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Studies on grief trajectories within the first two years following loss are limited, especially among eastern cultures. This study aims to examine distinct grief trajectories among Chinese bereaved individuals as well as the factors predicting them. The data were collected in three waves over 18 months and involved 181 participants who completed measures of grief, meaning integration, and demographic and death-related information. Latent class growth analysis was utilized to identify grief trajectories. Univariate logistical regression and multivariate logistical regression were used to investigate the predictors. Four grief trajectories were identified: resilient (44.19%), chronic (17.15%), recovery (31.71%), and delayed (6.32%). Meaning integration at six months following loss distinguished the chronic trajectory from the resilient group, but not from the recovery group. Meaning integration at 12 months distinguished the chronic trajectory from the resilient trajectory and the recovery trajectory. However, it did not differentiate delayed pattern from recovery or resilient classes. These findings emphasize the need for caution in predicting grief trajectories by meaning integration early in the bereavement process. [ABSTRACT FROM AUTHOR]

Loss-adaptation has been described as being characterized by 'waves of grief', which may result in a Prolonged Grief Disorder (PGD). Although this assumption about the fluctuating nature of grief is supported by theoretical work, it is not (yet) supported by empirical work. We are the first to explore to what extent PGD reactions fluctuate in everyday life and whether fluctuations in PGD reactions are related to overall PGD levels using experience sampling methodology (ESM). Data from 38 bereaved individuals (74% women, on average 6 years post-loss, 47% lost a parent) were analyzed. For two weeks, five times per day, participants reported on the severity of 11 PGD reactions in the past three hours (ESM-PGD). At baseline, overall PGD severity (B-PGD) in the past two weeks was assessed with telephone-interviews using the Traumatic Grief Inventory–Clinician Administered. Root Mean Square of Successive Differences (RMSSD) were calculated to reflect fluctuations in ESM-PGD. Spearman correlations between RMSSD values of the 11 ESM-PGD reactions and B-PGD scores were computed. Mean B-PGD scores were below the clinical cut-off. Some fluctuations in ESM-PGD reactions were found, as indicated by varying RMSSD values, but also floor effects were detected. B-PGD levels were related to RMSSD values for ESM-PGD (ρ between 0.37 and 0.68, all p <.05; and between 0.36 and 0.63 after removal of floor effects). We found that (some) ESM-PGD reactions fluctuated in everyday life. This may offer new theoretical insights into loss-adaptation, which may result in optimizing PGD treatment. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionBereavement following violent death has been associated with prolonged grief disorder, major depression, PTSD, and substance use disorders. Emotional distress related to the often sudden, visceral, and horrifying nature of violent losses and assignment of blame for the loss may affect the use and effectiveness of post-loss coping strategies. Given a lack of agreement on how to define and classify coping strategies, a structured review was conducted to organize the current literature by synthesizing findings on coping strategies and violent loss outcomes.ERIC, Google Scholar, PsycINFO, PsycNET, PubMed, and Web of Science database searches identified quantitative, qualitative, and mixed method studies that reported findings regarding coping strategies among adults bereaved by violent circumstances. A thematic analysis of coping strategies from those articles was used to identify distinct coping dimensions.The review identified 80 studies (42 quantitative, 35 qualitative, three mixed-methods). Most studies used samples of individuals bereaved by suicide (n = 50), homicide (n = 24), and/or accidental death (n = 12). Coping strategies were organized into three primary dimensions: engagement, disengagement, and socially-supported coping. These dimensions were found to differentially relate to grief severity, PTSD, MDD, and general psychological distress, with engagement and socially-supported strategies generally associated with better outcomes and disengagement strategies with worse outcomes.The findings underscore the need for more refined theoretical frameworks and study designs, in addition to more sophisticated and germane measures, to better capture the dynamic nature of coping after violent loss. [ABSTRACT FROM AUTHOR]

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Introduction: Prolonged Grief Disorder is a newly established diagnostic category included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The present study aimed to introduce and psychometrically validate the Persian version of the Revised Prolonged Grief Scale.Method: The study employs a descriptive-survey design. For this purpose, 400 undergraduate students from Shahid Madani University of Azerbaijan were selected through purposive sampling and assessed using the Persian version of the Revised Prolonged Grief Scale and the Grief Experience Questionnaire.Results: Exploratory factor analysis indicated that a general factor can be extracted, accounting for 52% of the total variance in the scores. Confirmatory factor analysis demonstrated that the extracted single factor exhibits a good fit. The item homogeneity coefficient was 0.89 when calculated using Cronbach's alpha and 0.88 when determined through the split-half method. The positive and significant correlation coefficient between the scores of prolonged grief disorder and the experience of grief indicates the convergent validity of the prolonged grief disorder scale. The diagnostic validity of the Prolonged Grief Disorder Scale was confirmed by comparing two groups: subjects diagnosed with prolonged grief disorder and their normal counterparts, revealing a significant difference between the two groups.Discussion and Conclusion: The Persian version of the Prolonged Grief Disorder Scale demonstrates adequate validity for the local sample and can be utilized as a reliable and effective tool for both clinical and research purposes.

