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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]

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]

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]

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 study investigates linguistic predictors of reduction in prolonged grief symptoms following a writing intervention in an internet‐based cognitive behavioural therapy for people bereaved by cancer. Data stem from a randomized control clinical trial with 70 people. The Linguistic Inquiry and Word Count program was used to analyse patient language. Absolute change scores and reliable change index were used to calculate reduction in grief symptoms and clinical significant change. Best subset regression and Mann–Whitney U tests were conducted. A higher reduction of prolonged grief symptoms was correlated with more social words in the first module (β = −.22, p =.042), less risk (β =.33, p =.002) and body words (β =.22, p =.048) in the second module and more time words in the third module (β = −.26, p =.018). Patients with clinically significant change showed a higher median in function words in the first module (p =.019), a lower median in risk words in the second module (p =.019) and a higher median in assent words in the last module (p =.014) compared to patients without clinically significant change. Findings suggest that it may be beneficial for therapists to encourage a more detailed description of patients' relationship with their deceased relative during the first module, a change in perspective during the second module and a summary of past, present and future aspects at the end of therapy. Future studies should include mediation analyses to allow causal attribution of the studied effects. [ABSTRACT FROM AUTHOR]

Objective: Existential isolation refers to an individual's awareness of the unbridgeable gulf between oneself, other people and the world. This kind of isolation has been found to be higher in individuals with nonnormative experiences, such as racial or sexual minorities. Bereaved individuals may experience a stronger sense of existential isolation and feel that no one shares their feelings or perceptions. However, research on bereaved people's experiences of existential isolation and its effects on post‐loss adaptation is scarce. This study aims to validate the German and Chinese versions of the Existential Isolation Scale, investigate cultural and gender differences in existential isolation and explore the associations between existential isolation and prolonged grief symptoms in German‐speaking and Chinese bereaved individuals. Methods: A cross‐sectional study with 267 Chinese and 158 German‐speaking bereaved participants was conducted. The participants completed self‐report questionnaires assessing existential isolation, prolonged grief symptoms, social networks, loneliness and social acknowledgement. Results: The results indicated that the German and Chinese versions of the Existential Isolation Scale demonstrated adequate validity and reliability. No cultural or gender differences (or their interaction) were found for existential isolation. Higher existential isolation was associated with elevated prolonged grief symptoms, which was further moderated by the cultural group. The relationship between existential isolation and prolonged grief symptoms was significant for the German‐speaking bereaved people but not significant for those from China. Conclusion: The findings highlight the role of existential isolation in the adaptation to bereavement and how different cultural backgrounds moderate the effect of existential isolation on post‐loss reactions. Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

Clinical theories of adaptation in bereavement highlight a need for flexible shifting between mental states. However, prolonged motivational salience of the deceased partner may be a complicating factor, particularly when coupled with perseverative thinking about the loss. We investigated how prolonged grief symptoms might relate to resting state functional brain network connectivity in a sample of older adults (n = 38) who experienced the death of a partner 6–36 months prior, and whether intranasal oxytocin (as a neuropeptide involved in pair‐bonding) had differential effects in participants with higher prolonged grief symptoms. Higher scores on the Inventory of Complicated Grief (ICG) were associated with lower anticorrelation (i.e., higher functional connectivity) between the defaultretrosplenial – cingulo‐operculardACC network pair. Intranasal oxytocin increased functional connectivity in the same defaultretrosplenial – cingulo‐operculardACC circuit but ICG scores did not moderate effects of oxytocin, contrary to our prediction. Higher ICG scores were associated with longer dwell time in a dynamic functional connectivity state featuring positive correlations among default, frontoparietal, and cingulo‐opercular networks, across both placebo and oxytocin sessions. Dwell time was not significantly affected by oxytocin, and higher prolonged grief symptoms were not associated with more variability in dynamic functional connectivity states over the scan. Results offer preliminary evidence that prolonged grief symptoms in older adults are associated with patterns of static and time‐varying functional network connectivity and may specifically involve a default network‐salience‐related circuit that is sensitive to oxytocin. [ABSTRACT FROM AUTHOR]

