Experiences and needs of Chinese women after a stillbirth: a qualitative phenomenological study.

OBJECTIVES: We aimed to explore the lived experiences and needs of women after a recent stillbirth event. DESIGN: Qualitative phenomenological study. SETTING: The current study was conducted in a tertiary obstetric hospital in East China between 25 January 2024 and 29 March 2024. PARTICIPANTS: 14 women having experienced a stillbirth within the last 6 months. RESULTS: Researchers agreed on four key themes including individual variations in emotional reaction and recovery, physical recovery and concerns about future pregnancies, the critical role of social support systems and variations in perceptions of stillbirth as the death of a fetus versus a human being, along with related mourning rituals. These themes collectively highlight the multifaceted nature of the stillbirth experience, underscoring the complex interplay between personal, cultural and medical factors that shape women's emotional and physical responses. CONCLUSIONS: Post-stillbirth experiences among Chinese women are deeply individualised and influenced by a complex interplay of personal emotions, cultural contexts and medical interactions. It is imperative for healthcare systems to implement tailored care strategies beyond standard protocols to proactively address their varied emotional landscapes and physical concerns with an enhanced awareness of cultural sensitivities. Specialised training for healthcare providers should be devised to recognise and respond to the unique grief processes. Comprehensive support systems should be established to significantly enhance the recovery journey by providing essential resources and community connections.

[EMOTIONAL CHALLENGES, RESILIENCE, AND CONTINUOUS EXPOSURE TO TRAUMATIC STRESS AMONG THE SOROKA UNIVERSITY MEDICAL CENTER STAFF: CASE DESCRIPTION].

INTRODUCTION: We present a case study dealing with the emotional coping of a physician's exposure to continuous traumatic stress starting with the events of Oct. 7, 2023 and during the following months. BACKGROUND: The medical staff at Soroka Medical Center in southern Israel have faced unprecedented challenges over the past months due to ongoing conflict along the Gaza border. Since October 7, 2023, over 2,550 wounded patients have been treated at Soroka for injuries of varying severity, with more than 250 requiring life-saving surgeries. As the region's largest trauma center, Soroka's staff have endured continuous exposure to traumatic stress, suffering, distress and grief - both within the hospital and in their personal lives. CONCLUSIONS: While the long-term impacts remain to be seen, preliminary findings suggest that organizational efforts during routine may help mitigate potential negative effects of exposure to traumatic stress in the course of emergency. Further research is needed to understand how cumulative exposure interacts with process of recovery and growth. DISCUSSION: The current report presents the different layers of traumatic exposure, the associated risk and resilience factors and a perception that was instilled in the hospital in the years preceding the current war which promoted a culture of proactive peer discourse about emotional hardship and normalization of referral for professional help when needed. We also present coping behaviors that were common among many staff members and organizational responses, considering the uniqueness of the current challenges, their scope and duration.

The Norwegian traumatic grief inventory-self report plus (TGI-SR+): a psychometric evaluation in traumatically bereaved people.

Background: Prolonged grief disorder (PGD) has been added to the ICD-11 and DSM-5-TR. The Traumatic Grief Inventory-Self Report Plus (TGI-SR+) assesses self-rated PGD intensity as defined in ICD-11 and DSM-5-TR. The TGI-SR + is available in multiple languages, but has not been validated yet in Norwegian.Objective: The aim of this study was to evaluate the psychometric properties of the Norwegian TGI-SR + .Method: Bereaved adults (N = 307) whose child or sibling died ≥6 months ago due to a sudden or violent loss completed the TGI-SR + and measures for posttraumatic stress, depression, and precursor PGD symptoms. We examined the factor structure and internal consistency of the ICD-11 and DSM-5-TR PGD items. Convergent validity and known-groups validity was evaluated. Probable PGD cases, pair-wise agreement between diagnostic scoring rules for both PGD criteria-sets, and cut-off scores were calculated.Results: The 1-factor model for ICD-11 and DSM-5-TR PGD showed the best fit and demonstrated good internal consistency. Convergent validity was supported by strong associations between summed ICD-11 and DSM-5-TR PGD scores and summed posttraumatic stress, depression, and precursor prolonged grief scores. Known-groups validity was supported by PGD intensity being related to educational level and time since loss. The perfect pair-wise agreement was reached using the ICD-11 and DSM-5-TR PGD diagnostic scoring rules. The optimal cut-off score for detecting probable PGD cases, when summing all TGI-SR + items, was ≥73.Conclusions: The Norwegian TGI-SR + seems a valid and reliable instrument to assess ICD-11 and DSM-5-TR PGD intensity after losing a child or sibling under traumatic circumstances.