A minority of bereaved adults experiences prolonged grief disorder, depression, and/or posttraumatic stress disorder, with heightened risks observed among bereaved parents. Cognitive-behavioural therapies, both face-to-face and online, have demonstrated efficacy in treating post-loss mental health problems. Mobile phone applications potentially offer an efficient and cost-effective way to deliver self-help to bereaved adults, yet controlled effectiveness studies are lacking. Therefore, we examined the short-term efficacy of the My Grief app, based on cognitive-behavioural therapy, in 248 bereaved parents, in a randomised controlled trial (Clinicaltrials.gov, identifier: NCT04552717). Participants were randomly allocated to access to the My Grief app (n = 126) or a waitlist (n = 122). At baseline and post-assessment, symptoms of prolonged grief, posttraumatic stress, and depression, negative grief cognitions, rumination, and avoidance were assessed. Reductions in prolonged grief and posttraumatic stress symptoms and negative cognitions in the intervention group were larger than in the control group, albeit with small effect sizes. Fifteen app users reported negative experiences with the app; for example, some mentioned that it elicited painful memories and emotions related to their loss. My Grief appears to achieve modest improvements in mental health in bereaved parents. Given that it is accessible and low-cost, it is an important addition to the suite of prolonged grief interventions. [ABSTRACT FROM AUTHOR]

Traumatic death is a risk factor for prolonged grief. Network analysis offers a perspective for understanding traumatic bereavement at a symptom interaction level. This study estimates regularized partial correlation grief networks for bereavement due to earthquake (n = 818) and illness (n = 237), using symptoms from the Inventory of Complicated Grief (ICG) as the nodes. Difficulty in accepting death and loneliness were highly central nodes in both networks. Trust difficulties and longing for the deceased exhibited high centrality in the earthquake‐bereaved sample but not in the illness‐bereaved sample. The earthquake bereavement network was characterized by high connectivity and a diversity of central symptoms. These results provide insights into understanding the severity of grief after a traumatic loss. Although promoting the integration of the reality of loss and alleviating loneliness is important, it might also be worth considering the role of post‐loss interpersonal trust and the distress associated with longing for the deceased for traumatic bereavement. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 high death tolls have brought about many bereavements all over the world. In this brief report, we aim to describe the effects of traumatic end-of-life experiences causing prolonged grief and loneliness as mediators for psychiatric disorders in the elderly. Case: The patient was a 60-year-old woman with chronic sleep disturbance since her only daughter suddenly passed away after several days of being isolated in the hospital during the COVID-19 pandemic and being hastily buried with the COVID-19 protocols. The patient yearned for her daughter but at the same time also avoided all memories of her daughter. She felt anxious most of the day which escalated to panic attacks requiring visits to the emergency room. Various examinations were carried out with normal results, except for blood pressure. She was diagnosed with prolonged grief, generalized anxiety, post-traumatic stress disorder, and hypertension. Treatments included SSRI, benzodiazepine, antihypertensive medicine, and psychotherapy. Improvements were significant within 9 months of therapy. Discussion: Traumatic end-of-life events may precipitate prolonged grief and loneliness. Bereavement is the most common cause of loneliness in the elderly. Untreated prolonged grief and loneliness generate a loss of sense of self and purpose and are associated with low-grade peripheral inflammation and poor health. The combination of pharmacotherapy and psychotherapy is the most effective treatment which improves the patient's outcome significantly. Conclusion: Traumatic end-of-life experiences are associated with prolonged grief disorder, loneliness, and poor physical and mental health outcomes, hence the right holistic approach is necessary to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Parent-clinician communication is essential for high-quality end-of-life (EOL) care in children with cancer. However, it is unknown how parent-clinician communication affects parents' experience in the first two years after their child's death. To examine the association between communication and prolonged grief among parents whose child died from cancer and to explore the mediation effect of preparation for EOL care. We analyzed data from a cross-sectional survey of parents of children who died from cancer in the prior 6-24 months. We used multiple linear regression to examine the association between communication variables and prolonged grief symptoms. We also examined how preparation for EOL mediates these associations. Across N = 124 parents, the mean age was 46 years, 82% were White, and 64% were mothers. The average PG-13 sum score was 32.7 ± 10.6 (range 11-55, with higher scores indicating greater symptom severity). Most parents reported "very good/excellent" communication with clinicians (80%), adequate prognostic information (64%), and high levels of trust (90%). Nearly 39% of parents reported feeling "not at all prepared" for their child's EOL. Compared to parents who wanted more prognostic information, parents who perceived prognostic information to be adequate had significantly lower PG-13 sum scores (36.4 ± 10.8 vs. 30.5 ± 10.1, F = 9.26, P = 0.003). Preparation for EOL fully mediated this association. Early bereaved parents report severe prolonged grief symptoms. Interventions focused on providing adequate prognostic information and improving preparation for EOL may mitigate parental prolonged grief symptoms in the first two years of their bereavement. [ABSTRACT FROM AUTHOR]

Coronavirus is an infectious disease that has left tens of millions of deaths around the world, and which has had social, economic, emotional, and psychological consequences. To mitigate the spread of the virus, several countries have adopted restrictive measures that impacted the way people experienced the end-of-life and the death of their loved one. This study aimed to identify the variables associated with prolonged grief symptoms in the context of both pandemic-related losses and the unique challenges related to end-of-life care. An anonymous online survey was disseminated widely through various channels including local press, social media, professional networks and hospitals. Socio-demographic information was collected, as well as information related to loss (cause of death, place of end-of-life care and death) and bereavement, and on the impact of the restrictions imposed by the pandemic. The participants were 163 bereaved who lost a loved one who received end-of-life care during the pandemic in Portugal. Most participants were female, married, professionally active and had lost their grandparents. A hierarchical multiple regression was performed to determine the factors associated with prolonged grief symptoms. The results showed that more prolonged grief symptoms were associated with less social support, worsening of the financial situation, greater psychological impact of restrictions on communicating with the deceased, and the deceas having received end-of-life care in a hospital. The early identification based on these factors of individuals at higher risk for more prolonged grief symptoms could allow for targeted interventions and support services.This study unveils crucial factors contributing to heightened grief amid pandemic-related losses and challenges in end-of-life care, which provide practical insights for healthcare practitioners. Highlight the importance of personalized interventions to fortify social connections, address financial challenges, and offer compassionate alternatives to hospital-centric care. Policymakers can leverage this information to optmise grief management during public health crises. [ABSTRACT FROM AUTHOR]