More recently, the prolonged grief disorder (PGD) has been recognized as a mental health disorder following bereavement, which is distinct from depression and PTSD. However, the number and proposed symptom items vary across the ICD‐11 and the DSM‐5‐TR criteria for PG. The Traumatic Grief Inventory‐Self Report Plus (TGI‐SR+), which is an updated version of the TGI‐SR, is currently the only robust instrument that assesses PG according to the ICD‐11 and DSM‐5‐TR criteria. For research and clinical use among French‐speaking countries, the forward‐backward procedure was applied to translate the TGI‐SR+ into French language. Exploratory factor analysis and parallel analysis converged towards a two‐dimensional structure for the TGI‐SR+, representing adaptation difficulties and traumatic separation distress. However, items mapping onto ICD‐11 and DSM‐5‐TR criteria for PG represented a one‐dimensional structure. Findings based on item response theory method provided strong evidence for discriminative characteristics of the items. The internal reliability was excellent for the TGI‐SR+ (McDonald's ω = 0.97) and ICD‐11 and DSM‐5‐TR criteria for PGD (McDonald's ω = 0.95). We also demonstrated a very high temporal stability for the TGI‐SR+ total score (ICC =.91, p < 0.0001) and ICD‐11 PGD and DSM‐5‐TR PGD (ICC = 0.90, and ICC = 0.88, ps < 0.0001, respectively). The concurrent validity of the instrument was also demonstrated, such that the TGI‐SR+ total score and all combinations were positively and significantly associated with the levels of depression, anxiety and post‐traumatic stress symptoms. However, the effect sizes were moderate. We conclude that for research and clinical use among French bereaved populations, the TGI‐SR+ is a sound tool with very good psychometric properties. [ABSTRACT FROM AUTHOR]

Objectives: The study aims to develop a continuing bonds scale, investigate the relationship between continuing bonds and adjustment after loss, and test the moderating role of meaning reconstruction in this relationship. Methods: Data were collected from two different samples of 306 (Study 1) and 271 (Study 2) bereaved adults. Results: The four factors structure of the Multidimensional Continuing Bonds Scale (MCBS) was explored and confirmed. Hierarchical regression analysis revealed that continuing bonds showed a significant relationship with prolonged grief symptoms after controlling the risk factors such as gender, age of the deceased, time since loss, and cause of death. Meaning reconstruction moderated the relationship between continuing bonds and prolonged grief symptoms. Conclusion: The results revealed that the MCBS can be used as a valid and reliable scale to assess the continuing bonds construct. The relationship between continuing bonds and prolonged grief symptoms varies according to the levels of meaning reconstruction. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore psychological symptoms in widowed parents with minor children, 2–4 years after the death of their partner. A second aim was to examine the associations between psychological symptoms and nonmodifiable and modifiable illness and healthcare‐related factors. Methods: A cross‐sectional survey study on widowed parents with minor children after the loss of a partner to cancer. In total, 42 parents completed an online questionnaire including instruments for assessing symptoms of anxiety, depression, grief rumination, prolonged grief, and posttraumatic stress. Descriptive statistics, Spearman's correlation coefficients, Mann–Whitney U tests and Kruskal–Wallis tests were used to analyze differences in symptomology based on modifiable and nonmodifiable factors. Results: Parents reported moderate–severe symptoms of anxiety, posttraumatic stress, and depression. Reporting having received more information during the partner's illness regarding how the illness could affect the partner's somatic and psychological health and where to turn for support were associated with fewer psychological symptoms. Conclusions: A substantial proportion of widowed parents with minor children reported a moderate–severe symptom burden regarding depression, anxiety, and posttraumatic stress, and less so with prolonged grief symptoms. This study also highlighted the value of receiving information from healthcare personnel regarding the somatic and psychological effects of a partner's illness and where widowed parents can turn for support. [ABSTRACT FROM AUTHOR]

People bereaved through road traffic accidents (RTAs) are at risk for severe and disabling grief (i.e., pathological grief). Knowledge about needs and use of bereavement care, including psychotherapy, pharmacotherapy, and support groups, is limited. This study charted (correlates of) the needs and use of bereavement care in RTA bereaved people. Furthermore, although online grief treatment seems effective, it is unknown whether it is perceived as acceptable. Accordingly, we examined the acceptability of online treatment. Dutch RTA bereaved adults (N = 273) completed self‐report measures about needs and use of bereavement care, acceptability of online grief treatment, and pathological grief. Regression analyses were used to identify correlates of care needs and use and acceptability of online treatment. The majority (63%) had received help from psychotherapy, pharmacotherapy, and/or support groups. One in five participants had not used bereavement care services, despite reporting elevated pathological grief levels and/or expressing a need for care, pointing to a treatment gap. Use of psychological support before the loss was the strongest predictor of bereavement care needs and use following the loss. A minority (35%) reported being inclined to use online grief treatment if in need of support. More openness towards online services was related to greater acceptability of online treatment. In conclusion, 20% of RTA bereaved people with pathological grief or care needs had not received care. This treatment gap may be reduced by improving accessibility of online treatments. However, as only 35% was open to using online treatments, increasing the acceptability of (online) treatments appears important. [ABSTRACT FROM AUTHOR]

