed to demonstrate effectiveness and cost-effectiveness amongst patients; while further intervention development and feasibility studies are warranted to explore its value for bereaved carers and staff.

Responding to Suicide in School Communities: An Examination of Postvention Guidance from Expert Recommendations and Empirical Studies.

PURPOSE OF REVIEW: We review the published literature on a school's response after a student dies by suicide ("postvention"). We examine published recommendations based on expert guidance and empirical studies that have evaluated postvention measures. RECENT FINDINGS: Experts recommend careful communication with family, staff, and students that adheres to published suicide reporting guidelines. Experts also emphasize the importance of identifying and supporting high-risk students. Few robust, controlled studies have identified effective postvention measures. Effective measures tended to occur in group settings (e.g., group therapy), focus on improving grief symptoms, and involve mental health professionals. Postvention has not been robustly studied in the school context. Expert recommendations and a few evidence-backed studies provide the frame for a coherent, school-based postvention response. Further research is needed to strengthen and expand our collective understanding of effective postvention measures in the school context as youth suicide attempts continue to rise.