Introduction: Complicated grief can affect a large number of individuals who have lost a relative due to cancer. Objectives: To assess the efficacy of a cognitive–behavioral grief therapy (CBGT) group for complicated grief (CG) in those who have lost a relative due to cancer in comparison with a psychoeducational and emotional expression intervention group (PSDEEI). Methods: A randomized clinical trial was used, in which 249 relatives of deceased cancer patients with CG were randomly assigned to CBGT or PSDEEI. Complicated grief (Inventory of Complicated Grief [ICG]), depression (Beck Depression Inventory [BDI-II]), hopelessness (Beck Hopelessness Scale [BHS]), anxiety (Beck Anxiety Inventory [BAI]) symptoms, and general health (Goldberg's General Health Questionnaire [GHQ28]) were assessed at pretreatment, posttreatment, and follow-up at 6 and 12 months. Results: The CBGT group improved significantly (p  < 0.001), with the scores in ICG, BDI-II, BAI, BHS, and GHQ28 (p  < 0.001) being higher than those for the PSDEEI group in each of the assessed moments, with high effect sizes: ICG (η 2 = 0.16), BDI (η 2 = 0.10), BAI (η 2 = 0.06), BHS (η 2 = 0.21), and GHQ28 (η 2 = 0.21). At the 12-month follow-up, the number of cases of CG decreased by 81.1% for the CBGT group vs. 31.7% in the PSDEEI group. Significance of results: The CBGT treatment was effective for CG, depression, anxiety, and hopelessness symptoms and for mental health and was superior to the PSDEEI treatment. [ABSTRACT FROM AUTHOR]

AbstractUnderstanding the healthcare needs of bereaved individuals following terrorism is crucial for organizing healthcare services. This cross-sectional study examined the terror-related healthcare needs, healthcare utilization, and satisfaction with professional healthcare among 122 traumatically bereaved parents and siblings eight years after the 2011 Utøya terrorist attack in Norway. Results showed that over 50% of the participants currently needed help coping with their grief or with mental and somatic symptoms, and only 34% were actively utilizing healthcare related to the terror attack. Furthermore, 68% reported not getting sufficient help, suggesting a treatment gap. One-third rated the professional help and treatment as unsatisfactory, with 28% reporting that they had not received competent help. More somatic and posttraumatic stress symptoms were associated with higher healthcare needs, whilst higher levels of insomnia symptoms were associated with lower healthcare satisfaction. This emphasizes the need to recognize, professionally intervene, and provide competent support for traumatically bereaved individuals. [ABSTRACT FROM AUTHOR]

Objective: The Traumatic Grief Inventory‐Self Report Plus (TGI‐SR+) measures the most recent prolonged grief disorder (PGD) symptom sets defined in the 11th edition of the International Statistical of Diseases and Related Health Problems (ICD‐11) and the text revision of the fifth edition of the Diagnostical and Statistical Manual of Mental Disorders (DSM‐5‐TR). However, the TGI‐SR+ has not yet been translated and validated in Chinese. This study aims to evaluate the psychometric properties of the Chinese translation of the TGI‐SR+. Methods: We examined the Chinese TGI‐SR+'s factor structure, internal consistency, convergent validity, discriminant validity, known‐groups validity, and optimal clinical cut‐off scores in 443 Chinese bereaved adults. Results: Confirmatory factor analyses showed that the two‐factor models showed the best fit for the Chinese TGI‐SR+ items assessing ICD‐11 and DSM‐5‐TR prolonged grief symptoms. Items assessing ICD‐11 and DSM‐5‐TR prolonged grief symptoms demonstrated good internal consistency. Associations of TGI‐SR+ scores with symptom levels of prolonged grief (assessed by the International Prolonged Grief Disorder Scale), posttraumatic stress, anxiety, and depression supported convergent and discriminant validity. Associations with background/loss‐related variables provided evidence for known‐groups validity. Cut‐off points for probable ICD‐11 PGD (liberal scoring rule), probable ICD‐11 PGD (conservative scoring rule), and probable DSM‐5‐TR PGD were ≥67, ≥75, and ≥68, respectively. Discussion: The Chinese TGI‐SR+ appears to be a reliable and valid measure to assess prolonged grief symptoms per ICD‐11 and DSM‐5‐TR among Chinese bereaved adults. [ABSTRACT FROM AUTHOR]

Most studies examining prolonged grief disorder (PGD) in people bereaved during the COVID‐19 pandemic are focused on psychopathology. However, mental health encompasses both absence of psychopathology and presence of well‐being. This is the first study examining symptom profiles of early PGD and subjective mental well‐being in 266 Dutch adults recently bereaved during the pandemic. Early PGD and well‐being indicators were assessed with the Traumatic Grief Inventory–Self Report Plus and the World Health Organization–Five Well‐Being Index, respectively. Latent class analysis identified four classes: low PGD/high well‐being (32%), low PGD/moderate well‐being (24%), moderate PGD/high well‐being (23%) and high PGD/low well‐being class (21%). People in the poorer mental health classes were more likely to be female, lower educated, suffering from a mental disorder, have a poor health status, closer kinship to the deceased, and higher risk of severe COVID‐19. Classifying adults according to symptom profiles of negative and positive outcomes provides a more complete picture of mental health in bereaved people and offers potential intervention targets. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground: 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.