The TGI-SR + is a self-report instrument assessing ICD-11 and DSM-5-TR prolonged grief disorder intensity.The Norwegian TGI-SR + seems to be a valid and reliable instrument to assess prolonged grief disorder intensity.Optimal cut-off for detecting probable prolonged grief disorder cases is ≥73 in this traumatically bereaved sample of parents and siblings.

Prevalence and correlates of ICD-11-based prolonged grief disorder in a representative Slovakian sample of recently bereaved adults.

Background: Prolonged Grief Disorder (PGD) has recently been included in both the ICD-11 and DSM-5-TR diagnostic manuals. Studying its prevalence and correlates across cultures is vital for more effective identification, treatment, and prevention.Objective: This study aimed to examine prevalence rates of ICD-11-based PGD, in a representative Slovakian sample in response to deaths of loved ones occurring during the previous year. Further aims were to examine the factor structure of PGD symptoms and correlates of summed PGD item scores and PGD 'caseness'.Method: Self-reported data on PGD, depression, anxiety, alcohol use, and descriptive characteristics were gathered from a representative sample of the Slovak population (N = 319).Results: Data were gathered from N = 1853 people; 319 participants (17.2%) reported a loss in the past year. The prevalence of probable PGD among these bereaved participants was 1.99% for recent losses (<6 months, n = 151) and 7.75% for more distant losses (6-12 months, n = 130). The most frequently endorsed symptoms included longing/yearning for the deceased, sadness, denial/unrealness, and difficulty accepting the death. PGD symptoms had a unitary factor structure which was consistent for subsamples bereaved 1-5 and 6-12 months. The severity of PGD varied with kinship. Depression and anxiety, but not alcohol misuse, were associated with PGD severity and PGD caseness.Conclusions: These findings underscore that a significant group of people develop PGD between 6-12 months following a loss. This emphasises the need for targeted psychological interventions.

Prolonged Grief Disorder (PGD) is newly included in ICD-11 and knowledge about its prevalence and correlates in the general population is urgently needed.In a representative Slovakian sample (N = 1853), 319 people (17.2%) reported a loss during the past year; 7.75% of people, bereaved 6­12 months earlier, met criteria for ICD-11-based PGD.PGD severity and caseness were associated with kinship (but less strongly with other sociodemographic and loss characteristics) and with depression and anxiety (but less strongly with problematic alcohol use).At 6­12 months following loss, PGD seems fairly common in the general population and timely identification and mitigation of PGD is an important public health issue.

Effect of logotherapy counseling program on chronic sorrow, dignity, and meaning in life of palliative care patients: a randomized controlled trial.

PURPOSE: Palliative care patients experience chronic sorrow with loss in dignity and meaning in life. Logotherapy is an effective way to cope with loss. This study aimed to evaluate the effect of logotherapy on chronic sorrow, dignity, and meaning in life of palliative care patients. METHODS: This study was conducted with 58 adults hospitalized due to advanced cancer and assigned to either intervention or control group by simple randomization. Data were collected with descriptive information form, Palliative Performance Scale, Patient Dignity Inventory (PDI), Prolonged Grief Disorder Scale-Patient Form (PGDS-PF), and Meaning in Life Questionnaire (MIL) on admission, at the 4th and 8th weeks. The intervention group received eight sessions of logotherapy. The control group received routine care. RESULTS: The mean scores of PGDS-PF (p = 0.01), PDI (p = 0.01), and searched meaning subdimension of MIL (MIL-SM) (p = 0.11) decreased in the intervention group compared to controls, both at the 4th and 8th week evaluation. The mean score of the present meaning subdimension of MIL (MIL-PM) (p = 0.02) increased at the 4th week evaluation but decreased at a non-statistically significant level at the 8th week. The mean scores of PGDS-PF and PDI increased in the control group while MIL-PM and MIL-SM decreased, both at the 4th and 8th week evaluation. CONCLUSIONS: Logotherapy was found effective in decreasing the sorrow and dignity-related distress of palliative care patients, while increasing finding meaning in life. Logotherapy is recommended to be used by palliative care professionals to empower patients. TRIAL REGISTRATION: Clinicaltrials registration number and date: NCT05129059, 19/01/2021.

