Living with spousal loss: Continuing bonds and boundaries in remarried widows' marital relationships.

The grief literature emphasizes widows' continuing bonds with their deceased spouses as a significant part of their grief process. Yet, little is known about what happens to those bonds when a widow remarries and there is a second spouse, and how these bonds are dealt with by the new family members. This study explored the continuing bonds of remarried Israeli widows, the role the second spouse plays in these processes, and the ambiguity and permeability of the boundaries between the first and the second marital relationships. Semi-structured interviews were conducted with 29 Israeli remarried military widows, over three decades after their first husbands' deaths. Data were analyzed by using thematic content analysis. Findings revealed that most of the women maintained continuing bonds with their deceased husbands, whereas a few of them severed these bonds. In all of the scenarios, however, the second husband played a major role, resulting in different levels of boundaries, from strict to blurred, between the first and the second marriages. These findings suggest that in order to obtain a full understanding of grief's impact on the second marital relationship, grief should be considered a couple-hood process in which the boundaries between the relationships are dynamic. The association between these patterns and personal and marital adjustment should be further explored.

En las publicaciones sobre el duelo se hace hincapié en que las viudas continúen los vínculos con sus cónyuges fallecidos como una parte importante de su proceso de duelo. Sin embargo, se sabe poco acerca de lo que sucede con esos vínculos cuando una viuda vuelve a casarse y hay un segundo cónyuge, y acerca de cómo los nuevos miembros de la familia manejan estos vínculos. En este estudio se analizó la continuidad de los vínculos de viudas israelíes que volvieron a casarse, el papel que desempeña el segundo cónyuge en estos procesos y la ambigüedad y la permeabilidad de los límites entre la primera y la segunda relación conyugal. Se realizaron entrevistas semiestructuradas con 29 viudas de militares israelíes que volvieron a casarse durante tres décadas después de la muerte de su primer marido. Los datos se analizaron usando el análisis de contenido temático. Los resultados revelaron que la mayoría de las mujeres mantuvieron la continuidad de los vínculos con los familiares de sus maridos fallecidos, mientras que algunas los cortaron. Sin embargo, en todas las situaciones, el segundo marido desempeñó un papel importante y hubo diferentes niveles de límites, desde definidos hasta desdibujados, entre el primer matrimonio y el segundo. Estos resultados indican que, con el fin de comprender completamente el efecto del duelo en la segunda relación conyugal, el duelo debe considerarse un proceso de pareja en el cual los límites entre las relaciones sean dinámicos. Deberá analizarse más profundamente la asociación entre estos patrones y la adaptación personal y conyugal.

Meaning Co-Construction: Facilitating Shared Family Meaning-Making in Bereavement.

Meaning-oriented approaches to grief therapy have made substantial contributions by defining the internal processes of meaning-making and, more recently, clinical scholars have introduced relational approaches as means for continuing bonds with the deceased and increasing social support for the bereaved. However, the complicated interactive processes of interpersonal meaning-making pose added challenges as family members attempt to coregulate each other's grief experiences. While systemic therapists have consistently emphasized the essential role of familial relationships in fostering resilience through interpersonally constructed meaning, there remains a need for clarity in terms of the specific processes by which this occurs. The Meaning Reconstruction Model and Emotionally Focused Therapy provide process-oriented therapeutic strategies for facilitating interpersonal interactions that foster deep relational connection and self-identity transformation. In this article, we explore how these models can be integrated and applied to the dynamic needs of families who are adjusting to loss. Future clinical and research directions are also discussed.