Objective: To assess differences in prolonged grief, depression, posttraumatic stress, and sleep disturbances in bereaved parents across years since loss (1-5 years) and by gender and to assess potential interactive effects of time since loss and gender on bereavement outcomes.Methods: This study examined symptom levels of prolonged grief disorder, depression, posttraumatic stress, and insomnia in bereaved parents. A sample, including 133 mothers and 92 fathers who had lost a child to cancer 1 to 5 years previously, subdivided to five subsamples, one for each year since loss. Analysis of variance (ANOVA) was used to assess differences in symptom levels, related to years since loss, and gender.Results: Regardless of how many years had passed since the loss, symptom levels of prolonged grief, depression, posttraumatic stress symptoms, and insomnia were elevated in all subsamples. Mothers showed higher symptom levels of prolonged grief, depression, and posttraumatic stress than fathers. However, no significant interaction effects were found between years since loss and gender on any of the symptom levels.Conclusions: Cancer-bereaved mothers and fathers are vulnerable to prolonged grief and psychological symptoms up to 5 years after the death of their child. Findings highlight that bereaved parents may need long-term support, and the results deserve further attention in research and clinical care. [ABSTRACT FROM AUTHOR]

In the bereavement literature, prolonged grief, described in the new DSM-5 as persistent complex bereavement disorder, is considered a pathological disorder affecting a small but significant minority of bereaved persons. In the ambiguous loss literature, in contrast, prolonged grief is viewed as inevitably linked to the ambiguity of the bereaved person, and its causes are linked to the ambiguity, such as persistent hope, the absence of cultural and religious rituals to provide meaning to a loss, and the grief being so large as to disenfranchise community members. Based on a literature review and qualitative fieldwork with parents of missing persons in Uganda, this article examines the emotional, social, cultural, and socioeconomic aspects of the ambiguity that relatives of missing persons experience in the aftermath of wartime disappearances. I argue that, in such contexts, explanations of prolonged grief as a pathological disorder cannot be sustained. [ABSTRACT FROM AUTHOR]

Objective: Most reactions to loss can be characterized by three prototypical trajectories of resilience, gradual recovery, and chronic distress (Bonanno, 2004). However, research on the factors that uniquely predict these trajectories of response has been limited. We examined theoretically relevant predictors of each of the trajectory patterns. Method: We assessed 115 bereaved spouses at 1.5 to 3 years postloss and 74 married controls. To identify grief trajectory, we provided bereaved participants with a graphical depiction of the trajectories and asked them to select the one that best described their experience. Results: Group comparisons revealed substantial differences between resilient and prolonged grievers, and almost no differences between resilient and married controls. Multivariate analyses indicated that prolonged grief, when compared to resilience, was uniquely associated with maladaptive dependency traits, difficulty accessing positive memories of the deceased, and higher recalled marital adjustment. Conclusion: The present results extend our understanding of factors associated with distinct trajectories of adjustment after loss. [ABSTRACT FROM AUTHOR]

