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The International Classification of Diseases Eleventh Edition (ICD-11), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), now include prolonged grief disorder (PGD). Since criteria for PGD in both classification systems differ from prior proposed grief disorders and each other, the validation of a single instrument to screen for prolonged grief (PG) symptoms of both new diagnoses is critical for bereavement research and care. Therefore, we evaluated the psychometric properties of the Swedish version of the Traumatic Grief Inventory Self-Report Plus (TGI-SR+). Two-hundred and forty-eight bereaved parents completed questions about sociodemographic and loss-related variables, the TGI-SR+, and symptom measures of post-traumatic stress (PTS), depression and an older measure of PG symptoms, the Prolonged Grief Disorder-13 (PG-13). Confirmatory factor analyses showed that a one-factor model best fit DSM-5-TR and ICD-11 PG symptoms and the analyses of the internal consistency and inter-item correlations showed that these symptoms could be reliably assessed. In support of convergent validity, DSM-5-TR and ICD-11 PG symptoms correlated with symptoms of PTS, depression and PG assessed with the PG-13. In support of known-groups validity, DSM-5-TR and ICD-11 PG symptoms were higher among lower educated (vs. higher educated) participants and related negatively to time since loss. ROC analyses showed optimal cut-off score of ≥71 and ≥72 to determine probable caseness for DSM-5-TR and ICD-11 PGD, respectively. Results support the reliability and validity of the Swedish TGI-SR+ as a screening instrument for PG in research and bereavement care.

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.

Background and objectives: Savoring beliefs refer to people’s beliefs about their ability to generate, increase, and prolong enjoyment from positive experiences. The role of these beliefs in affecting responses to negative events is largely unexplored. This study aimed to increase knowledge about the role of savoring beliefs in symptoms of posttraumatic stress (PTS) following negative life events and the incremental role of these beliefs beyond the impact of worry, depressive rumination, and neuroticism. Design: A two-wave longitudinal survey. Methods: Two-hundred and five students completed the Savoring Beliefs Inventory, measuring one’s ability to generate pleasure from past, present, and anticipated experiences at Time 1 (T1). Six months later (at T2), they rated adverse life-events experienced between T1 and T2 and completed measures of PTS (associated with the most distressing event experienced in this time-frame) and depression. Results: Savoring beliefs at T1 were correlated with PTS total scores and PTS clusters and depression at T2. Regression analyses indicated that savoring beliefs regarding present and future (but not past) events were associated with some, but not all T2-outcomes, above and beyond worry, depressive rumination, and neuroticism. Conclusions: This study confirms that increased savoring beliefs could mitigate the impact of confrontation with adverse events.

Objective: A prior study with people exposed to a traumatic event indicated that posttraumatic anger is a multidimensional construct that consists of five factors comprising anger at (a) the criminal justice system, (b) other people, (c) the self, and (d) a perpetrator and (e) a desire for revenge. Preliminary evidence shows that anger at the self and perpetrators is related to posttraumatic stress disorder (PTSD) symptoms. Expanding the focus from trauma victims to people exposed to a traumatic loss of a significant other, for example, due to road traffic accidents, may enhance our knowledge on factors that are amenable to change in the treatment of prolonged grief disorder (PGD) and PTSD. Method: We examined the (a) factor structure of the 20-item Posttraumatic Anger Questionnaire in 209 Dutch people bereaved by road traffic accidents using confirmatory factor analysis and (b) associations between the posttraumatic anger factors and PGD and PTSD using structural equation models. Results: The expected five-factor structure of the Posttraumatic Anger Questionnaire was supported. Anger at the self was related to greater PGD (b =.35) and PTSD (b =.50) symptoms over and above known risk factors of distress. A desire for revenge (b =.20) was uniquely and positively associated with PTSD symptoms. Conclusion: Pending replication of our findings in longitudinal studies, we conclude that anger subtypes relate differently to distress after traumatic loss. Anger toward the self seems the most detrimental type of anger and may therefore be an important target in treatment.