Los enfoques de la terapia de duelo orientados al significado han hecho aportes significativos mediante la definición de los procesos internos de la creación de significado y, más recientemente, los investigadores clínicos han incorporado enfoques relacionales como medio para continuar los vínculos con el fallecido y aumentar el apoyo social para el doliente. Sin embargo, los complicados procesos interactivos de la creación de significado interpersonal plantean nuevos desafíos mientras los familiares intentan corregular las experiencias de duelo de cada uno. Si bien los terapeutas sistémicos han enfatizado uniformemente el papel fundamental que desempeñan las relaciones familiares a la hora de fomentar la resiliencia mediante un significado construido interpersonalmente, queda la necesidad de aclarar los procesos específicos por los cuales esto ocurre. El modelo de reconstrucción de significado y la terapia centrada en las emociones ofrecen estrategias terapéuticas orientadas al proceso para facilitar interacciones interpersonales que fomentan una conexión relacional profunda y la transformación de la identidad propia. En este artículo, analizamos cómo estos modelos pueden integrarse y aplicarse a las necesidades dinámicas de las familias que se están adaptando a una pérdida. También se comentan las direcciones clínicas y científicas futuras.

Dyadic Relationships between a Surviving Parent and Children in Widowed Families: A Systematic Scoping Review.

The death of a family member affects not only individual family members but also their relationships and interactions. Grief has been studied mostly as an intrapersonal experience. Adopting the family perspective, this systematic scoping review focused on parent-child relationships in widowed families so as to identify what is already known on this topic and the research gaps for future study. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Four databases (Web of Science, Psycinfo, PubMed, and CINAHL Plus) were searched. Search terms were combinations of two concepts: (1) loss of a parent (20 terms) and (2) parent-child (eight terms). 5,419 studies were identified during the search, of which 36 studies were included in the review following two rounds of screening. Four research themes emerged, and the aggregated findings were identified: (a) The surviving parent and children are likely to become closer following the loss of a parent, while other relevant factors need to be taken into account; (b) Better parent-child relationships play a protective role in children's adjustment to loss; (c) The surviving parent and children's adjustment to loss are interdependent; (d) Through parenting, communication style, coping strategy, and other attributes, the surviving parent can influence their children's adjustment. Gender and age differences were identified in parent-child relationships. The findings further justify the importance of a family perspective when conducting research and practice on bereavement. Several research gaps were identified. Existing studies paid insufficient attention to children's agency and bidirectional relationships, and the interaction process and its role underlying parent-child bidirectional causality. A conceptual framework of parent-child relationships in widowed families is proposed based on these findings.

La muerte de un miembro de la familia afecta no solo a los miembros individuales de la familia, sino también sus relaciones e interacciones. El duelo se ha estudiado habitualmente como experiencia intrapersonal. Adoptando la perspectiva familiar, esta revisión sistemática exploratoria se centró en las relaciones entre progenitor e hijos en familias donde había fallecido uno de los progenitores con el objetivo de identificar lo que ya se sabe sobre este tema y las deficiencias en las investigaciones para futuros estudios. La revisión sigue las pautas de la extensión para revisiones sistemáticas exploratorias de los Ítems de Referencia para Publicar Revisiones Sistemáticas Exploratorias y Metaanálisis (PRISMA-ScR). Se realizaron búsquedas en cuatro bases de datos (Web of Science, Psycinfo, PubMed y CINAHL Plus). Los términos buscados fueron combinaciones de dos conceptos: (1) pérdida de un progenitor (20 términos) y (2) progenitor-hijo (ocho términos). Se identificaron 5419 estudios durante la búsqueda, de los cuales 36 se incluyeron en la revisión después de dos rondas de selección. Surgieron cuatro temas de investigación y se indicaron los resultados colectivos: a. El progenitor superviviente y los hijos tienden a desarrollar un vínculo más estrecho después de la muerte del otro progenitor, si bien es necesario tener en cuenta otros factores relevantes; b. Una mejor relación entre progenitores e hijos desempeña un papel protector en la adaptación de los hijos a la pérdida; c. La adaptación a la pérdida del progenitor superviviente y de los hijos es independiente; d. Mediante la crianza, el estilo de comunicación, la estrategia de afrontamiento y otros atributos, el progenitor superviviente puede influir en la adaptación de sus hijos. Se identificaron las diferencias de género y de edad en las relaciones entre progenitores e hijos. Los resultados justifican además la importancia de una perspectiva familiar a la hora de llevar a cabo investigaciones y prácticas sobre la pérdida de un ser querido. Se detectaron varias deficiencias en las investigaciones. Los estudios existentes prestaron poca atención a la voluntad de los hijos y a las relaciones bidireccionales, así como al proceso de interacción y su papel detrás de la causalidad bidireccional entre progenitores e hijos. Sobre la base de estos resultados, se propone un marco conceptual de relaciones entre padres e hijos en familias donde falleció uno de los progenitores.

