Perceived social support and symptoms of prolonged grief after a drug-related death.

Social network support can be important when adjusting to life after the death of a close family member or friend. However, research has yielded inconclusive results regarding the relationship between social support and complicated grief reactions. Persons bereaved after a drug-related death (DRD) are a group of people who are at high risk of developing bereavement complications. Based on a Norwegian study on DRD bereaved close family members and friends (n = 250), this study examines the association between perceived social support, societal stigma, own social withdrawal, and prolonged grief symptoms (PGS). Own social withdrawal predicts the most variance in PGS symptoms: 8%, perceived social support: 3%, and societal stigma: 1%. Together the three focal variables explain 17.5% of variations in PGS. Results from the study point to the importance of social network support, which could reduce bereavement complications after a DRD.

Drug-Death Related Bereavement and Social Support.

The loss of a close one to drug-related death (DRD) has been characterized as a form of stigmatized bereavement, and research has shown that there is a high risk of bereavement complications. Social support can be a buffer against bereavement complications, but because of stigma, DRD bereaved persons access to social support can be challenged. Based on data from a Norwegian sample of DRD bereaved persons (N = 252) the present study examines (1) bereaved persons' perceived access to different aspects of social support, and (2) the association between bereaved persons' experiences of societal stigma, own withdrawal, self-blame, and their perceptions of social support. Results show (1) that bereaved persons' access to contact with persons in the same situation is particularly low compared to other support aspects, and (2) that perceived stigma (4%) and own withdrawal (5%) predict variations in drug-related death bereaved persons' perception of social support.

The social health domain of people bereaved by a drug-related death and associations with professional help: A cross-sectional study.

People bereaved by traumatic deaths are vulnerable to long-lasting impairments in social health, including the quality of social relationships and the capacity to manage their social lives. In this Norwegian study involving 255 participants bereaved by a drug-related death, we aimed to investigate their social health and associations with professional help. The results of a cross-sectional survey showed that participants on average rated their social health as poor, though with large variations within the group. Participants who reported high satisfaction with professional help reported significantly higher scores on most social health-related variables. More research is needed on professional help focusing on the social health of traumatically bereaved people.

"How Do Municipal Managers Describe Improving the Services Provided to Drug Death-Bereaved Persons?" a Qualitative Study.

Bereavement following drug-related losses is potentially traumatizing and may cause adverse health outcomes. These bereaved experiences are unacknowledged and omitted in municipal health and welfare service delivery. Reflexive thematic analysis was applied to six focus group interviews with 26 municipal managers. Knowledge about municipal managers' perspectives for improving psychosocial follow-up to drug-death-bereaved persons was perceived as vital for improving the quality of public services. The findings show how the services are perceived to be affected by macro-, meso, and micro-level processes. The participants suggested that service delivery should be based on an integrated organizational approach. Political, organizational, administrative, financial, and communicative processes are addressed and discussed in light of Osborne's theory of public service logic. The managers argue that a broad, contextual frame and infrastructure, enhancing managers' latitude of action regarding employees and facilitating collaborative service flexibility, would provide more sustainable, competent services.

Prevalence and predictors of prolonged grief symptoms among those bereaved from a drug-related death in a convenience sample of Norwegian parents: A cross-sectional study.

Drug-death bereaved parents are at risk of high levels of prolonged grief (PG) symptoms. We included 93 Norwegian drug-death bereaved parents in a cross-sectional survey and aimed to explain PG symptoms. High levels of PG symptoms (M = 30.69) were identified. Low level of self-efficacy and withdrawal from others were the most strongly associated with high levels of grief symptoms (p < .001). However, contrary to our expectations, social support, gender, employment, demanding life situations, and perceived proximity did not correlate significantly to PG symptoms. Our findings can enhance individual follow-up of drug-death bereaved parents.

Does 'Time Heal all Wounds?' The Prevalence and Predictors of Prolonged Grief Among Drug-Death Bereaved Family Members: A Cross-Sectional Study.

Despite rising rates of drug-related deaths (DRDs), the consequences of DRDs for bereaved family members are scarcely investigated. This study aimed to estimate the prevalence of prolonged grief (PG) symptoms in bereaved family members after DRDs, identify predictors of PG and examine whether symptom levels decrease with time. A cross-sectional design based on survey data from parents (n = 93), siblings (n = 78), children (n = 24) and other family members (n = 39) was conducted (n = 234). Descriptive analyses, a multivariate linear regression, and ANOVA were performed. 60 family members (26%) suffered from high levels of PG symptoms after DRDs (parents 31.2%, siblings 21.8%, children 20.9%). The strongest associations were found between a high level of symptoms and 'months since the loss', 'suicidal thoughts' and 'withdrawal from others'. The ANOVA analyses showed that time does not always 'heal all wounds', and the bereaved who lost one to 2 years ago had the highest level of PG symptoms.

Why Informal Support Fails for Siblings Bereaved by a Drug-Related Death: A Qualitative and Interactional Perspective.