The aim of this systematic review and meta-analysis was to provide an overview of existing controlled trials focusing on the impact of multiple family therapy (MFT) on mental health problems and family functioning, and to examine the efficacy of MFT. Relevant studies were selected following a screening of 3376 studies identified by a systematic search of seven databases. The following data were extracted: participant characteristics, program characteristics, study characteristics, and information of mental health problems and/or family functioning. A total of 31 peer-reviewed, English, controlled studies evaluating the effect of MFT were included in the systematic review. Sixteen studies presenting 16 trials were included in the meta-analysis. All but one of the studies was at risk of bias, with problems concerning confounding, selection of participants and missing data. The findings confirm that MFT is offered in diverse settings, with studies presenting a variety of therapeutic modalities, focal problems, and populations. Individual studies reported some positive findings, including improvements in mental health, vocational outcomes, and social functioning. The findings of the meta-analysis suggest that MFT is associated with improvements in symptoms of schizophrenia. However, this effect was found not to be significant due to the large amount of heterogeneity. In addition, MFT was associated with small improvements in family functioning. We found little evidence to suggest that MFT successfully alleviates mood and conduct problems. To conclude, more methodologically rigorous research is needed to further examine the potential benefits of MFT, as well as the working mechanisms and core components of MFT.

Commemorative events, organized in the aftermath of war or large-scale violence, can have an emotional impact on those who are attending. We examined several characteristics that might influence this impact. In a quasi-experimental pretest-posttest study, participants (n = 307) watched footage of the broadcast of the Dutch National Commemoration, in which World War II is remembered. A control group of 48 participants watched the commemoration broadcast live on Remembrance Day. They were matched for age, gender, war experience and migration background with 48 participants from the study group who watched the footage, to conduct a comparability check. We found some evidence that watching the footage was comparable to watching the commemoration live on Remembrance Day in terms of emotional response and experience of psychosocial factors. Participants in the footage sample (n = 307) responded with an increase of negative and decrease of positive emotions. Individual characteristics were limitedly related to the emotional response; posttraumatic stress symptom severity predicted increased negative emotions. Experiencing meaning making, support and, to a lesser extent, recognition through commemorating was related to experiencing more positive emotions. The findings indicate these psychosocial factors may buffer the emotional distress elicited by commemoration and contribute to important cognitive and social benefits. Practical implications are discussed.

Background: The coronavirus disease 2019 (COVID-19) pandemic is associated with an increase in mortality rates globally. Given the high numbers of deaths and the potentially traumatic characteristics of COVID-19 deaths, it is expected that grief-related distress levels are higher in COVID-19 bereaved (compared to non-COVID-19 bereaved) people. This living systematic review (LSR) investigates the empirical evidence regarding this claim. More specifically, this LSR summarizes studies evaluating prevalence and correlates of positive and negative psychological effects of COVID-19 bereavement. This iteration synthesizes evidence up to July 2022. Methods: Systematic searches were conducted in PsychInfo, Web of Science, and Medline by two independent reviewers. Eligible studies included quantitative peer-reviewed articles reporting on positive and/or negative psychological outcomes, using validated measures, in COVID-19 bereaved adults. The primary outcome was prolonged grief symptoms (PG). Results: Searches identified 9871 articles, whereof 12 studies met the inclusion criteria. All studies included prevalence rates and/or symptom-levels of psychological outcomes after COVID-19 losses. Prevalence rates of psychological outcomes were primarily reported in terms of (acute) PG, pandemic grief, depression, anxiety, and functional impairment, and varied widely between studies (e.g., ranged between 29% and 49% for acute PG). No studies reported on prevalence rates of positive psychological outcomes. Closer kinship to the deceased, death unexpectedness, and COVID-19 stressors were identified as correlates of increased psychological symptoms. Conclusions: Due to the small number and heterogeneity of studies, knowledge about psychological effects of COVID-19 bereavement is limited. This LSR offers a regular synthesis of up-to-date research evidence to guide clinicians, policy makers, public health professionals, and future research on the psychological effects of CO