ABSTRACTBackground: 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.

ABSTRACTBackground: 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.

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.

In this article, we examine prolonged grief through an existential theoretical lens. In particular, we critically compare criteria for prolonged grief disorder with existential theoretical principles, including existential phenomenology, existential relatedness, and existential givens of human existence: death anxiety, existential freedom, existential isolation, and existential meaning/meaninglessness. We explore how existential perspectives and principles provide a clinically useful explanation for the presence and etiology of many of the symptoms of prolonged grief. We also describe counseling implications for treating prolonged grief phenomenologically, relationally, and through the lens of the four existential givens. [ABSTRACT FROM AUTHOR]

The uncertainty of the COVID-19 pandemic caused many psychological impairments like intense anxiety, feelings of helplessness, grief of losing loved ones, stress, fear of death and had adverse long-term impacts on the individuals. One of the demographics highly affected are the college students. This study aims to understand the course of grief and stress of college students who have faced bereavement during the pandemic by comparing their perception of stress and prevalence of grief after a period of 18 months. The study was collected in two phases with a gap of 18 months. The first phase of the study was conducted in April 2022 (during the pandemic) where the Pandemic Grief Scale and COVID-19 Student Stress Questionnaire were administered to 210 participants. The second phase of the study was held in December 2023, post pandemic where a follow-up was conducted on 80 participants using the Prolonged Grief Questionnaire (PG-13 Diagnostic Tool) and Perceived Stress Scale. The results depicts a significant positive correlation between pandemic grief and covid-related stress among college students during phase 1 of the study and a significant positive correlation between prolonged grief and perceived stress in phase 2 of the study post pandemic. It was also revealed that significant participants (n=21 out of 80) that were selected for the follow-up have shown signs of prolonged grieving and perceived stress post 18 months of bereavement. The participants with symptoms of prolonged grief have reported higher levels of perceived stress, suggesting that significant number of people from the non-clinical population might suffer from prolonged grief and stress that often go overlooked. The results indicate the need to provide supportive interventions aimed at promoting Counselling and psycho-social support. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic disrupted many areas of life, including culturally accepted practices at end-of-life care, funeral rites, and access to social, community, and professional support. This survey investigated the mental health outcomes of Australians bereaved during this time to determine how these factors might have impacted bereavement outcomes. Methods: An online survey indexing pandemic and bereavement experiences, levels of grief, depression, anxiety, and health, work, and social impairment. Latent class analysis (LCA) was used to identify groups of individuals who shared similar symptom patterns. Multinomial regressions identified pandemic-related, loss-related, and sociodemographic correlates of class membership. Results: 1911 Australian adults completed the survey. The LCA identified four classes: low symptoms (46.8%), grief (17.3%), depression/anxiety (17.7%), and grief/depression/anxiety (18.2%). The latter group reported the highest levels of health, work, and social impairment. The death of a child or partner and an inability to care for the deceased due to COVID-19 public health measures were correlated with grief symptoms (with or without depression and anxiety). Preparedness for the person's death and levels of pandemic-related loneliness and social isolation differentiated all four classes. Unemployment was associated with depression/anxiety (with or without grief). Conclusions: COVID-19 had profound impacts for the way we lived and died, with effects that are likely to ricochet through society into the foreseeable future. These lessons learned must inform policymakers and healthcare professionals to improve bereavement care and ensure preparedness during and following future predicted pandemics to prevent negative impacts. [ABSTRACT FROM AUTHOR]

The benefits of expressive writing have been explored since at least the 1980s. The effect of expressive bereavement-related writing has been studied primarily in college students, yielding inconclusive results. Nonetheless, recent effective, integrated psychotherapy protocols, targeting complicated and prolonged grief, include writing assignments, typically in the form of letters. The present paper explores how and why letter writing might be effective and meaningful as a therapeutic tool in the context of grief psychotherapy. It describes how working with letters, addressed to the deceased, might help facilitate self-disclosure, promote exposure to what is avoided, confront unfinished business, encourage continuing bonds, and help achieve a coherent narrative around experiences with the loss. As a therapeutic tool, letter writing has the potential to be helpful to many bereaved people, as it is a simple, effective, and meaningful way to access and work with relevant clinical material in the context of psychotherapy. [ABSTRACT FROM AUTHOR]

Attachment theory is a key paradigm for understanding individual differences for the elaboration of the grieving processes, however limited attempts to systematically synthesize are found on the literature. Our aim is to conduct a bibliometric analysis about the relationship between complicated grief and attachment over the past twenty years. A bibliographic search was made in the Core Collection of Web of Science, the bibliometric analysis was performed using the software Hiscite version 2010.12.6, and VosViewer were used for the construction of bibliometric maps. Results show 276 publications from 2003 until 2023 from 789 authors, published in 143 scientific journals. The field presents a regular increase and sustained number of publications. The topics most researched were bereavement, complicated grief and attachment, and since 2018 has been increased interest in prolonged grief disorder. In conclusion, this bibliometric analysis contributes to the understanding of the current state of this topic and its evolution, being relevant to consider attachment style in bereavement interventions. [ABSTRACT FROM AUTHOR]