How loss of nature through clear-cutting forestry affects well-being.

The United Nations declares that the global degradation of ecosystems represents a danger to human health. Deterioration of forests is one of several threats against the natural systems. The aim of this exploratory study was to investigate people's experiences with clear-cutting and how it had affected their health and well-being. Qualitative data from six people who valued forest ecosystems were collected through semi-structured interviews and analyzed in accordance with Graneheim and Lundman's qualitative content analysis (Graneheim, U. H. and Lundman, B. (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112). Clear-cutting was not regarded as an environment-friendly forestry method. The interviewees described emotional reactions such as grief and poor mental well-being when beloved forests were clear-felled. The grief was partly because of a personal loss of place and recreation area that was important for their physical and emotional well-being. Another part was grief on behalf of nature itself, that is, the loss of habitats of animals and plants and a worsening of the global climate. The interviewees held that emotions related to loss of nature were insufficiently communicated in public discourse. They felt powerless and unable to influence forestry because of what they experienced as an impenetrable industry. Clear-cutting of forests may result in poor well-being among people who value forest ecosystems. More focus on planetary health is needed, including healthy public policy promoting forest management that considers people's need for nature experiences and possible ecological grief when forests are totally and abruptly cleared.

End-of-life care and grief: study conducted with family members of COVID-19 victims. / Cuidados no final de vida e luto: estudo com familiares de vítimas da COVID-19.

This article aims to investigate the implications of grief among family members of COVID-19 victims; verify the prevalence of prolonged grief symptoms; and identify family members' expectations regarding end-of-life care for their loved ones affected by COVID-19. Descriptive, cross-sectional research, with a quantitative-qualitative approach. Data collection was performed using an online questionnaire, guided by the PG-13 instrument. Descriptive and inferential statistics were applied. The results were presented descriptively and with the aid of tables. The study sample included 142 family members, mostly female, who presented emotional, physical, social, and financial implications as a result of grief. A prevalence of prolonged grief symptoms was observed in 11.4% of the mourners with more than six months and 29.6% of those with less than six months. Three thematic categories were identified: transparency in communicating the health situation, access to moments of farewell, and promotion of comfort in care actions. The symptoms of Prolonged Grief Disorder have a significant association with the degree of kinship. In final care, family members' expectations were classified as: permission for a dignified farewell, effective communication, and promotion of comfort and care.

O objetivo deste artigo é investigar implicações do luto em familiares de vítimas da COVID-19; verificar a prevalência de sintomas de luto prolongado; identificar expectativas dos familiares acerca do cuidado em fim de vida de seus entes acometidos por COVID-19. Pesquisa descritiva, transversal, com abordagem quanti-qualitativa. Coleta de dados mediante questionário on-line, norteado pelo instrumento PG-13. Aplicou-se estatística descritiva e inferencial. Os resultados foram apresentados de forma descritiva e com auxílio de tabelas. Amostra de 142 familiares, maioria do sexo feminino, que apresentaram implicações emocionais, físicas, sociais e financeiras em decorrência do luto. Houve prevalência de sintomas de luto prolongado em 11,4% dos enlutados com mais de seis meses e 29.6% dos que tinham menos de seis meses. Foram identificadas três categorias temáticas: transparência na comunicação da situação de saúde, acesso a momentos de despedida e promoção de conforto nas ações de cuidado. Os sintomas de Transtorno de Luto Prolongado possuem associação significativa com o grau de parentesco. Nos cuidados finais as expectativas dos familiares foram classificadas em: permissão para despedida digna, comunicação efetiva e promoção de conforto e cuidado.

Opioid Epidemic Grief and Characterological Harm Reduction.

This article considers what it might mean to do the moral work of grieving during an opioid epidemic. Becoming callous, bitter, or resentful are harms we can suffer to our characters when grieving losses, especially at epidemic scale. This article suggests how appreciating beauty can play roles in grieving that could help mitigate these harms.

Prolonged Grief Disorder in ICD-11 and DSM-5-TR: Factor structure, and psychosocial and loss-related correlates in a sample of widowed persons. / Zespól zaloby przedluzonej w ICD-11 i DSM-5-TR: struktura czynnikowa oraz korelaty socjodemograficzne i zwiazane ze strata w próbie osób owdowialych.