Drug-related deaths constitute a significant challenge that strongly impacts the lives of the bereaved and the risks of mental and social problems are well-documented. This paper is the first one to explore how bereaved siblings experience informal support after drug-related deaths. Reflexive thematic analysis is used to analyze ten semi-structured interviews with bereaved siblings. Three main themes were identified: (1) valued support elaborates on the range of desired support and content of the support received; (2) barriers to support were connected to complex family relations, different grief reactions, and stigma, shame, and devaluation; (3) ways to promote support focus on openness and mutual closeness. The discussion revolves around the 'strong' sibling role, complex family relations, stigma, protective silence, and disenfranchised grief. Interactional aspects involved in social support and the importance of addressing this in clinical practice, to utilize the vital support potential for the bereaved experiencing drug-related death, are discussed.

How do family members experience drug death bereavement? A systematic review of the literature.

Despite high rates of drug-related deaths (DRDs), drug-related bereavement has been sparsely investigated. A systematic literature search for qualitative and quantitative studies was conducted. Studies on bereaved DRD family members and systems influencing bereavement were eligible for inclusion. Eight studies were included. Three themes emerged from the thematic analysis (Emotional Roller Coaster, Lack of Understanding by the Social World, and Meaning Making) describing an emotional and existential overload, stigmatization and lack of understanding and help from support systems. The results also shed light on life after the loss. Directions for further research were subsequently outlined.

Long-Term Reactions to the Loss of a Close Friend in an Extreme Terror Incident.

This article presents results from one of the first longitudinal studies exploring the effects of losing a close friend to traumatic death, focusing on complicated grief over time and how this is affected by avoidant behavior and rumination about the loss. The sample consists of 88 persons (76% women and 24% men, mean age = 21) who lost a close friend in the Utøya killings in Norway on July 22, 2011.Quantitative data were collected at three time-points; 18, 28, and 40 months postloss. Main findings are that bereaved friends are heavily impacted by the loss and their grief reactions are affected negatively by avoidant behavior and rumination. This indicates that close bereaved friends are a group to be aware of and that there is a need for better strategies for identifying individuals in need for follow-up.

Early intervention for bereaved children: What mental health professionals think.

People rarely specify what "early intervention" following bereavement means, so we explored the views of experienced professionals working primarily with bereaved children. In an anonymous online survey, 84 mental health professionals answered questions about the content and timeframe of early intervention. The types of interventions varied, but conversation and support were most frequent. Most considered early intervention to mean before or during the first month following the loss. Although meta-analyses show little benefit of early intervention, professionals disagree and see the need to tailor interventions to the type of death, the situation of the family, and the intensity of reactions.

How Do Drug-Death-Bereaved Parents Adjust to Life Without the Deceased? A Qualitative Study.

Knowledge about how bereaved persons grieve can enhance quality in providing the support and potential services that they need. We aimed to identify ways in which drug-death-bereaved Norwegian parents go on with their lives and what inhibits or promotes adaptation during their grieving. Reflexive thematic analysis was used to analyze 14 semistructured in-depth interviews. We generated three themes: (I) processing grief emotions, (II) proactive coping, and (III) giving and receiving support and assistance. Processing guilt rumination, reflections on blame and a burden of grief emotions characterized grieving early on. Using cognitive strategies and functional-support-giving were found to be the most frequently used strategies. Oscillation between processing stressors and reorientation to the world promoted adjustment to ongoing life. We discuss characteristics of parents who struggle to reorient and outline important implications for policy and practice.

Characteristics of the social networks of families living with parental cancer and support provided.

OBJECTIVE: To examine the characteristics of the social networks of families living with parental cancer and the kind of social support they provide compared with what the families report having received. BACKGROUND: Parental cancers are highly distressing for both parents and children. Among other concerns, families report a severe lack of social support. However, we know little about these families' private social networks, nor support provided and received as reported by network members and the family. METHODS: Using a descriptive cross-sectional design, 16 families living with parental cancer and 130 of their network members participated. Healthy parents and network members filled out The Assistance Questionnaire-Receivers of support (AQR)/The Assistance Questionnaire-Providers of Support (AQP). RESULTS: Network members were mainly resourceful friends (44%) and family members (42%). Only 1/3 became supporters at diagnosis, and nearly 50% had to be asked. Supporters provided a variety of types of help, especially emotional support. A match between the perception of the healthy parent and that of the network members was found for provided (p = 0.211) and received (p = 0.741) support. Supporters were satisfied with their provided support, experiencing it as rewarding and associated with few negative aspects. The STROBE checklist for observational studies was followed in reporting the results. CONCLUSIONS: The social networks, being mainly family and friends, were able to provide different types of help, especially emotional support. A useful suggestion may be to involve supporters at an earlier stage, providing more practical support. RELEVANCE FOR CLINICAL PRACTICE: Nurses are in a unique position to promote social support for families living with parental cancer by embracing a network focus, by emphasising the importance and potential of social support, by helping families to map their network and by teaching them how to be explicit in their requests for support.

The Role of Self-Esteem in Suicides Among Young Men.