Immigrants Coping with Transnational Deaths and Bereavement: The Influence of Migratory Loss and Anticipatory Grief.

This study examines immigrants' experiences of bereavement and coping with the deaths of family members in a transnational context. Data were collected through in-depth personal interviews with middle-aged and older immigrants from different countries of origin, who have been living in the United States for a majority of their adult lives. Thematic analysis of participants' narratives showed that immigrants' geographic distance from family complicated caregiving circumstances and rituals surrounding burial, and impacted the grieving process. At the same time, this distance also served as an emotional barrier and provided protection from prolonged grief. Immigrants' U.S.-based family and work responsibilities served as buffers from prolonged grief. Over time, immigrants became Americanized in their attitudes toward coping with death and favored a fast return to productive activities. Finally, immigrants' experience of migratory loss and anticipatory grief early in immigration, along with their personal growth and resilience developed over time, impacted their bereavement experiences later in life. Considering the limitations and the exploratory nature of the present study, further research is needed to investigate the specifics of coping with loss and bereavement among immigrants.

"We Hardly Ever Talk about It": Emotional Responsive Attunement in Couples after a Child's Death.

Within Western cultural traditions, the idea that parents should talk about the death of their child with each other is deeply rooted. However, across bereaved parent couples there are wide variations in communication about their grief with each other. In this study, we explored the experiences of bereaved couples related to the process of talking and not talking. We used a thematic coding approach to analyze 20 interviews with 26 bereaved parents (11 interviewed as couples, four as individuals). Four main meanings emerged out of our analysis: not talking because of the inadequacy and pointlessness of words in grief, not talking as a way to regulate emotions in daily life, not talking as an expression of a personal, intimate process, and not talking because the partner has the same loss but a different grief process. In addition, we found that the process of talking and not talking can partly be understood as an emotional responsive process on an intrapersonal and interpersonal level. In this process partners search for a bearable distance from their own grief and their partner's, and attune with their relational context. A better understanding of this process is sought in a dialectical approach, emphasizing the value of both talking and not talking in a tense relationship with each other. Implications for clinical work are described.

Development of a self-management mobile app for bereaved adolescents: evaluating patient and public involvement.

Background: Losing a family member during childhood is a potentially traumatic event and increases the risk of mental health difficulties. Adolescents have the right to express their views in research of relevance to them, but few studies have involved bereaved adolescents as collaborators (i.e. Patient and Public Involvement (PPI)). Furthermore, to ensure meaningful and non-tokenistic involvement, bereaved adolescents' levels of participation and experiences of taking part in research need to be evaluated.Objectives: The aim was to describe and evaluate a PPI process working with bereaved adolescents to develop a self-management mobile app for adolescents in grief.Methods: The PPI process consisted of four workshops during which the app's logo, colours, name, content, and layout were discussed with six parentally bereaved adolescents aged 13-18 years. The adolescents were recruited through a non-profit organisation providing support for adolescents in grief. The PPI process was documented and evaluated using participant observations and an online survey completed by the adolescents, covering the themes of social context, participation, and influence.Results: The adolescents perceived the social context as comfortable and inclusive, where their knowledge was valued. Their participation was characterised by ownership and motivated by a desire to help others with similar experiences. The adolescents' ability to participate in PPI activities was assisted by the researchers' flexibility, although challenging assignments may have made participation harder. Throughout PPI activities, adolescents contributed with relevant input and reported feeling influential. The study reached the intended levels of participation and appeared to adequately fulfil the adolescents' right to participation.Conclusions: Engaging adolescents who have undergone a potentially traumatic event, such as the loss of a family member, in research can enhance the overall relevance of the study. Moreover, it can entail a meaningful and positive experience for the participating adolescents, while also fulfilling their fundamental right to participation.