The death of a loved one may lead to posttraumatic stress disorder (PTSD). Although it is conceivable that unnatural losses (caused by e.g., accidents, homicide, or suicide) render people more vulnerable to PTSD than natural losses (e.g., caused by illnesses) this is an understudied issue. The current study sought to enhance knowledge about the presentation and prevalence of PTSD symptoms, in people confronted with natural, non-sudden and unnatural, sudden losses. Considering that PTSD is defined differently in DSM-5 and ICD-11, we compared PTSD severity and prevalence rates between these diagnostic systems. Self-reported data were available from a heterogeneous sample of 1064 bereaved people (Mage = 52.13 years, 86 % female). Confirmatory factor analyses supported the DSM-5-based and ICD-11-based symptom clustering. DSM-5 yielded higher prevalence rates of probable PTSD than ICD-11 criteria. PTSD cluster and total scores were significantly higher for participants confronted with unnatural losses than participants confronted with natural losses. Rates of probable PTSD (based on DSM-5 and ICD-11) were also higher in the former group. Confrontation with an unnatural loss was not associated with PTSD scores beyond other sociodemographic and loss-related variables considered. Results show that bereavement-related PTSD is assessed differently in DSM-5 and ICD-11. Cause of death affected PTSD but less strongly than anticipated.

Prolonged grief disorder, a condition characterized by severe, persistent, and disabling grief, is newly included in ICD-11 and DSM-5-TR. Prolonged grief symptoms can be effectively treated with face-to-face or internet-delivered cognitive behavioral therapy. Traumatic losses may elicit higher prevalence of severe grief reactions. While face-to-face cognitive behavioral therapy appears efficacious in treating prolonged grief symptoms in traumatically bereaved individuals, it is not yet clear if internet-based cognitive behavioral therapy is efficacious for this population. Therefore, we investigated the efficacy of a 12-week internet-delivered cognitive behavioral therapy for people bereaved through traffic accidents in a randomized waitlist-controlled trial (registration number: NL7497, Dutch Trial Register). Forty adults bereaved though a traffic accident were randomized to internet-based cognitive behavioral therapy (n = 19) or a waitlist control condition (n = 21). Prolonged grief, post-traumatic stress, and depression symptoms were assessed at baseline, post-treatment, and 8-week follow-up. Dropout in the treatment condition was relatively high (42%) compared to the control condition (19%). Nevertheless, multilevel analyses showed that internet-based cognitive behavioral therapy strongly reduced prolonged grief, post-traumatic stress, and depression symptoms relative to the control condition at post-treatment and follow-up. We conclude that internet-based cognitive behavioral therapy appears a promising treatment for traumatically bereaved adults.

The field of traumatic stress is often referred to as being in a state of controversy and lack of continuity. Throughout history, disputes repeatedly centered on defining the psychological consequences of severe adverse events and on their causes. Even to this day this is current. To understand these controversies, an extensive historical literature review is presented of how mental consequences of trauma have been described in history, of the circumstances in which this took place, and of the disputes that have influenced the conceptualization of these mental responses. We found psychotrauma always being surrounded by controversy. Significant heterogeneity in symptom expression has been described over the centuries to this day. Some symptoms appeared steadily over many decades, but often each time period showed its own core symptoms. At syndrome level, we found an acute condition, one with longer duration, and a complex condition. Also here, definitions varied over the decades. Finally, causes have always been debated, such as biological, psychological, socio-economic, cultural, political, or legal. To better reflect the described ongoing variation in symptomatology, a more flexible diagnostic approach is proposed with a combination of both staging and subtyping that offers room for a more flexible, symptom-oriented, and personalized perspective.

To date, there have been no cohort studies of sexual harassment incidence and its relation to mental health within humanitarian field-workers. Research among numerous occupations suggests an association between workplace sexual harassment and several health complaints. This study examined the incidence and severity of sexual harassment and its association with changes in mental health in a cohort of international humanitarian aid field-workers (iHAWs). Four hundred and seventy-eight iHAWs filled in questionnaires about sexual harassment, depression, anxiety, and Post-Traumatic Stress Disorder (PTSD) as part of a larger study on health and well-being. Six percent of male and 18% of female iHAWs reported experiencing sexual harassment during their latest field assignment, with most reporting low levels of nonphysical forms of sexual harassment. Sexual harassment was predictive of negative changes in both depression and anxiety symptom severity between before and after an assignment for females; for males, it predicted negative changes in PTSD symptom severity. Sexual harassment did not predict utilization of mental healthcare services within 2 months after the end of assignment. The current findings are the first figures derived from a representative sample of iHAWs on the incidence of sexual harassment during a field assignment and show sexual harassment to be a relatively common and present issue. The findings are mostly in line with the extant literature and underscore the importance of attending to the issue of sexual harassment in the humanitarian sector.