Prolonged Grief Disorder occurs within 7-10% of the bereaved population and is a more complicated and persistent form of grief which has been associated with suicidality, mental health disorders, sleep disturbance, poor health behaviors, and work and social impairment. EMDR is a fitting treatment option for those with Prolonged Grief, focusing on processing past memories, blocks, current triggers, future fears, and preparing the person for living life beyond the loss in line with the Adaptive Information Processing Model and grief frameworks. This paper discusses the theory, research regarding the application of EMDR with prolonged grief, and gives insight and guidance to clinicians working in this area including a case example. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to determine the relationship between sociodemographic characteristics, prolonged grief, meaning reconstruction, and posttraumatic growth of elderly individuals who have lost loved ones. Methods: A total of 122 elderly individuals who had lost loved ones were included in the research conducted in a nursing home. Results: The levels of Prolonged Grief Inventory (PG-13), Grief and Meaning Reconstruction Inventory (GMRI), and Posttraumatic Growth (PTG) scale were found to be high among the individuals in the study. While the PG-13 scores of single individuals who have lost their spouses are statistically significantly higher compared to married individuals, the scores for GMRI are higher for elderly individuals with chronic illness and expected death compared to those who have experienced sudden loss. A significant negative correlation was also determined between PG-13, GMRI, and PTG scores. Conclusion: Counseling to reconstruct grief and meaning is recommended for at-risk groups. [ABSTRACT FROM AUTHOR]

Prolonged Grief Disorder occurs within 7-10% of the bereaved population and is a more complicated and persistent form of grief which has been associated with suicidality, mental health disorders, sleep disturbance, poor health behaviors, and work and social impairment. EMDR is a fitting treatment option for those with Prolonged Grief, focusing on processing past memories, blocks, current triggers, future fears, and preparing the person for living life beyond the loss in line with the Adaptive Information Processing Model and grief frameworks. This paper discusses the theory, research regarding the application of EMDR with prolonged grief, and gives insight and guidance to clinicians working in this area including a case example.

Mobile health (mHealth) apps have been shown to be useful to monitor and reduce mental health problems across a variety of stress-related and affective disorders, yet research on the value of apps for prolonged grief is scarce. Therefore, the main aim of this study was to elucidate bereaved parents' experiences of using the self-help app My Grief with a focus on helpfulness, satisfaction, and usability. Data were derived from closed-ended and open-ended questions administered at the 3-month post-assessment of the intervention group (n = 67) within a randomized controlled trial testing the effects of access to the My Grief app. The sample consisted of 88 % women, with a mean age of 47 years, who predominantly lost their child to cancer (41 %), on average 4.8 years ago. Participating parents indicated that the My Grief app helped them increase their knowledge about prolonged grief and track their grief over time. The app was experienced as easy to navigate and around half of the parents used the app more than one day a week. Almost all parents were satisfied with the app and would recommend it to other parents in similar situations. The findings add to the knowledge base justifying mHealth within support systems for bereaved adults.

The enduring question of whether grief can ever be pathological (and, if so, when) has been shrouding mental health and psychiatric care over the last few years. While this discussion extends beyond the confines of psychiatry to encompass contributions from diverse disciplines such as Anthropology, Sociology, and Philosophy, scrutiny has been mainly directed toward psychiatry for its purported inclination to pathologize grief--an unavoidable facet of the human experience. This critique has gained particular salience considering the formal inclusion of prolonged grief disorder (PGD) in the 11th edition of the International Classification of Diseases (ICD-11) and the subsequent Text Revision 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This study contends that the inclusion of prolonged grief disorder as a diagnostic entity may be excessively rooted in Western cultural perspectives and empirical data, neglecting the nuanced variations in the expression and interpretation of grief across different cultural contexts. The formalization of this disorder not only raises questions about its universality and validity but also poses challenges to transcultural psychiatry, due to poor representation in empirical research and increased risk of misdiagnosis. Additionally, it exacerbates the ongoing concerns related to normativism and the lack of genuine cultural relativism within the DSM. Furthermore, the passionate discussion surrounding the existence, or not, of disordered forms of grief may actually impede effective care for individuals genuinely grappling with pathological forms of grief. In light of these considerations, this study proposes that prolonged grief disorder should be approached as a diagnostic category with potential Western cultural bias until comprehensive cross-cultural studies, conducted in diverse settings, can either substantiate or refute its broader applicability. This recalibration is imperative for advancing a more inclusive and culturally sensitive understanding of grief within the field of psychiatry. [ABSTRACT FROM AUTHOR]