A collaborative process with parentally bereaved adolescents to develop a psychosocial self-management mobile app for adolescents in grief was described and evaluated.Adolescents made significant contributions, took ownership, and experienced having influence over the decisions made, which increased the relevance of the intervention.The collaborative process reached the intended level of participation and created a positive and meaningful experience for the adolescents.

Somatic symptoms and insomnia among bereaved parents and siblings eight years after the Utøya terror attack.

Background: Levels of prolonged grief symptoms (PGS) and post-traumatic stress symptoms (PTSS) can be high, many years following bereavement after terror, but knowledge concerning somatic health is scarce. Terrorism is a serious public health challenge, and increased knowledge about long-term somatic symptoms and insomnia is essential for establishing follow-up interventions after terrorism bereavement.Objective: To study the prevalence of somatic symptoms and insomnia and their association with PGS, PTSS, and functional impairment among terrorism-bereaved parents and siblings.Methods: A cross-sectional quantitative study included 122 bereaved individuals from the Utøya terror attack in Norway in 2011. The sample comprised 88 parents and 34 siblings aged 19 years and above (Mage = 49.7 years, SDage = 13.8 years, 59.8% females). The participants completed questionnaires 8 years after the attack assessing somatic symptoms (Children's Somatic Symptoms Inventory) and insomnia (Bergen Insomnia Scale) along with measures of PGS (Inventory of Complicated Grief), PTSS (Impact of Event Scale-Revised), and functional impairment (Work and Social Adjustment Scale).Results: Fatigue was the most frequently reported somatic symptom (88% of females and 65% of males). Females reported statistically significantly more somatic symptoms than males. In total, 68% of the bereaved individuals scored above the cut-off for insomnia. There were no statistically significant gender differences for insomnia. Female gender, intrusion, and arousal were associated with somatic symptoms. Intrusion and somatic symptoms were associated with insomnia. Somatic symptoms, avoidance, and hyperarousal were associated with functional impairment.Conclusion: Many bereaved parents and siblings report somatic symptoms and insomnia eight years after the terror attack. Somatic symptoms are associated with functional impairment. Long-term follow-up and support after traumatic bereavement should focus on somatic symptoms and insomnia.

Many bereaved individuals, especially females, reported insomnia and somatic symptoms, including fatigue, pain, and other related symptoms.Somatic symptoms, avoidance, and hyperarousal were identified as being associated with functional impairment among the bereaved.Post-traumatic stress symptoms played a more significant role than prolonged grief symptoms in explaining the reduced physical health experienced by the bereaved.

[Association between therapeutic adherence and phases of grief in patients with type 2 diabetes mellitus]. / Asociación entre la adherencia terapéutica y las fases de duelo en pacientes con diabetes mellitus tipo 2.

OBJECTIVE: To evaluate the association between therapeutic adherence and the phases of grief in patients with type 2 diabetes mellitus. DESIGN: Cross-sectional observational study. SITE: Family Medicine Unit No. 53 of the Mexican Institute of Social Security in the State of Guanajuato. PARTICIPANTS: A total of 354 patients with type 2 diabetes mellitus were recruited, of whom 236 corresponded to the group without therapeutic adherence and 118 to the group with therapeutic adherence. INTERVENTIONS: Two structured surveys were administered to both groups. MAIN MEASUREMENTS: The Morisky 8 scale was used to measure therapeutic adherence and the phases of grief scale (EFD-66) to measure grief due to loss of health. RESULTS: The median denial phase and depression phase scores were higher in the nonadherence group than in the adherence group (p=.000). The median negotiation phase and acceptance phase score was higher in the adherence group than in the nonadherence group (p=.000). Multivariate analysis identifies that denial is the main factor associated with non-adherence (OR=1.25; 95% CI: 1.14-1.37); while negotiation (OR=0.88; 95% CI: 0.82-0.94) and acceptance are associated with adherence (OR=0.79; 95% CI: 0.75-0.83). CONCLUSIONS: There is an association between therapeutic adherence and phases of grief.