Background: With the release of the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR), criteria for Prolonged Grief Disorder (PGD) were included. This necessitates studying grief trajectories based on these criteria. Objective: This is the first study examining latent trajectories of DSM-5-TR-based PGD symptom levels and testing whether specific risk factors (e.g. cause of death) predicted PGD trajectories. Method: We evaluated latent DSM-5-TR PGD trajectories using pooled existing data collected at 6–12, 13–24, and 25–60 months post-loss in Danish and Dutch bereaved adults (N = 398). Latent Growth Mixture Modelling (LGMM) was employed to determine the trajectories. Multinomial logistic regression analyses were used to examine which risk factors predicted class membership. Results: The four-class LGMM solution with a quadratic term was best-fitting the data. This solution represented four trajectories: High stable PGD (6%), High PGD quick recovery (10%), High PGD slow recovery (35%), and Low PGD symptoms (49%). Participants with a higher educational level were more likely to be assigned to the Low PGD symptoms trajectory compared to High stable PGD and High PGD slow recovery trajectories. Unnatural causes of death increased the likelihood of being in the High stable PGD and High PGD slow recovery trajectories compared to the Low PGD symptoms trajectory. Conclusions: Consistent with prior research, the Low PGD symptoms trajectory was the most common. A significant minority experienced high and stable levels of PGD within five years after the loss. About one-third of participants experienced high acute grief levels that decreased slowly; how slow decreasing symptoms relate to an individual’s functioning requires further attention. This study demonstrates that a significant minority of bereaved people develop acute PGD symptomatology that does not diminish within five years post-loss, emphasizing the need for early sc

Deaths of relatives and peers in potentially traumatizing circumstances may lead to symptoms of prolonged grief (PG, e.g.,yearning, preoccupation) and posttraumatic stress (PTS, e.g., re-experiencing, hypervigilance). There is limited knowledge about how symptoms of PG and PTS co-occur following such events. The current study aimed to identify patterns of DSM-5-TR defined PG symptomatology and PTS in a sample of 213 youngsters, involved in a school bus accident killing seven peers 2 months earlier. Using latent class analysis, three groups were identified evidencing moderate endorsement of most symptoms (Class 1), high endorsement of almost all but the avoidance symptoms (Class 2), and high endorsement of almost all symptoms (Class 3), respectively. Classes differed in terms of levels of grief, PTS, and depression, assessed concurrently, and—in a subgroup of n=137 participants—assessed at 16 month follow-up. E.g., Class 3 membership was associated with a greater likelihood of meeting criteria for DSM-5-TR defined prolonged grief disorder at follow-up. Gender (fewer females in Class 1) but not age and proximity to the accident were associated with class membership. Findings indicate that it is important to identify groups with elevated PG and PTS early after traumatic bereavement who may be en route to persistent mental health problems.

Introduction: Unaccompanied refugee minors (URMs) are at increased risk of developing mental health problems, such as symptoms of posttraumatic stress disorder (PTSD) and depression. In addition, URMs face several barriers to mental health care. Few studies have evaluated trauma-focused interventions for URMs that target these issues. The current study evaluated a multimodal trauma-focused treatment approach for URMs. It aimed to provide an initial indication of the effectiveness of this treatment approach and to provide a qualitative evaluation assessing treatment satisfaction of the participating URMs. Methods: A mixed-methods study was conducted among ten URMs, combining quantitative data with qualitative data through triangulation. Quantitative data were collected using a non-concurrent multiple baseline design in which repeated, weekly assessments were carried out during a randomized baseline period, during treatment, and during a 4-week follow-up period. Questionnaires assessing PTSD (Children’s Revised Impact of Event Scale) and symptoms of depression (The Patient Health Questionnaire-9, modified for adolescents) were used. In addition, treatment satisfaction was measured post-treatment using a semi-structured interview. Results: During the qualitative evaluation, all but one URM noted they found the trauma-focused treatment approach useful and felt the treatment had positively impacted their wellbeing. However, the results of the quantitative evaluation did not show clinically reliable symptom reductions at posttest or follow-up. Implications for clinical practice and research are discussed. Discussion: The current study presents our search in developing a treatment approach for URMs. It adds to the current knowledge about methodological considerations in evaluating treatments for URMs, the potential effects of trauma-focused treatments on URMs, and the implementation of treatments for URMs. Clinical trial registration: The study was

