Disenfranchised Grief: Which Grieving Rules Do German Mid-adolescents Hold?

Every society adheres to grieving rules that govern how people experience loss and grief. These are rarely communicated explicitly, which can lead to insecurities in dealing with one's own grief and the grief of others. This is particularly true for adolescents. Based on Doka's concept of disenfranchised grief, this study explores the grieving rules of mid-adolescents. Cross-sectional data collection took place in November and December 2022 at six secondary schools in Germany. A total of 226 adolescents predominantly aged between 14 and 16 years completed the questionnaire. The analysis of the data shows that in some respects, mid-adolescents have similar grieving rules as adults. However, they are more inclusive when it comes to losses of ex-partners, pets and people with intellectual disabilities. Possible sources of (self-)disenfranchisement are parasocial relationships and the duration of grief. Open communication about grieving rules is suggested to prevent possible disenfranchisement.

Correction to: Religiosity/Spirituality and Mental Health: A Meta-analysis of Studies from the German-Speaking Area.

The original version of the article contained an error in the values of Table 1.

Religiosity/Spirituality and Mental Health: A Meta-analysis of Studies from the German-Speaking Area.

The meta-analysis presented here investigates the relationship between religiosity/spirituality (R/S) and mental health based on 67 studies from the German-speaking area (Germany, Austria, Switzerland). The weighted average correlation is .03 (95% CI [.01, .05]), indicating that a greater R/S is minimally but significantly associated with better mental health. The results are moderated by the type of R/S measure: negative R/S types correlate - .20 with mental health, whereas other R/S measures exhibit small positive associations. In comparison with US-American meta-analyses, the average effect size is lower, and the associations between negative R/S types and lower mental health are particularly strong.

[When the diagnosis came in Bereavement care in Germany in 2020/2021: Where do we stand?] / Als die Diagnose kam Wo steht die deutsche Trauerversorgung im Jahr 2020/2021?

BACKGROUND: In Germany, numerous health care providers work in the field of bereavement care. An epidemiological study of the field immediately after the introduction of the ICD-11 diagnosis "Prolonged Grief Disorder" (PGD) is pending. METHODS: The second survey of the trend study, which is designed over a total of three measurement points at intervals of one decade each, explores whether and to what extent the field of bereavement care has evolved after the introduction of the grief-specific diagnosis PGD. For this purpose, providers of bereavement care at various organizational levels were asked to participate in an online survey. The survey was conducted from October 2020 to January 2021. RESULTS: 456 questionnaires were included in the study. Data analysis was descriptive. 80.5% of the participants have an additional grief-specific qualification, 59.4% base their work on a grief-specific concept. In view of the PGD diagnosis, only a few respondents have participated in a PGD-related advanced training. Most are afraid that the topic of grief will increasingly be subsumed in the medical-psychological-therapeutic field. An increase in bereavement research and the number and quality of continuing education is also expected. DISCUSSION: Some positive trends in German bereavement care can be identified. However, there is a need for further development in the areas "designation of the activity", "diagnostics", and "intervention". Also, there is a need for training with regard to PGD. CONCLUSION: After the introduction of PGD, the field of bereavement care in Germany turns out to be slightly different. The diagnosis is viewed skeptically.

[Before the diagnosis was established A retrospective analysis of bereavement care in Germany]. / Bevor die Diagnose kam Eine Retrospektive der Trauerversorgung in Deutschland.

INTRODUCTION: In Germany, many health care providers work in bereavement care. An epidemiological study of this field of work has not yet been conducted. METHODS: In the initial survey of this three-phase trend study the situation of grief-specific health care in Germany in 2009/2010 is examined, i. e., at the time before the introduction of the new ICD-11 diagnosis of Prolonged Grief Disorder. For this purpose, bereavement care providers at different organizational levels participated in an online survey. RESULTS: 410 questionnaires were included in the study. Data analysis was descriptive. The most frequent reason for using grief-specific support services was the loss of a partner. In more than half of all cases of bereavement, people experienced a loss that was preceded by an illness and suffering. More than half of those providing bereavement care do not follow a concept of intervention. DISCUSSION: There is considerable need for further development in German bereavement care, in particular with regard to qualification and the degree of professionalization, designation of the respective interventions, diagnostics, and intervention. CONCLUSION: This three-phase trend study enables health care providers to derive bereavement care service standards that aim to treat people according to their needs. Whether the diagnosis of Prolonged Grief Disorder has led to changes in bereavement care is currently analyzed in the second survey phase of the study.

The 'smallest real difference' as a measure of sensitivity to change: a critical analysis.

If assessment instruments are used to measure efficacy or effectiveness, for example of rehabilitation programmes, they have to be sensitive (or responsive) to change. However, up to now there has been no consensus on what coefficient should be used for this end. Various effect sizes and criterion measures are widely acknowledged; tests of inferential statistics are also still used. The different coefficients may well provide different rank ordering of competitive instruments. Recently, the so-called 'smallest real difference' (SRD) was proposed as a measure of sensitivity to change. In the original formulation, the SRD was defined as the 95% confidence limit of the standard error of measurement (SEM) of the difference scores. Conceptually this is equivalent to what is known as the 'reliable change index' in psychotherapy research. The absolute values of the SEM/SRD indicate measurement error. In our view, this is merely complementary to the reliability concept and not a measure of sensitivity to change. Instead, we suggest using the percentage of patients reaching the SRD criterion to compare the sensitivity to change of competitive instruments. In contrast to other sensitivity-to-change indices, such an approach takes the different reliabilities of competitive assessment instruments explicitly into account.

Positive and negative religious coping in German breast cancer patients.

A growing interest has been focusing on the relationship between religious coping and psychosocial adjustment among cancer patients. However, previous research mostly has not differentiated between positive and negative components of religious coping. The current cross-sectional study investigated the role of both positive religious coping, i.e., a confident and constructive turning to religion, and negative religious coping, i.e., religious struggle and doubt, in a sample of 156 German breast cancer patients. Participants were assessed upon admission to an inpatient rehabilitation program. In addition to religious coping, two basic nonreligious coping styles (depressive coping and active problem-focused coping) and psychosocial adjustment (anxiety and depression) were measured. Major research questions concerning the mediating role of nonreligious coping and the relative predictive power of positive and negative religious coping were primarily addressed using structural equation modeling. Results indicated that the relationship between religious coping and psychosocial outcomes was completely mediated by nonreligious coping, whereby only depressive coping and not active problem-focused coping proved to be a mediating variable. Positive and negative religious coping were somewhat positively related to each other; their (indirect) predictive power on psychosocial adjustment was identical though in an opposite direction. All in all, the results correspond to previous Anglo-American research. There are, however, some discrepancies which may be due to the specific religious-cultural background in Germany.

[Assessment of spirituality/religiosity in the context of health related quality of life]. / Erfassung von Spiritualität/Religiosität im Kontext der gesundheitsbezogenen Lebensqualität.

Patients' evaluations of their health status (health related quality of life, HRQOL) are increasingly taken into account in medical research and practice. In the Anglo-American literature a growing interest in including the life domain "spirituality/religiosity" as a component of HRQOL is observed. German studies in this research area are still scarce. As a guidance for further research, this paper gives an overview of instruments for the assessment of spirituality/religiosity in the context of HRQOL-research. Special attention is payed to German scales and adaptations. Since only few of the established multidimensional HRQOL-instruments include spirituality/religiosity, several short scales are described that allow additional assessment of spirituality/religiosity in an economical way.