This study explores self-esteem in suicide among young males with no earlier history of suicide attempt(s) or treatment in mental health services. The data come from an ongoing psychological autopsy study; 10 cases of young men aged 18 to 30, were selected to generate a phenomenologically based understanding of the psychological mechanisms and processes involved in the suicidal process. The analyses are based on in-depth interviews with 61 closely connected individuals, as well as suicide notes. We used Interpretative Phenomenological Analysis. For these young men, the transition to young adulthood, a period of major life challenges, seemed to be associated with personal defeats. According to their significant others, the deceased seemed to have experienced intolerable discrepancies between their actual performances and their ideal self standards. Four themes emerged from the analysis: (a) striving to find a viable path to life as an adult man; (b) experiencing a sense of failure according to own standards; (c) emotional self-restriction in relationships; and (d) strong feelings of loneliness and rejection of self. Improved understanding of suicides outside the mental illness paradigm may have important implications for preventive strategies.

What distinguishes prolonged grief disorder from depression? / Hva skiller forlenget sorg-forstyrrelse fra depresjon?

Prolonged grief disorder, which is proposed as a new diagnosis in ICD-11, and depression have some similarities but also several key differences. In order to provide the correct help and treatment, it is important for doctors to be able to ascertain whether a person is struggling with prolonged grief or has become depressed following the loss of a loved one.

Parents' Perception of Their Relationship Following the Loss of a Child.

It is known that if one partner wants to talk after the loss of a child, while the other does not, the less satisfied they are with the relationship. The aim of this study was to increase our understanding of parental relationships following the loss of a child. A questionnaire on various aspects of the relationship was sent to 1,027 members of bereavement support organizations for parents who have lost children in Norway. The studied sample ( N = 285) consisted of 169 women (59.3%) and 116 men (40.7%), representing 175 couples. Although the participants were generally satisfied with their relationship and felt that it was strengthened, there were challenges of communication and interaction. The loss made the relationship special, and they felt they had learned to know each other on a deeper level. The importance of talking together and communicating thoughts and feelings was emphasized by the parents. Women initiated talk more often and evidenced a greater need to talk. A deterioration of the relationship tended to be related to a lack of understanding, communication, and care. Communication, respect, and understanding were underlined as core factors for perceiving a relationship as positive.

Young Road Fatalities.

This study presents the findings from in-depth interviews with 24 people from 15 families in Norway who lost their young son or daughter in a traffic accident. Their grief has several dimensions: the loss of a young life, the loss of life quality, the effect on family events and their meaning, and the new responsibilities brought onto family members. For each young fatality, many relatives and friends are affected with a wide range of emotional and socioeconomic consequences. Parents report that grief is more overwhelming during the first few years and never disappears, while over the years they slowly learn to cope with it. Here we especially highlight the role of traffic authorities and what professional actors can do to meet the bereaved with empathy and minimize negative effects.

Grief and Traumatic Grief in Children in the Context of Mass Trauma.

Children who have had someone close die as a result of a mass trauma event such as war, armed conflict, acts of terror, political violence, torture, mass accidents, and natural disasters are at risk for biopsychosocial problems. Research on how to classify when grief becomes complicated or traumatic in children is scarce, and while functioning level may provide a good indication, assessing functioning may be difficult in mass trauma environments where routines and structure are often lacking. There are promising trauma- and grief-focused interventions for children post-mass trauma, which are mostly provided in school settings. However, more advanced multi-method interventions are needed that address grief and trauma in the context of the child's overall mental health, parent/caregiver role in assisting the child, family system issues, ways to provide safe caring environments amidst chaos and change, and interventions that take into account local consumer perspectives, including the voices of children.

Suicide-bereaved siblings' perception of health services.

The authors investigated suicide-bereaved siblings' reported reasons for seeking or not seeking professional support, their reported satisfaction when receiving it, and their recommendations to health services when meeting suicide-bereaved siblings. Using qualitative content analysis of 18 interviews with suicide-bereaved siblings, the authors found that the perception of health services as being helpful was influenced by both the participants' and by the deceased siblings' experiences with health services. They conclude that the bereaved sibling's and the deceased sibling's unmet needs may generate negative attitudes toward health services, which reduces the likelihood of seeking professional help as well as medication acceptance in some cases.

Barriers and facilitative factors in the provision of first-responder services to persons bereaved following a drug-related death: A qualitative study.

Aim: To broaden our knowledge from the perspective of municipality first-responder services of what prevents and what facilitates the provision of professional assistance to the bereaved after a drug-related death during the acute phase. Method: A reflexive thematic analysis was applied in six focus group interviews with 27 first-responder personnel in Norway. Results: The acute phase presented a challenging and complex support situation. We identified two main barriers: failure to initiate services and difficulties meeting with bereaved persons who use drugs. Facilitative factors were associated with competence and proactive cooperation. We discuss the findings in light of associated stigma, disenfranchised grief and an ecological approach to public services. Conclusion: First-responder professionals must understand drug-related death as a potentially traumatising event and initiate the procedures set out in the national guidelines. To achieve this, first-responder health and welfare services must become more knowledgeable about drug-related loss and bereavement, acute grief reactions and the need for psychosocial follow-up.