Background: The disappearance of a significant person is an ambiguous loss due to the persistent uncertainty about the whereabouts of the person. Measures specifically capturing the psychological consequences of ambiguous loss are lacking. Therefore, this study aimed to develop the Ambiguous Loss Inventory Plus (ALI+) and evaluated its suitability for use with relatives of missing persons.Methods: ALI+ items were generated based on established measures for prolonged grief symptoms and literature on psychological responses to ambiguous loss. Eight relatives of missing persons (three refugees, five non-refugees) and seven international experts on ambiguous loss rated all items in terms of understandability and relevance on a scale from 1 (not at all) to 5 (very well). Results: On average, the comprehensibility of the items was rated as high (all items ≥ 3.7). Likewise, all items were rated as relevant for the assessment of common responses to the disappearance of a loved one. Only minor changes were made to the wording of the items based on the experts’ feedback.Conclusions: These descriptive results indicate that the ALI+ seems to cover the intended concept, thus showing promising face and content validity. However, further psychometric evaluations of the ALI+ are needed.

Objectives: In the present study, we examined relations between premigration, perimigration, and postmigration risk factors (i.e., potentially traumatic events [PTEs], postmigration living problems [PMLPs], stressful life events) and psychological symptoms (i.e., anxiety/depression, posttraumatic stress) in Syrian emerging adults with refugee backgrounds; we also tested cultural identity conflict as a possible mediator of these relations. We expected that greater exposure to migration risk factors was associated with more psychological symptoms and that higher cultural identity conflict would contribute to these associations. Methods: We used data from the first wave of Karakter, a longitudinal study of 158 Syrians with refugee backgrounds (69.0% men, age range 18–35). Participants completed a questionnaire assessing PTEs, PMLPs, stressful life events, cultural identity conflict, and symptoms of anxiety/depression and posttraumatic stress. Results: Correlational analyses indicated that more PTEs and stressful life events were related to higher levels of cultural identity conflict and more psychological symptoms. Furthermore, greater cultural identity conflict was associated with more psychological symptoms. We did not observe indirect effects of cultural identity conflict in the mediation analyses. Conclusions: Results suggest that postmigration stressors and cultural identity conflict are associated with psychological symptoms among Syrian emerging adults who have resettled in the Netherlands.

Background: Recovery after the death of a loved one involves decreasing sadness and grief, but also involves maintaining and strengthening satisfaction with life (SWL). Greater SWL may buffer the development of emotional problems following loss, including symptoms of prolonged grief. There is limited knowledge on how SWL may develop following loss and how it relates to such symptoms. The aim of this study was to examine to what extent SWL following partner-loss was characterized by time-invariant (trait-like) and time-varying (state-like) components and to examine associations of these components with long-term prolonged grief. Method: Data were available from elderly bereaved people who lost their partner. They provided self-reported data on SWL at two, six, 13, 18 and 48 months post-loss and rated prolonged grief severity at 48 months. Latent trait-state-occasion (TSO) modeling was employed to distinguish the time-invariant and time-varying components of SWL. Regression analysis tested associations of these components with prolonged grief at 48 months. Results: In this sample, SWL consisted of significant time-invariant and time-varying components. The time-varying components were larger than the time-invariant component at 4 of 5 assessment points. At 48 months post-loss, the time-varying component of SWL was more strongly associated with concurrently assessed prolonged grief than was its time-invariant component. Conclusion: After partner loss, SWL appears to be more strongly “state-like” than “trait-like”. This suggests that it may be successfully boosted by external influences (including bereavement care interventions).