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.

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.

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.

Healing grief - an online self-help intervention programme for bereaved Chinese with prolonged grief: study protocol for a randomised controlled trial.

Background: In China, mental health services do not currently meet the needs of bereaved people with symptoms of prolonged grief disorder (PGD). Internet-based grief interventions may help fill this gap, but such programmes have not yet been developed or evaluated in China. The proposed study aims to investigate the effectiveness, acceptability, and feasibility of an online self-help intervention programme named Healing Grief for bereaved Chinese with prolonged grief, and to explore the psychological mechanisms of potential improvements.Methods: We designed a two-arm randomised controlled trial. At least 128 participants will be randomly assigned to either an Internet-based intervention group or a waitlist-control group. The Internet-based intervention will be developed based on the dual process model, integrating techniques of psychoeducation, behavioural activation, cognitive reappraisal, and meaning reconstruction, and will be delivered via expressive writing. The intervention comprises six modules, with two sessions in each module, and requires participants to complete two sessions per week and complete the intervention in 6 weeks. The primary outcomes include effectiveness, acceptability, and feasibility. The effectiveness will be assessed by measures of prolonged grief, posttraumatic stress, anxiety, and depressive symptoms. Acceptability and feasibility will be evaluated using survey and interview on user experience characteristics. Secondary outcomes include moderators and mediators, such as dual process coping, grief rumination, mindfulness, and continuing bond, to explore the psychological mechanisms of potential improvement. Assessments will take place at pre-intervention, post-intervention, and 3-month follow-up.Conclusion: The proposed study will determine the effectiveness, acceptability, and feasibility of the newly developed online self-help intervention for bereaved Chinese with prolonged grief and clarify how the intervention helps with symptom improvements. Such an intervention may play an important role in easing the imbalance between the delivery and receipt of bereavement psychological services in China.

In China, mental health services are not widely available for bereaved people.The proposed study will be the first one to develop and evaluate an Internet-based self-help grief intervention for bereaved Chinese with prolonged grief.The proposed study will determine whether and how the intervention helps to improve the mental health of bereaved Chinese with prolonged grief.

Nursing care plan for dealing with perinatal bereavement according to the theory of dysfunctional bereavement. Clinical case.

We present the clinical case report on a 33-year-old woman who, after a perinatal death, presented a complicated grieving process. The aim was to apply an individualised care plan that enabled reestablishment of the woman's emotional balance and environment after an experience of perinatal death. During the first visit to her midwife, the Athens Insomnia, Continuity Bonds and Goldberg Anxiety and Depression scales were applied. Focussed assessment was made using the Gordon patterns and based on the nursing approach described in the Dysfunctional Bereavement Theory. Six International NANDA diagnostic labels were identified (maladaptative grieving, insomnia, hopelessness, ineffective mothering process, moral distress and anxiety), and these were prioritised using clinical network reasoning, using the Outcome Present State Test (OPT) model, observing the relationships between the labels, diagnoses and identifying how they affected the rest. For each International NANDA diagnostic labels, the nursing outcomes were planned, along with the planned nursing interventions. The expected results included the description of the evaluation indicators using the Likert scales. Both results and interventions were agreed between the professional and the mother. The care plan raises the difficulty that nursing professionals face when attending to situations of complicated grief, and specifically, those associated with perinatal death. This situation makes key competencies necessary in training, as well as the need to find out about new nursing approaches.

The semiology of migration.