Children and adolescents who experience the loss of a beloved one in traumatic circumstances can experience prolonged grief symptoms, characterized by symptomatology that may alter the grieving process, impair global functioning, and interact with cognitive development. Cognitive behavioral therapy (CBT) has been showing significant results in treating grief-related issues. The present systematic review assessed the effectiveness of CBT for prolonged grief symptoms in the pediatric population. This study was carried out by two independent reviewers who searched electronic databases through a combination of keywords and a set of inclusion and exclusion criteria. A total of 20 studies were selected and data were synthesized in these categories: characteristics of the participants; specificities of the instruments; effectiveness of CBT. The results of this systematic review highlighted significant improvements in prolonged grief symptoms and global functioning following CBT. No significant age, gender, or ethnicity differences were found in most studies. The Inventory of Prolonged Grief for Children/Adolescents and the Inventory of Complicated Grief-Revised for Children appear to be the pediatric population's most sensitive prolonged grief measures. The treatments were adapted based on various contextual and structural factors without losing clinical significance. Significant effect sizes were found for primary and most secondary outcomes. This systematic review underlines the effectiveness of CBT for prolonged symptoms in the pediatric population. Nonetheless, the included studies had a certain degree of heterogeneity, and their quality varied due to some biases. A validation procedure of standard methodologies for prolonged grief symptoms in children and adolescents is required to establish shared directions both in research and clinical settings. [ABSTRACT FROM AUTHOR]

After the sudden and violent death of a loved one, many bereaved experience symptoms of prolonged grief (PG) and posttraumatic stress (PTS). The present study investigated the cross‐sectional and longitudinal associations of grief‐related rumination with PG and PTS symptoms among bereaved parents and siblings after the Utøya terror attack in Norway on 22 July 2011 (N = 110, Mage = 43.2 years, 59.1% female). Participants' responses on the Rumination Scale, the Inventory of Complicated Grief and the Impact of Event Scale‐Revised 28, 40 and 102 months after the loss were analysed. Cross‐sectionally and longitudinally, grief‐related rumination was positively and strongly linked with PG and PTS symptoms. When controlling for the baseline levels of PG and PTS symptoms and demographics of the sample, grief‐related rumination predicted PG symptoms after 12 months but not after 74 months. Further, grief‐related rumination predicted significantly the PTS symptoms of avoidance after 12 and 74 months and hyperarousal after 74 months beyond sample demographics and baseline symptoms. The results suggest that grief‐related rumination is an important factor in PG and PTS symptoms after traumatic bereavement. [ABSTRACT FROM AUTHOR]

This article argues that the current approach to diagnosing complicated grief in children overlooks important social and personal actors that impact how children react to and cope with death. Family dynamics, community support, and individual reactions should all be considered when assessing and providing care. The article recommends a multifaceted approach to grief diagnosis that considers the child's social environment. Helping parents navigate their own grief can support their child, and schools should create a welcoming and sensitive environment for bereaved children. By addressing these factors, negative consequences, such as social withdrawal, academic underachievement, and poor wellbeing, can be reduced. [ABSTRACT FROM AUTHOR]

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Copyright of European Journal of Psychotraumatology is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Symptoms of prolonged grief disorder (PGD), depression, and posttraumatic stress disorder (PTSD) often emerge concurrently in bereavement. The understanding of temporal relationships between these syndromes in a general bereaved population is limited. This study aims to investigate temporal relationships between these syndromes from 2 months postloss throughout the two first years of bereavement. Method: Data were derived from a registry-based cohort study with 1,224 adult participants, who lost a spouse or parent. Participants completed self-report measures of PGD, depression, and PTSD at 2, 6, 11, 18, and 26 months postloss. Random intercept cross-lagged panel analyses examined the temporal relationships between PGD, PTSD, and depression. Results: In spousal and parental bereavement, high levels of grief symptoms at 2 months postloss predicted subsequent high symptoms of PTSD and depression at 6 months postloss, not vice versa. PGD, PTSD, and depression showed strong intertwined relationships over the two first years of bereavement. Between-person differences explained an increasingly large amount of variance in symptoms of PGD, PTSD, and depression over time. Losing a spouse and younger age was associated with higher symptoms of PGD, PTSD, and depression compared to losing a parent and older age. Conclusion: In the early years of bereavement, large differences exist between bereaved individuals in general levels of PGD, PTSD, and depression. Within bereaved individuals, the temporal relationships between these syndromes become increasingly complex and intertwined over time. Findings should be interpreted with respect to the nonclinical sample and self-report data used. General Scientific Summary: This study suggests that high levels of early grief symptoms evolve into symptoms of posttraumatic stress disorder (PTSD) and depression within bereaved individuals. Furthermore, symptoms of prolonged grief disorder (PGD), PTSD, and depression become increasingly intertwined through the first years of spousal and parental bereavement. [ABSTRACT FROM AUTHOR]

This study investigated the association between prolonged grief (PG) severity and meaning-making narration in a cross-cultural context, and specifically aimed to illustrate the role of value orientation in shaping the grieving process. 30 Chinese and 22 Swiss parents who lost their child were asked to narrate and appraise specific memories to reflect their self-evaluation of traditional and modern values. The self-reported Prolonged Grief Disorder Scale (ref ICD-11) assessed PG severity. Compared with the Swiss sample, the Chinese sample provided more elaborated memories, which was not associated with symptom severity. Both Chinese and Swiss bereaved parents with more severe PG provided more narratives of loss-related memories, particularly in response to modern values. They also provided more appraisals of negative meanings for self-defining memories, particularly in relation to their traditional values. These findings indicate that, despite cultural differences in narration tendency, PG severity in bereaved parents was associated with the maladaptive integration of autobiographical memories across different cultures, in relation to value orientations. A clinical implication is the potential value of facilitating narrations of grieving clients that center on value orientations to mitigate the hardship of the personal loss. [ABSTRACT FROM AUTHOR]

