Fifty years ago, Elisabeth Kübler-Ross' On Death and Dying provided a model of dying as stages of coping with impending loss of one's life. She sought to give dying hospital patients a voice; the result gave a new model for speaking about dying and grieving. This paper examines the model and religious appropriations and crticism of her theme of death as loss.
This article investigates longitudinal variations in grief, self-rated health, and symptoms of anxiety and depression among family caregivers in palliative care. Data were taken from a randomized psycho-educational intervention trial and were collected at four time-points; at baseline, upon completion, 2 months later, and 6 months after the patient’s death. In total, 117 family caregivers completed all questionnaires. The participants’ grief was stable across the measurements, while anxiety, depression, and health varied significantly (p < 0.05). No significant differences were found between the intervention or control group. In conclusion, grief emerged as a constant phenomenon, distinct from symptoms of anxiety and depression.
BACKGROUND: Suicide is the leading cause of death in Korean adolescents and it exposes school teachers to the impact of student suicide.
AIMS: This study aimed to explore the bereavement experience of teachers following student suicide.
METHOD: Using semistructured questions, five female teachers working at secondary schools in Korea were interviewed on their bereavement experiences. Data were analyzed using a phenomenological approach.
RESULTS: Participants described their experiences in dimensions of individuals and professions, yielding four major themes and 11 subthemes. They made efforts to learn about the suicide as a first step toward understanding. Participants suspended their grief in public owing to the atmosphere in their workplace. They aimed to tolerate the suicide and recognized their role anew in preventing student suicide.
CONCLUSION: Following student suicide, bereaved teachers experience a variety of effects, dysfunctions, and adjustments as individuals and professionals. Their experience should be understood in both individual and collective ways in school settings and in the cultural context. The findings encourage school health providers to develop programs and policies to help teachers bereaved by student suicide.
Grief and bereavement are universal human experiences that do not discriminate based on sex, gender, or sexual orientation. Existing literature provides valuable insight into the bereavement experiences of persons who identify as heterosexuals, but much less can be found on persons who identify as lesbian, gay, bisexual, or transgender/queer* (LGBT*). Given that the historical experiences of loss and personal characteristics such as interpersonal, familial, and social patterns of coping with grief are likely to influence the bereavement process, this study focused on the impact of partner bereavement on the interpersonal relationships and subsequent partnerships of the LGBT* bereaved. To this end, the purpose of this study was to use a mixed-methods approach to better understand how LGBT* persons described their experiences with partner bereavement and to identify what effect these experiences had on interpersonal relationships and subsequent partnerships.
OBJECTIVE: The clinical and nosological significance of grief reactions in youth exposed to a shared trauma (9/11) was tested by examining whether the (1) predictors (i.e., non-loss related trauma vs. traumatic bereavement), (2) clinical correlates, (3) factorial structure, and (4) phenomenology of grief reactions are distinct from those of major depressive disorder (MDD) and 9/11-related posttraumatic stress disorder (PTSD).
METHOD: In a representative sample of New York City schoolchildren (N=8,236; grades 4-12; n=1,696 bereaved), assessed six months post-9/11, multivariate regressions examined (1) predictors of grief, PTSD, and MDD, and (2) the incremental validity of grief in predicting health problems and functional impairment; factor analysis and latent class analysis determined, respectively, (3) the factorial and (4) syndromic distinctiveness of grief, PTSD, and MDD.
RESULTS: Four types of evidence supporting the distinctiveness of grief emerged. (1) Bereavement was associated with grief independently of PTSD and MDD, but not with PTSD and MDD after adjusting for grief; conversely, non-loss related trauma was associated primarily with PTSD. (2) Grief contributed uniquely to functional impairment. (3) Grief reactions loaded on a separate factor. (4) Youth with elevated grief reactions fell into two classes characterized by only moderate and negligible probability of co-occurring PTSD and MDD symptoms, respectively.
CONCLUSION: A multi-faceted approach provided convergent evidence that grief reactions are independent of other common types of post-disaster child and adolescent psychopathology, and capture a unique aspect of bereavement-related distress. These findings suggest that grief reactions in traumatically bereaved youth merit separate clinical attention, informing tailored interventions.
BACKGROUND: Legacy-making (i.e., a way for patients with terminal illness to create or do something for others as a means of remembrance) is rising in popularity in palliative medicine, although only one study has examined its impact in a pediatric population.
OBJECTIVE: In response to the gaps in literature, this study (1) examines the impact of legacy artwork on bereaved caregivers' psychological functioning and grief and (2) compares caregivers' perceptions of support provided by the hospital throughout their child's cancer journey between the intervention and control groups.