INTRODUCTION: The phenomenon of migration generates a series of experiences in the human being that are translated into emotions, feelings, adaptation processes, grief and psychopathological processes, and even pathological expressions, represented by clinical pictures of different kinds. OBJECTIVE: The purpose of this article is to carry out a conceptual and clinical reflection on the semiology around the concept and experience of migration, in order to illustrate the complexity that it entails as a human phenomenon. METHODS: A reduced narrative review, circumscribed and restricted to the semiological, psychopathological and clinical aspects of migration. DISCUSSION: The separation, ruptures and losses that derive from migration do not go unnoticed by the individual. They are inscribed in his/her corporality as physiological injuries that affect his/her life and as symbolic injuries that affect his/her existence. CONCLUSIONS: Migration supposes a rupture of the totality of being. The context, the perception of others and relationships are cut off from the total unity that is the individual, as if he/she lost half of him/herself.

Nursing care in perinatal grief. A systematic and critical review of attitudes and knowledge in clinical practice.

AIM: To review and synthesize the available evidence on the attitudes and knowledge of nurses regarding the perinatal grief of the parents. METHODS: A systematic review of original articles published from January 2016 to February 2023 without language limit in the Scopus, PubMed, Cinahl, PsycINFO, ScienceDirect and Web Of Science databases was carried out. The Prisma Statement methodological framework was used for systematic reviews and meta-analyses. The entire process was carried out in pairs, with discrepancies being resolved by a third reviewer. The quality of the articles was evaluated following the CASPe criteria (Critical Appraisal Skills Program Spanish). RESULTS: Twelve articles were obtained in this review after applying the inclusion criteria, of which. Except for one cross-sectional quantitative study (8.33%), the rest were qualitative studies carried out through interviews (75%) or discussion groups (16.66%). It is highlighted that there are different biopsychosocial problems related to the care needs demanded by the family and that, due to poor training or culture of the health professional, are not adequately addressed. DISCUSSION: The studies found show various resources to adequately attend to perinatal grief, there being discrepancies in relation to allowing or not allowing the body of the deceased baby to be shown and/or taken; There are also disagreements regarding whether the healthcare team should base its practice on protocols or theories such as the Kubler-Ross theory of grief. Most of the studies (75%) consider that more training and awareness is necessary, contemplating the biopsychosocial nature of the user.

Experiences of grief and moral sentiments in survivors of the armed conflict in Medellín, Colombia.

The objective of the study is to understand the experience of grief and moral sentiments in survivors of the armed conflict in the city of Medellín, Colombia, through qualitative research. In total, 32 people affected by different victimising acts in the context of the armed conflict participated. There is a direct relationship between moral sentiments and the processes of handling and processing loss. Moral sentiments frame the experience of emotions in the victim, after the events have occurred, which influence the way in which the pain experienced is processed. These sentiments permeate the processes of dealing with the incident in survivors, the ways in which they perceive themselves and the perpetrators, and the social stances they adopt to face life. We conclude that moral factors play a role in the emotional recovery of victims and are indicative the possibility or difficulty of processing the events that occurred.

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

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.

Grief and delivering a statement in court: a longitudinal mixed-method study among homicidally bereaved people.

Background: Participating in a criminal trial may increase the likelihood of developing psychopathology. In 2021, people bereaved by a plane disaster (flight MH17) had the opportunity to deliver a victim personal statement (VPS) in Dutch court.Objective: This longitudinal mixed-method study examined different aspects of 84 bereaved people's experiences with VPS delivery.Method: Motivations to deliver, or not deliver, an oral VPS were examined qualitatively using thematic content analysis. Whether background and loss-related variables were related to the decision to deliver a VPS was examined using binary logistic regression analyses. Between-group (delivered VPS vs. did not) and within-group (pre- vs. post-VPS) comparisons were made regarding prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression levels using t-tests and paired t-tests.Results: Bereaved people were most frequently motivated to deliver an oral VPS to describe the impact of the incident, while those who did not deliver an oral VPS commonly wanted to protect themselves from the perceived emotional burden. None of the correlates - i.e. biological sex, age, level of education, number of losses, and (closest) relationship to the deceased - were related to the decision to deliver a VPS. Lastly, significantly higher PGD, PTSD, and depression levels were reported by people who delivered a VPS than those who did not, before and after the court hearing. No significant within-group differences were found over time.Conclusions: Professionals may provide emotional support to bereaved people who want to deliver a VPS and manage their expectations if they want to deliver a VPS for the purpose of symptom reduction. Future research may benefit from examining other ways in which VPS delivery might have beneficial or detrimental effects for specific individuals. Overall, implementing VPS delivery in court on the basis of emotional restoration remains empirically unsupported, if defined as a reduction in psychopathological levels.