OBJECTIVES: This study sought to determine whether the symptoms of prolonged grief disorder (PGD) according to ICD-11 and DSM-5-TR have a unifactorial structure. Second, we sought to determine the sociodemographic and loss-related correlates of PGD symptom severity according to ICD-11 and DSM-5-TR. METHODS: People who had lost a spouse (N = 144) in the past six months were examined using the Polish versions of the Prolonged Grief Disorder-13 scale (PG-13) and Inventory of Complicated Grief (ICG). Selected PG-13 and ICG items were included in the analyses to cover the PGD criteria according to ICD-11 and DSM-5-TR. RESULTS: Confirmatory factor analyses supported the one-dimensional structure of both sets of symptoms of the disorder. Briefer time since loss and loss due to an accident were associated with PGD symptom severity according to both ICD-11 and DSM-5-TR. CONCLUSIONS: PGD is a one-dimensional and internally consistent psychopathological syndrome. Widows and widowers who have recently lost their spouse due to an accident may be at especially heightened risk of developing severe levels of PGD symptoms.

War, terror and mourning. Cultural memory in the inner dialogue.

This text compares four essays dealing with war, state terror in dictatorships, social violence such as racism, mourning and the avoidance of mourning. It shows that dictatorships share similarities in their techniques of manipulation, linguistic style and reference to history. They seek to exploit national myths through manipulative alienation. Myths are a central element of cultural memory, and their effect can be understood through a model of internal dialogue. This dialogue determines whether the regime's attempts at manipulation are successful.

The inability to mourn and nationalism in Japan after 1945.

Failure to deal with the issue of collective and social loss increases the risk of extreme nationalism. When taken too far, a repetition of manic defence can arise that manifests itself in the form of war. In this paper, the notion of the "inability to mourn" by the German Psychoanalysts A. and M. Mitshcerlich (1967) is discussed in relation to the problem of Japan's post World War II nationalism, and its silence on social matters. The process of confronting past atrocities committed by the state is then discussed from the perspective of structural theory.

The inability to mourn: Past and current challenges for psychoanalysis.

Although the capacity to mourn is ubiquitously acknowledged as critical for individual psychic functioning, the impact of this capacity on a collective social level has been examined to a very limited extent in the psychoanalytic literature to date. The two papers that take up this this topic thus bring various critical and complex issues to our attention. After reviewing and commenting on these papers, I discuss how these issues are particularly relevant today to society in general and psychoanalysis in particular. I believe that the ability to mourn is under siege in the Western world at present, with respect to both "macro" mourning that is, mourning for significant losses such as a beloved person, ideal, or country, and "micro" mourning or mourning for losses inherently and unavoidably implicated in choices we make in everyday life. These mourning processes are undermined by the impact of complex socioeconomic parameters on psychic functioning, as evidenced by various internal problems and symptomatology characteristic of our times. In turn, difficulties in mourning contribute to social problems including social injustice, wars and the climate crisis. As psychoanalysts we are called upon to address these issues in our clinical work as well as in our global community.

Traumatic loss: a systematic review of potential risk factors differentiating between posttraumatic stress disorder and prolonged grief disorder.

Background: When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief.Objective: This systematic review investigates which characteristics differentiate between the development of the respective disorders or are associated with comorbidity.Method: A systematic literature search using Medline, PubMed, APA PsycInfo and Web of Science yielded 46 studies which met the inclusion criteria. In these studies, PTSD was assessed using 17 and pathological grief using 16 different validated instruments. In the quality assessment, 12 studies were classified as average, 30 as above average, and 4 as excellent. The investigated risk factors were categorized into 19 superordinate clusters and processed using narrative synthesis.Results: The relationship to the deceased, mental health issues, and religious beliefs seem to be associated specifically with pathological grief symptoms compared to PTSD symptoms. Social support and social emotions emerged as significant correlates and potential risk factors for both PTSD and pathological grief. Included studies had mainly cross-sectional designs.Conclusions: Differentiating factors between pathological grief and PTSD appear to exist. The results should be considered within the limitations of the heterogeneity of the included studies and the research field. There is a lack of studies (1) using a longitudinal study design, (2) starting data collection early following the traumatic loss, (3) using standardized, up-to-date measurement instruments and (4) including comorbidity in their analyses. Further research is urgently needed for more accurate (acute) screenings, prognoses, and interventions following traumatic loss.