Background and objectives: A rise in prolonged grief disorder (PGD) levels was expected due to COVID-19 deaths. We tested this assumption, by comparing PGD-severity among people who experienced a death of a loved one during the pandemic caused by a natural (e.g., illness), COVID-19, or unnatural (e.g., accidents, suicides, homicides) loss on average 8 months earlier and in a subgroup of people bereaved ≥12 months earlier. Design and methods: Self-rated DSM-5-TR (acute) PGD levels (using the Traumatic Grief Inventory-Self Report plus) were compared among Dutch adults who experienced a natural (N = 1036), COVID-19 (N = 76), or unnatural loss (N = 271) during the pandemic. Analyses of covariance were used. Results: About two-thirds of the participants scored above the cut-off for (acute) probable PGD. Significantly higher acute PGD-severity was found in people after unnatural loss compared with COVID-19 (B = -2.44 (SE=0.87), p = .005) or natural loss (B = -1.78 (SE=0.45), p<.001). No significant differences in acute PGD-severity was found between people who experienced a natural or COVID-19 loss (B = 0.66 (SE=0.80), p = .413). PGD levels did not differ between the three groups for people who lost their loved one ≥12 months earlier (N = 380). Conclusions: We found that acute PGD-severity was significantly higher following unnatural deaths than after COVID-19 deaths or natural causes, but no differences were found for people who experienced a loss ≥12 months earlier.

BACKGROUND: There is a need for an interview-based measure to assess Prolonged Grief Disorder (PGD) included in the text revision of the fifth Diagnostic and Statistical Manual for Mental Disorder (DSM-5-TR) and 11th edition of the International Classification of Disease (ICD-11). We evaluated the psychometric properties of the Traumatic Grief Inventory-Clinician Administered (TGI-CA); a new interview measuring DSM-5-TR and ICD-11 PGD severity and probable caseness.METHODS: In 211 Dutch and 222 German bereaved adults, the: (i) factor structure, (ii) internal consistency, (iii) test-retest reliability, (iv) measurement invariance across subgroups (e.g., differing in language), (v) prevalence of probable caseness, (vi) convergent validity, and (vii) known-groups validity were examined.RESULTS: Confirmatory factor analyses (CFAs) showed acceptable fit for the unidimensional model for DSM-5-TR and ICD-11 PGD. Omega values indicated good internal consistency. Test-retest reliability was high. Multi-group CFAs demonstrated configural and metric invariance for DSM-5-TR and ICD-11 PGD criteria for all group-comparisons; for some we found support for scalar invariance. Rates of probable caseness for DSM-5-TR PGD were lower than ICD-11 PGD. Optimal agreement in probable caseness was reached when increasing the number of accessory symptoms for ICD-11 PGD from 1+ to 3+. Convergent and known-groups validity was demonstrated for both criteria-sets.LIMITATIONS: The TGI-CA was developed to assess PGD severity and probable caseness. Clinical diagnostic interviews for PGD are needed.CONCLUSIONS: The TGI-CA seems a reliable and valid interview for DSM-5-TR and ICD-11 PGD symptomatology. More research in larger and more diverse samples is needed to further test its psychometric properties.

The Traumatic Grief Inventory Self-Report (TGI-SR), which aims to assess both Persistent Complex Bereavement Disorder and Prolonged Grief Disorder, has been validated in several languages. This study sought to validate the French-Canadian version. We conducted an online survey exploring the impact of the COVID-19 pandemic on grief. With data from 728 participants, the scale demonstrated high internal consistency, correlated significantly with three other scales known to measure similar concepts, and distinguished between groups known to be different. This study supports the use of the TGI-SR French-Canadian version by clinicians and researchers to assess complications of grief.