METHODS: Forty-four caregivers whose children died of cancer completed a demographic questionnaire specifically created for this study, the Brief Symptom Inventory-18, and the Prolonged Grief Disorder-13. They also answered questions regarding supportive services provided to them toward the end of the child's life, at the time of death, and after the child's death. Those caregivers who endorsed participating in legacy artwork were identified as the intervention group, whereas those who did not were classified as the control group.
RESULTS: There were no significant differences in psychological functioning among caregivers who participated in legacy artwork versus those who did not participate. However, caregivers who created legacy artwork with their child reported significantly less symptoms of prolonged grief and a greater perception of support from health care providers compared with caregivers who did not engage in this activity.
CONCLUSION: Although preliminary, these findings suggest that legacy artwork may have the potential to improve grief and overall satisfaction of support from the hospital in bereaved caregivers.
BACKGROUND: Young adults represent a minority in research; they are often considered too young or too old for participation. There is sparse information, especially in bereavement research, regarding how this age group perceives research participation and what they consider beneficial or harmful.
AIM: To explore how parentally bereaved and nonbereaved young adults perceive research participation.
DESIGN: Qualitative analysis of free-text comments collected in a Swedish nation-wide survey.
SETTING/PARTICIPANTS: Parentally cancer-bereaved and nonbereaved young adults between 18 and 25 years old living in Sweden.
RESULTS: Five categories were identified from the free-text comments, three among the cancer-bereaved: (1) therapeutic to remember the deceased, (2) valuable to help others and improve care, and (3) short-term distressful-long-term beneficial, and two among the nonbereaved: (1) increased reflection and awareness about life, and (2) an opportunity to help others.
CONCLUSIONS: It is important to invite young adults to participate in bereavement research. The results suggest that potential harm is minimal and that participating in bereavement research can have a beneficial effect on young adults.
BACKGROUND: While bereavement is associated with increased mortality, it is unclear how bereaved families utilize the healthcare system after the death of their loved ones.
OBJECTIVE: The aim of this study was to examine the association between bereavement and healthcare expenditures for surviving spouses.
METHODS: We used data from the Health and Retirement Study, a nationally representative cohort study of older adults linked to Medicare claims. We determined a spouse's total Medicare expenditures 2 years before and after their partner's death across six biennial interview waves. Using coarsened exact matching, we created a comparison group of non-bereaved dyads. Costs were wage index- and inflation-adjusted to 2017 dollars. We used generalized linear models and difference-in-differences (DID) analysis to calculate the average marginal effects of bereavement on Medicare spending by gender. We also examined subgroup differences based on caregiver status, cause of death, and length of terminal illness.
RESULTS: Our sample consisted of 941 bereaved dyads and a comparison group of 8899 matched dyads. Surviving female spouses (68% of the sample) had a $3500 increase in spending 2 years after death (p < 0.05). Using DID analyses, bereavement was associated with a $625 quarterly increase in Medicare expenditures over 2 years for women. There was no significant increase in post-death spending for male bereaved surviving spouses. Results were consistent for spouses who survived at least 2 years after the death of their spouse (70% of the sample)
CONCLUSIONS: Bereavement is associated with increased healthcare spending for women regardless of their caregiving status, the cause of death, or length of terminal illness. Further study is required to examine why men and women have different patterns of healthcare spending relative to the death of their spouses.
OBJECTIVE: Family caregivers of cancer hospice patients likely benefit from clinician provision of verbal support and from expression of positive emotions. Our aim was to identify the effects of hospice nurse supportive communication as well as caregiver-nurse exchange of positive emotions on family caregiver depression during bereavement.
METHOD: This prospective, observational longitudinal study included hospice nurses (N=58) and family caregivers of cancer patients (N=101) recruited from 10 hospice agencies in the U.S. Digitally recorded nurse home visit conversations were coded using Roter Interaction Analysis System to capture emotion-focused caregiver-nurse communication and supportive nurse responses. Caregivers completed the Hospital Anxiety and Depression Scale Anxiety Subscale and Geriatric Depression Scale-Short Form at study enrollment and at 2, 6 and 12 months after patient death.
RESULTS: Caregivers had moderate levels of depression at study enrollment and throughout bereavement. Multilevel modeling revealed that caregiver positive emotion communication and nurse emotional response communication are associated with caregiver depression in bereavement. There was no significant association between caregiver distress communication and depression in bereavement.