When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief. This systematic review investigates which characteristics can differentiate between the development of the respective disorders or are associated with comorbidity.The relationship to the deceased, mental health issues, and religious beliefs seem to be specific characteristics for predicting pathological grief. Social support and social emotions were frequently reported as significant correlates of both PTSD and pathological grief.The studies to date have been very heterogeneous and mainly cross-sectional. Further research considering both disorders after traumatic loss in longitudinal study designs is urgently indicated for better (acute) screenings, prognoses, and interventions.

Nurses' experience of loss, grief, family health and care targeting patients and families in long-term cancer illness: A qualitative study.

PURPOSE: This study aimed to explore the experiences of registered nurses in hematology departments and primary care settings regarding loss, grief, and family health in adult patients and their families during long-term cancer illnesses. METHOD: A qualitative study was conducted taking a phenomenological hermeneutic approach. Data were collected between February and March 2023 through individual, semi-structured interviews with 12 nurses working in hematology departments and primary care settings in Denmark. The interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS: The analysis resulted in the identification of four main themes with related subthemes: (1) Patients' individual losses leading to grief reactions, (2) Nurses' experience of families grieving the loss of former daily living, (3) Supporting families with family health as an implicit concept, and (4) Overcoming barriers through nurses' care interventions targeting family health. Results showed that nurses encountered various losses and grief reactions affecting both patients and families. Barriers such as experience levels and working conditions affected care quality. Despite challenges, nurses addressed these by utilizing communication, involving families, and directing them to additional healthcare services. CONCLUSION: The study unveiled limited nurse awareness of family health, acknowledging its significance in patient and family care. The findings highlight the importance of improving nurses' comprehension of effectively supporting families as a cohesive unit in the context of long-term cancer illnesses.

LPS-induced whole-blood cytokine production and depressive symptoms in dementia spousal caregivers: The moderating effect of childhood trauma.

Dementia spousal caregivers are at risk for adverse mental and physical health outcomes. Caregiver burden, anticipatory grief, and proinflammatory cytokine production may contribute to depressive symptoms among caregivers. People who report childhood trauma are more likely to have exaggerated stress responses that may also contribute to depressive symptoms in adulthood. This study aimed to test whether the relationship between whole-blood cytokine production and depressive symptoms is strongest in caregivers who report high levels of childhood trauma. METHODS: A sample of 103 dementia spousal caregivers provided self-report data on demographics, health information, caregiver burden, anticipatory grief, and depressive symptoms. We also determined lipopolysaccharide-induced whole-blood cytokine production as the primary measure of immune cell reactivity. We measured interleukin-1ß (IL-1ß), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10) and converted z-scores of each cytokine into a composite panel. We regressed depressive symptoms on proinflammatory cytokine production, caregiver burden, and anticipatory grief, adjusting for demographic and health-related covariates. RESULTS: Whole-blood cytokine production and childhood trauma were associated with depressive symptoms. Childhood trauma moderated the relationship between whole-blood cytokine production and depressive symptoms. Whole-blood cytokine production was only associated with depressive symptoms at mean and high levels of childhood trauma, but not at low levels of childhood trauma. The main effects of burden and anticipatory grief on depressive symptoms were strongest for caregivers reporting high levels of childhood trauma. DISCUSSION: Childhood trauma has lasting impacts on psychosocial experiences later in life and has effects that may confer susceptibility to inflammation-related depression. Our findings contribute to ongoing efforts to identify risk factors for adverse mental health in dementia spousal caregivers.

Cluster analysis of prolonged grief, posttraumatic stress, and depression symptoms in bereaved asylum seekers and refugees.

Background: Refugees and asylum seekers (ASRs) are frequently exposed to loss in addition to a variety of other stressors and often display high levels of various psychological symptoms.Objective: The study aimed to primarily determine clusters of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression symptoms in bereaved ASRs and secondly identify predictors of cluster membership. Sociodemographic  - and flight-related variables were investigated in exploratory analyses.Method: ASRs in Germany (N = 92) with interpersonal loss exposure, i.e. at least one missing or deceased relative or friend, were assessed with interview-based questionnaires for PGD, PTSD, and depressive symptoms. We used k-means cluster analysis to distinguish symptom profiles and logistic regression analyses to identify predictors of cluster membership.Results: We found a three-cluster-solution. The PGD-cluster (30%) was characterised predominantly by PGD symptoms, while the PGD/PTSD-cluster (32%) had high PGD and PTSD and moderate depressive symptoms. The resilient cluster (38%) showed low symptoms overall. insecure residence status predicted membership in the PGD and PGD/PTSD clusters relative to the resilient cluster, whilst higher attachment anxiety predicted membership in the PGD/PTSD cluster relative to the other clusters. Explorative analysis revealed duration of stay as a significant predictor.Conclusion: Findings can extend the current knowledge about different symptom profiles among bereaved ASRs in Europe. Insights to attachment  - and migration-related variables distinguishing between these profiles offer starting points for interventions.