The Resolutions Approach (RA) is a solution-based intervention that has a unique way of dealing with parental denial of child abuse occurrences. The aim of this scoping review is to summarise knowledge about the benefits of the RA and identify areas for future research. After describing the theoretical background, the intervention steps are illustrated. Next, results of a systematic literature search on the effectiveness and other clinical benefits of the RA are presented. Finally, we provide suggestions for future research. Our search identified two published articles and one dissertation. Findings indicate that the RA might be useful in stopping child abuse and in improving cooperation between families and professionals. Parents experienced more control over their situation, and guardians perceived the method to be transparent. The RA is a well-described method that respectfully deals with families in which a lack of safety is observed. Future empirical research on the RA is necessary.

How traumatic events (TEs) should be defined, and how specific TEs are for Post-traumatic Stress Disorder (PTSD) were examined in a general mental health care population. Three definitions of TEs were defined, according to the PTSD criteria of DSM-IV. Half of the sample reported any TE, with a high prevalence of TEs among non-PTSD disorders. Previous mental health care, female gender, and the likelihood of assigning PTSD were associated with more severe trauma definitions. Reexperiencing symptoms were especially common among mood disorders. The implications for treatment are discussed and an alternative, dimensional definition of trauma has been proposed.

The present study aimed to examine whether day-level engagement in non-work activities can mitigate the adverse outcomes of job loss. Based on Jahoda's latent deprivation model, we hypothesized that engaging in such activities (e.g., meeting others) can fulfil five basic needs (e.g., need for time structure) and that fulfilment of these needs mitigates the negative consequences of job loss. A diary study was conducted on five consecutive days among 236 participants who had involuntarily lost their job, yielding 1046 daily measures of the time spent on activities, the evaluation of these activities, and emotional distress. Multilevel regression analyses showed that time spent on daily activities was associated with the degree of fulfilment of the basic needs and emotional distress, yet the effect sizes were small. Perceived utility of these daily activities showed more solid effect sizes with the basic needs and emotional distress. However, the mediation effect of the basic needs regarding the association between activities and emotional distress could not be confirmed. The present results suggest that, in addition to stimulating individuals who experience job loss-related emotional distress to undertake certain activities, the evaluation of these activities should also be taken into account in tailor-made interventions and preventive measures.

In this contribution, we respond to a letter in Omega: Journal of Death and Dying by Doka. Signatories of this letter to the President of the United States convey concerns that deaths during the COVID-19 pandemic will lead to a higher prevalence of severe and persistent grief, i.e., prolonged grief disorder. We support their call to action to direct government funding to helping those who develop this condition during the COVID-19 pandemic. However, we think that concerns about prolonged grief disorder during the pandemic can be more convincingly conveyed by firmly embedding such concerns within scientific literature. Therefore, we highlight prior scientifically informed opinion pieces from various international researchers who voiced similar concerns in the early months of the pandemic. Additionally, we provide an overview of pioneering empirical research elucidating whether prolonged grief disorder and related mental health problems will become more prevalent during the pandemic.

Item does not contain fulltext, The aim of this systematic review and meta-analysis was to provide an overview of existing controlled trials focusing on the impact of multiple family therapy (MFT) on mental health problems and family functioning, and to examine the efficacy of MFT. Relevant studies were selected following a screening of 3376 studies identified by a systematic search of seven databases. The following data were extracted: participant characteristics, program characteristics, study characteristics, and information of mental health problems and/or family functioning. A total of 31 peer-reviewed, English, controlled studies evaluating the effect of MFT were included in the systematic review. Sixteen studies presenting 16 trials were included in the meta-analysis. All but one of the studies was at risk of bias, with problems concerning confounding, selection of participants and missing data. The findings confirm that MFT is offered in diverse settings, with studies presenting a variety of therapeutic modalities, focal problems, and populations. Individual studies reported some positive findings, including improvements in mental health, vocational outcomes, and social functioning. The findings of the meta-analysis suggest that MFT is associated with improvements in symptoms of schizophrenia. However, this effect was found not to be significant due to the large amount of heterogeneity. In addition, MFT was associated with small improvements in family functioning. We found little evidence to suggest that MFT successfully alleviates mood and conduct problems. To conclude, more methodologically rigorous research is needed to further examine the potential benefits of MFT, as well as the working mechanisms and core components of MFT.