We are the first to examine if statement delivery changes grief-related distress.Statement delivery did not significantly change grief-related distress.Defining emotional restoration as a decrease in psychopathology remains unsupported.

'Feeling disconnected' - risk factors for PGD and themes in grief counselling during the COVID-19 pandemic. A mixed-method study.

Background: Due to its high death toll and measures to curb the pandemic, COVID-19 has affected grieving experiences and may contribute to risk factors for Prolonged Grief Disorder (PGD). Persons at risk for PGD often seek support from grief counselling.Objective: To explore whether pandemic-associated risk factors have become more important topics in counselling in a mixed-method design.Method: German grief counsellors (n = 93) rated whether pre-defined risk factors had become more important in grief counselling and indicated additional important themes in an open format.Results: The counsellors indicated that all pre-defined risk factors had become more important, though differing significantly in their frequency. Most frequently endorsed risk factors were lack of social support, limited possibilities to accompany a dying loved one and absence of traditional grief rituals. Qualitative analysis identified three additional themes: the societal impact of the pandemic, its impact on bereavement support and health care, and a chance for personal growth.Conclusions: The pandemic has affected bereavement experiences and grief counselling. Counsellors should monitor grief processes and specific risk factors to provide the best possible care for bereaved people when needed.

Pandemic-associated risk factors for PGD have become more important topics in grief counselling during COVID-19.Risk factors include especially a lack of social support, limited possibility to accompany a dying significant other and absence of traditional grief rituals.Future research is needed to investigate whether monitoring and addressing these risk factors can improve bereavement care.

Co-occurrence of approach and avoidance in prolonged grief: a latent class analysis.

Background: Prolonged grief disorder (PGD) has been included in the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR). Loss-related avoidance behavior perpetuates grief and effective interventions for prolonged grief symptoms target such avoidance behavior. Yet, behaviors characterized by approach of loss-related cues (i.e. rumination, yearning, proximity seeking) are also implicated in prolonged grief reactions.Objective: To solve this paradox, we will test the Approach Avoidance Processing Hypothesis, which holds that loss-related approach and avoidance behaviors co-occur in PGD, using latent class analyses (LCA).Methods: Two-hundred eighty-eight bereaved adults (92% female) completed questionnaires assessing loss-related approach behaviors (rumination, yearning, proximity seeking), loss-related avoidance behaviors (anxious avoidance, experiential avoidance) and ICD-11 and DSM-5-TR prolonged grief symptoms.Results: LCA demonstrated the best fit for a three-class solution comprising a low approach/low avoidance class (n = 98, 34%), a high approach/low avoidance class (n = 79, 27%), and a high approach/high avoidance class (n = 111, 39%). The latter class showed significantly higher prolonged grief symptom levels and higher odds of probable PGD compared to the other classes.Conclusions: Co-occurrence of loss-related approach and avoidance appears characteristic to prolonged grief reactions. Distinguishing bereaved people with these behavioral patterns from those solely experiencing loss-related approach behaviors may improve the efficacy of PGD therapies.

A latent class analysis of bereaved adults showed high approach/high avoidance, high approach/low avoidance and low approach/low avoidance classes.The high approach/high avoidance class showed highest prolonged grief symptoms and higher odds of probable prolonged grief disorder.Co-occurrence of loss-related approach and avoidance appears to characterize prolonged grief.