The enduring question of whether grief can ever be pathological (and, if so, when) has been shrouding mental health and psychiatric care over the last few years. While this discussion extends beyond the confines of psychiatry to encompass contributions from diverse disciplines such as Anthropology, Sociology, and Philosophy, scrutiny has been mainly directed toward psychiatry for its purported inclination to pathologize grief—an unavoidable facet of the human experience. This critique has gained particular salience considering the formal inclusion of prolonged grief disorder (PGD) in the 11th edition of the International Classification of Diseases (ICD-11) and the subsequent Text Revision 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This study contends that the inclusion of prolonged grief disorder as a diagnostic entity may be excessively rooted in Western cultural perspectives and empirical data, neglecting the nuanced variations in the expression and interpretation of grief across different cultural contexts. The formalization of this disorder not only raises questions about its universality and validity but also poses challenges to transcultural psychiatry, due to poor representation in empirical research and increased risk of misdiagnosis. Additionally, it exacerbates the ongoing concerns related to normativism and the lack of genuine cultural relativism within the DSM. Furthermore, the passionate discussion surrounding the existence, or not, of disordered forms of grief may actually impede effective care for individuals genuinely grappling with pathological forms of grief. In light of these considerations, this study proposes that prolonged grief disorder should be approached as a diagnostic category with potential Western cultural bias until comprehensive cross-cultural studies, conducted in diverse settings, can either substantiate or refute its broader applicability. This recalibration is imperative for advancing a more inclusive and culturally sensitive understanding of grief within the field of psychiatry.

Refugees often experience multiple losses. Despite this, and even though the loss is often due to unnatural causes and violent killings, the presence of Prolonged Grief (PG) among refugees may be obscured by other diagnoses such as depression and post-traumatic stress disorder (PTSD). In this cross-sectional study, we assessed the prevalence of PG and its comorbidity with depression and PTSD among 679 adult refugees in Sweden. Results showed that 401 (59.06 %) individuals had lost someone close to them, whom they were grieving intensely. Of these, 76 individuals (18.95 % of 401) fulfilled the criteria for PG. In the full sample, 304 individuals fulfilled the criteria for depression and 56 (18.42 % of 304) of these individuals also fulfilled the criteria for PG. Similarly, 315 fulfilled the criteria for PTSD. Among these individuals, 201 reported loss and 64 (20.32 % of 315) also fulfilled the criteria for PG. The results indicate that behind symptoms of depression and PTSD, there may be a layer of grief. This needs to be considered if we are to provide accurate and effective assessments and interventions for refugees.

Around 10% of bereaved youths experience symptoms of prolonged grief disorder (PGD). Recently, PGD was included in the two main classification systems for mental disorders: the ICD-11 and DSM-5-TR. Assessing PGD symptoms in youth is currently hindered by the lack of instruments for ICD-11 and DSM-5-TR criteria. To fill this gap, we developed an instrument to assess PGD symptoms in children and adolescents, the Traumatic Grief Inventory – Kids – Clinician-Administered (TGI-K-CA), based on input of grief experts and bereaved children. Five experts rated the items on alignment with DSM-TR and ICD-11 PGD symptoms and comprehensibility. The adjusted items were then presented to seventeen bereaved youths (Mdnage = 13.0 years, range = 8–17 years). Using the Three-Step Test Interview (TSTI), children were asked to verbalize their thoughts while answering the items. Issues raised by experts were mostly related to alignment with the DSM-5-TR/ICD-11 symptom, ambiguous formulation of the items, or low comprehensibility for children and adolescents. Items raising fundamental issues according to experts were adjusted. The TSTI showed that children encountered relatively few problems with the items. Frequently reported problems with some of the items (e.g. regarding comprehensibility) led to final adjustments. With input from grief experts and bereaved youths, an instrument to assess PGD symptoms as defined in DSM-5-TR and ICD-11 in bereaved youths was finalized. Further quantitative research is currently undertaken to evaluate the instrument's psychometric qualities. Children with symptoms of Prolonged Grief Disorder (PGD) experience a debilitating longing for and/or preoccupation with a deceased loved one. Assessment of PGD in youth is hindered by the lack of an instrument. With the involvement of grief experts and bereaved youth, the current study developed an instrument that can be used in bereaved children and adolescents. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Suicide-loss survivors (SLSs)-individuals who lost family member to suicide, have been recognized as at risk for several mental health complications, including depression and suicide. Recent studies have emphasized the contribution of prolonged grief (PG) symptoms and suicide-related shame as facilitators of depression and suicide risk in the aftermath of suicide loss. In this six-year longitudinal design study, we examined self-criticism as a moderator of the link between PG and depression and suicide risk, with suicide-related shame mediating these links. Participants were 152 SLSs (130 females) aged 18–70 who completed questionnaires assessing prolonged grief, depression, and suicide risk as well as trauma-related shame and self-criticism. A moderated mediation model shows that high self-criticism intensified the relations between PG and shame and between shame and depression and suicide risk, above and beyond the contribution of the longitudinal PG trajectory. Importantly, the indirect effects of PG on both depression and suicide risk via shame levels were found only among SLSs with high levels of self-criticism. The findings highlight the critical longitudinal role of self-criticism in facilitating depression and suicide risk among SLSs with higher levels of PG. Theoretical implications relating to healing processes and focused clinical recommendations are discussed, including interventions for addressing self-criticism and suicide-related shame in the aftermath of suicide loss. • Prolonged grief symptoms at T3 contribute significantly to depression and suicide risk at T4 among suicide-loss survivors. • Self-criticism intensified the association between shame levels and depression and suicide risk. • The indirect effect of prolonged grief on suicide risk via shame was evident only among SLSs with high self-criticism. [ABSTRACT FROM AUTHOR]