CONCLUSIONS: This is the first study to demonstrate that communication demonstrating emotional expression between cancer spouse caregivers and nurses during home hospice may have implications for caregiver depression up to a year after patient death. Our findings may help identify caregivers who may be coping well in the short term, but may struggle more over time.
BACKGROUND AND OBJECTIVES: According to the Dual Process Model (DPM), shifting between loss-oriented (LO) and restoration-oriented (RO) coping is essential for adjustment following bereavement. Knowledge about how LO and RO coping change over time and how such changes are related to adjustment is missing. With a prospective design this study investigated (1) relations between levels of LO/RO coping and selected outcomes and (2) changes in LO/RO coping across time and their relations to adjustment.
METHODS: A sample of 145 spousal bereaved individuals completed questionnaires measuring LO and RO coping, grief symptoms, positive affect, and attachment orientation approximately 2-3 months (baseline) and 7 months (follow-up) post-loss.
RESULTS: High usage of LO coping was associated with poorer outcomes and high usage of RO coping was associated with better outcomes at both baseline and follow-up. Individuals generally shifted towards more RO coping across time and those who exhibited this shift showed lower levels of grief at follow-up compared to individuals who changed towards more LO coping across time.
CONCLUSIONS: Individuals showing more RO coping reported better adjustment both early and later in the bereavement process. Changes in coping orientation over time might be useful for understanding complicated grief reactions following loss.
Being able to communicate effectively is an essential skill for all nurses. Communication in paediatric end of life care can be challenging for both the student and lecturer as it is a rare experience and challenging to teach. Innovative approaches to teaching communication skills such as role play, simulation and drama have been used; however there is a dearth of literature examining the use of drama in this specialist context. The aim of this study was to explore the effectiveness of a novel workshop in teaching transferable knowledge and skills in palliative, end of life and bereavement care communication to a convenience sample of first year pre-registration nursing students undertaking clinical skills training at a UK university. Qualitative and quantitative data were obtained from pre and post intervention questionnaires exploring student's perception of communication skills. Qualitative data were analysed thematically and quantitative data presented as standard descriptive statistics. The novel communication workshop facilitated students' exploration of how good and poor communication looks and feels and introduced aids to inform communication in clinical practice. Exposure to different learning approaches provided opportunities to both gain confidence in engaging in new learning activities and develop knowledge and skills through purposeful engagement.
Caumes, 17 ans, jeune homme fragile et écorché vif, vit entouré de ses amis, de sa famille et d'Esther, dont il est amoureux. Mais sa vie va être bouleversée en 2015 par les attentats de Charlie Hebdo et du Bataclan, et surtout par la mort d'Hakim, son ami qui meurt sous les coups de jeunes fachos.
Vient le moment du deuil, de la dépression et de la volonté d'en finir.
Pour s'en sortir, il écrit l'histoire qu'il vient de vivre et affronte les conséquences de ce choix.
Griffin a choisi de quitter Théo, son premier amour parti à l'autre bout du pays pour ses études. Les deux garçons s'aiment toujours et sont restés en contact. Griffin était convaincu qu'ils formeraient à nouveau un couple un jour, même quand Théo se met à fréquenter Jackson. Malheureusement, tout vole en éclats à la mort de Théo, laissant derrière lui un garçon qui a bien du mal à vivre dans un monde où il n'est plus.
Juniper Lemon tente de supporter l'absence de sa soeur, morte dans un accident de voiture, en continuant de remplir ses fiches d'index de bonheur. Un jour, elle perd la fiche vierge du jour, en faisant un trou de plus dans sa vie. Elle décide donc de la chercher dans le lycée... jusque dans les poubelle. Lorsqu'elle trouve par hasard un mot de suicide, elle décide de retrouver son auteur. Commence pour elle une véritable enquête qui va l'entraîner dans des amitiés inattendues. Grâce à ses nouveaux amis, elle se confrontera à sa famille, à la partie de vie que sa soeur lui cachait et à elle-même.
Sam, 9 ans, fait sa rentrée dans une nouvelle école et doit affronter de nouveaux copains avec la tristesse d'un petit garçon qui vient de perdre sa petite soeur d'une maladie neurodégénérative.
Nous le suivons dans sa nouvelle vie avec toutes ses questions, ses doutes, ses chagrins, les rencontres qui le consolent, les premières fois sans... Et les sentiments qui l'assaillent à la naissance d'une autre petite soeur.
Une petite fille décide un matin de faire l'école buissonière... Elle a besoin de refaire le chemin, qu'elle parcourait avec son grand-père qui vient de mourir, dans la Nature qu'il lui a appris à aimer. Elle prend le temps de se remémorer leurs bons moments.