Objectives Rumination is a risk factor after bereavement, predicting higher concurrent and prospective symptom levels of complicated grief and depression in mourners. Research has shown that rumination may consist of adaptive and maladaptive subtypes, but there has been a paucity of research in this topic in the bereavement area. Therefore, we aimed to clarify whether functional and dysfunctional forms of rumination can be distinguished after loss. Design Two-hundred and forty-two adults, who lost a first-degree family member on average 10 months previously, filled out questionnaires at three time points with 6 months between each time point. Methods Multiple regression analyses, controlled for loss-related variables, neuroticism, and baseline symptoms, were run to examine associations of subtypes of depressive rumination (brooding, reflection) and grief rumination (rumination about injustice, meaning, reactions, relationships and counterfactual thinking) with concurrent and prospective symptom levels of complicated grief and depression. Results Overall, grief rumination explained more variance in symptom levels than depressive rumination. Other major findings were that grief rumination about injustice predicted higher concurrent and prospective symptom levels of complicated grief and higher prospective symptom levels of depression. In contrast, grief rumination about emotional reactions was related to prospective reductions in symptoms of complicated grief. Reflection was also associated with prospective reductions of complicated grief and depressive symptom levels. Conclusions Results indicate that adaptive and maladaptive forms of ruminative thinking can be distinguished in bereaved individuals. Therapeutic interventions for complicated grief could potentially be improved by including techniques aimed at reducing maladaptive rumination and increasing adaptive rumination. Practitioner points Clinical implications Adaptive and maladaptive components of rumination after loss can be distinguished. They are differentially associated with concurrent and prospective symptom levels of complicated grief and depression in mourners., Adaptive rumination after bereavement is characterized by repetitive, self-focused thinking aimed at understanding one's depressive and loss-related emotional reactions., Maladaptive rumination is characterized by repetitive, self-focused thinking about injustice to the self and making passive comparisons between the current situation (in which one has experienced a loss) and unrealized alternatives., Psychological interventions for complicated grief may be improved by adding therapeutic techniques aimed at reducing maladaptive rumination and increasing adaptive rumination., Cautions and limitations This investigation relied exclusively on self-report measures., Conjugally bereaved women were overrepresented in the current sample., Complicated grief and depression levels in the current sample ranged from non-clinical to clinical. Effects may be more pronounced in a clinical sample. [ABSTRACT FROM AUTHOR]

Purpose Younger spouses or partners have been understudied in the prolonged grief literature. The purpose of this study was to determine rates of prolonged grief in young spouses or partners and the associations between prolonged grief and personality styles (specifically, narcissistic, histrionic, and obsessive), trauma history, and the perceived meaning of the loss in the young conjugally bereaved. Participants and method Participants between 20 and 50 years old who lost a spouse/partner to cancer 6 months-3 years prior to the study completed the following measures during one time point (via phone or in person interviews): Prolonged Grief-13, Traumatic Life Events Questionnaire, Millon Clinical Multiaxial Inventory-III, and Grief Meaning Reconstruction Inventory. Results Fifty-six spouses and partners (51.8% women) completed the interviews (mean age: 44.54 ± 4.20 years). The participants (49.1%) reported elevated rates of prolonged grief and 12.3% of the participants were diagnosed with prolonged grief with the recently published diagnostic algorithm. Bivariate analyses demonstrated an association between prolonged grief and negative meaning of the loss ( r = 0.73; p < 0.01) and the frequency of the traumatic events ( r = 0.23; p < 0.05). Multivariate analyses revealed that negative meaning of the loss was the only significant predictor of prolonged grief ( Beta = 0.71; p = 0.0001). Conclusion Elevated levels of prolonged grief were found in this population, suggesting a need for further research into young spousal grief. Young bereaved spouses may lack flexibility in reconstructing their view of the world as the death may invalidate their previously held world beliefs. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to describe the gender difference of grief experience and mood distress among caregivers who cared for terminal cancer patients residing in a hospice ward. Methods: This study recruited 432 caregivers who cared for terminal cancer patients in the hospice ward. Caregivers received telephone interviews 6 months after the patients had died. The Chinese versions of the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Inventory of Complicated Grief (ICG) developed in 1995 by Prigerson et al. were employed to assess the mood distress and grief status. Results: Total scores of BDI, BAI, and ICG were significantly higher in females. Six out of twenty-one items of BDI, lack of satisfaction, crying spells, sleep disturbance, fatigability, somatic preoccupation, and loss of libido, showed significantly higher scores in females. According to BAI, inability to relax, dizziness, fear of dying, fright, flushed face, and hot/cold sweats were significantly higher in females. After adjustment for potential confounders, the results show that female gender is associated with higher BDI (regression coefficient 3.24, 95% CI: 1.48-4.99), BAI (3.8; 1.11-6.50), and ICG (4.25, 1.09-7.40). Dichotomizing the BDI, BAI, and ICG into severe and nonsevere cases, the results showed that gender only contributes to severe anxiety status (BAI≧36), but not to severe depression (BDI≧29) or to prolonged grief (ICG≧25). Conclusions: Bereaved females had higher scores for depression and anxiety than males. Female gender is associated with severe anxiety; however, it is not associated with severe depression or prolonged grief. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]