Background: Losing a parent or spouse in adulthood may result in prolonged grief disorder (PGD) symptoms. PGD levels in parents may affect PGD levels in their adult offspring and the other way around. However, research on transmission of PGD in parent–child dyads is lacking. Consequently, we aimed to examine temporal associations between PGD levels in parent and adult children. Methods: In doing so, we analyzed longitudinal self-report data on PGD levels (using the PG-13) assessed at 2, 11, 18, and 26 months after loss in 257 adult parent–child dyads from Denmark. Cross-lagged panel modeling was used for data-analyses. Results: Changes in PGD levels in parents significantly predicted PGD levels in adult children, but not vice versa. Small through moderate cross-lagged effects (β = 0.05 through 0.07) were found for PGD levels in parents predicting PGD levels in adult children at a subsequent time-point. These cross-lagged effects were found while taking into account the association between PGD levels in parents and adult children at the same time-point as well as the associations between the same construct over time and relevant covariates. Conclusions: Pending replication of these findings in clinical samples and younger families, our findings offer tentative support for expanding our focus in research and treatment of PGD from the individual to the family level. [ABSTRACT FROM AUTHOR]

Intervening with bereaved students through counseling and psychotherapy can aid in reducing negative emotions and enhancing their adaptability. The current study aimed to identify the effectiveness of a group counseling program in reducing guilt and prolonged grief and increasing the psychological resilience of a sample of bereaved refugee adolescents in Jordanian schools. The study sample comprised 30 Syrian refugee students split equally between an experimental group and a control group. The authors used measures assessing levels of guilt, prolonged grief and psychological resilience, as well as a counseling program consisting of 14 sessions. After the group counseling program was developed and validated, the study authors implemented it in the experimental group. The results showed that there were statistically significant differences between the experimental group and the control group in terms of reducing guilt and prolonged grief levels, as well as increasing psychological resilience. Following the discussion of the results, the research implementation and limitations were added. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the prevalence and the psychological comorbidity of PGD among bereaved family caregivers of palliative care cancer patients. We also examined the discriminant validity of two simple and reliable tools in correctly categorized individuals with PGD. Methods: A cross-sectional study was conducted with 157 bereaved participants (77.1% females, mean age = 43.50 ± 14.04 years, mean time since the loss = 3.59 years) recruited from three palliative home care services. These participants completed the Prolonged Grief Scale (PG-13) and the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of PGD within the sample was 4.46% (i.e., = 7/157). Participants scored higher than the cut-off on the PG-13 and the HADS-D. Symptoms of PGD were positively correlated with depression levels. The ROC curve analysis showed that the HADS-D was outstanding in categorizing individuals with prolonged grief disorder from those without PGD. A HADS-D score of ≥7.5 was able to categorize participants with a sensitivity of 0.90 and a specificity of 0.73. Conclusions: Overall, these results highlight the relationship between grief and depression symptoms and their exceptional discriminant validity among correctly identified individuals with PGD.

This essay endeavors to understand the impact of COVID-19 hard lockdown restrictions on funeral gatherings from a Zimbabwean religious/spiritual perspective. For most Zimbabwean Christians and non-Christians, funeral rites of passage are at the apex of all religious activities and are revered in most social settings. The central questions to this study are: How have funeral gathering restrictions impacted on the religious/spiritual beliefs of many Zimbabwean immigrants living in South Africa, who were not able to attend funeral ceremonies back home in Zimbabwe? What religious/spiritual implications does it have to attend or not attend funeral ceremonies from a Zimbabwean religious perspective? These questions are raised because during the pandemic, most Zimbabweans who lived in South Africa were forbidden to go home to attend funeral ceremonies due to travelling restrictions between the two countries. This study found that most Zimbabwean immigrants who did not participate in funeral rites of passage due to COVID restrictions were left with spiritual distress after the pandemic. Data for this article were collected through interviews with individuals from Zimbabwe who are living in South Africa. Interviewees were selected using purposive sampling. Confidentiality, anonymity, and suppression of names are some of the ethical considerations maintained throughout this research.

Background: Working alliance is an important component in the therapy process, however its' role in bereavement interventions has rarely been studied. This study investigates the relationship between working alliance and treatment outcome, the change of working alliance throughout therapy and patient characteristics as predictors of working alliance. Methods: Data from a randomized controlled trial including 44 participants was used. Patient characteristics were assessed at baseline and working alliance was assessed after two, four, six, eight and ten sessions. A linear mixed model, multiple linear regression and best subset regression were conducted. Results: Working alliance changed significantly during therapy (β = 1.46, SE = 0.27, t(162) = 5.38, p <.001). Early working alliance predicted prolonged grief symptoms, when controlled for baseline scores of grief (β = −.27, p =.023). Moreover, self-efficacy (β =.47, p <.001) and need for social support (β = −.38, p =.010) predicted early working alliance. Conclusions: This study shows the relevance of establishing early working alliance in the therapeutic process. Attention should be paid to the initial self-efficacy and need for social support of patients, as it influences the experience of working alliance. To address individual working alliance patterns and characteristics in therapy, further research is needed. [ABSTRACT FROM AUTHOR]