Bereaved asylum seekers and refugees in Germany can be grouped into three symptom clusters: (1) predominantly prolonged grief, (2) high prolonged grief, high posttraumatic stress, and moderate depressive symptoms, and (3) low symptom load.Attachment  ­ and migration-related variables (i.e. residence status, duration of stay, and attachment anxiety) distinguish between cluster membership.Results highlight the importance of attending to profiles and not only single categories of symptoms and attachment features in bereaved asylum seekers and refugees.

Psychological sequelae following second-trimester termination of pregnancy: A longitudinal study.

INTRODUCTION: The decision to terminate a pregnancy due to fetal anomalies can have a significant emotional impact, especially in second-trimester terminations. Previous studies on the psychological consequences of pregnancy termination have had limitations, and little is known about the outcomes for partners and the impact of fetal donation. Therefore, we aimed to investigate the psychological effects of second-trimester pregnancy termination and identify factors associated with outcomes in both women and men, including donation of fetal remains to science. MATERIAL AND METHODS: A longitudinal cohort study was conducted at the Amsterdam UMC in the Netherlands, involving women and partners who underwent termination at or before 23 weeks and 6 days of gestation. Questionnaires were administered at termination, 6 weeks, and 4 months after. We utilized validated questionnaires to assess psychological morbidity (grief, post-traumatic stress and postnatal depression and quality of life [QoL]), and factors that could potentially influence outcomes. RESULTS: Of 241 participants, women displayed more pronounced psychological distress than men, though both groups improved over time. Four months after termination, 27.4% of women and 9.1% of men showed signs of pathological grief. Scores indicative for postnatal depression occurred in 19.8% women and 4.1% of men. A prior psychiatric history was a consistent predictor of poorer outcomes. Fetal donation to the Dutch Fetal Biobank was associated with reduced likelihood of symptoms of complicated grief four months after termination. CONCLUSIONS: Second-trimester termination of pregnancy for fetal anomalies can lead to psychological morbidity, particularly in women. However, there is a notable improvement over time for both groups. Individuals with prior psychiatric history appear more vulnerable post-termination. Also, fetal donation to science did not have a negative impact on psychological well-being.

The Grief Debate, the DSM, and Clinical Practice.

There has been an ongoing debate regarding grief, whether it may be at times pathological, and whether it is different from depression. This article addresses those questions by tracking the changing course of the Diagnostic and Statistical Manuals of Mental Disorders (DSMs) since DSM-III and by reviewing the debate concerning grief and depression. At the time when DSM-III was being prepared in the late 1970s (it was published in 1980), there was a concern that normal bereavement (or grief) was being diagnosed as major depression. To address this concern, the editors of DSM-III added a category of "uncomplicated bereavement." The fourth edition of the DSM (DSM-IV), published in 1994, then followed by a minor change. However, the editors of DSM-5 decided to eliminate the bereavement exclusion entirely. Their concern was simply whether the individual did or did not suffer from major depression. Since an individual might not warrant a diagnosis of major depression but might still be experiencing grief, the DSM discussion leads directly into the question of whether grief-later called prolonged grief disorder-and depression are separate conditions. Advocates for prolonged grief disorder maintained that grief is different from depression but that patients may present with a mix of grief and depressive symptoms that are clinically difficult to distinguish. Advocates of separate conditions have in fact developed an inventory of symptoms that identify prolonged grief disorder. However, inasmuch as a typical grief presentation will include depressive symptoms, the clinical challenge is to distinguish prolonged grief disorder and major depression, as well as to distinguish both from normal grief. Given the temporal limits of an average consultation, this article argues that making the required distinctions is an unrealistic expectation. Finally, researchers have developed specific treatment programs for prolonged grief disorder, but a conflict between the 2 primary researchers involved and the generalities in which the programs are phrased have led to the suggestion of a different approach to treatment that replaces generalities with a person-centered approach.