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AbstractThis systematic review examined the role of social environment in pre-death grief experiences of dementia caregivers. Ninety-three Chinese and English articles were included from a comprehensive search of empirical studies using nine databases. Six social environment domains were generated: the person with dementia, dyadic relationship, family members and the wider community, health and social care services, place of care, and social-cultural contexts. A complex interplay between caregivers and their social environments that aggravate and attenuate pre-death grief experiences is evident. Research has focused mainly on the effects of people with dementia and dyadic relationships and has paid modest attention to the effects of family, relatives, and health and social care services. Caregivers’ experiences with their friends, fellow caregivers, the wider community, and social-cultural norms are influential but understudied. Future research could adopt a systems thinking approach with sociological perspectives to generate a comprehensive and nuanced understanding of pre-death grief experiences. [ABSTRACT FROM AUTHOR]

In a widowed family, the surviving parent and children face the loss together. However, most previous research in bereavement has focused on individual experiences. Although the family perspective has been introduced into the field, neither theories nor empirical research has explored mutual interaction. Dyadic coping reflects the family perspective and has been proven to be an influential factor in couples facing life adversities. Nevertheless, it has not been explored in the context of bereavement-specific stressors, including loss- and restoration-related stressors, nor in the parent–child relationship. This research is the first exploration of parent–child dyadic coping in widowed families in the bereavement context and aims to form a comprehensive conceptualization of parent–child dyadic coping following bereavement. Qualitative semistructured interviews were conducted with 20 parents and children from widowed families in mainland China (11 surviving children and nine widowed parents, representing 19 families). Constructivist grounded theory was used to guide the analysis. The main themes identified were dyadic coping-related cognitions, loss-oriented dyadic coping, restoration-oriented dyadic coping, and contextual factors. Three foci (thou, we, and I) were identified for both loss- and restoration-oriented dyadic coping. A conceptualization model of bereavement dyadic coping within widowed families was developed. This study extends the single I-coping perspective in bereavement coping to a we-coping perspective, provides an interactional- and operational-level knowledge on dual-process coping, acknowledges the bilateral interaction in parent–child relationships, and offers implications for bereavement support practice for widowed families. [ABSTRACT FROM AUTHOR]

Grief‐related beliefs play an important role in bereavement adjustment. This study aimed to investigate the patterns and correlates of grief‐related beliefs among recently bereaved adults (n = 311). Latent class analysis results suggested three meaningful grief belief classes could be identified: the High grief belief class (24.1%), Predominantly counterfactual thoughts class (42.4%), and Low belief class (33.4%). Members in the High grief belief class reported the highest levels of grief symptoms, depression and PTSD symptoms, loneliness, and functional impairment. Compared with the Low belief class, unmarried people, people in poor health, individuals who lost parents, partners, or children, and those who experienced violent or unexpected death were more likely to belong to the High grief belief class. Findings of this study support the importance of examining grief‐related cognitions in research and clinical practice, especially counterfactual thoughts about the death, which may need to be specifically screened and targeted in treatment. [ABSTRACT FROM AUTHOR]

The meaning of patient deaths is key to understanding professional bereavement. To validate its construct, we applied partial least square structural equation modeling (PLS-SEM) to online survey data from 563 Chinese physicians and nurses. Both the personal meaning and professional meaning contribute significantly while not interchangeably to the meaning of patient deaths. In addition to the loss of an acquaintance, the loss of a valuable life, and the loss of a professional goal, patient deaths can also mean trauma, bad luck, identity crisis, a warning, a learning opportunity, and a time to empathize with others' sufferings. [ABSTRACT FROM AUTHOR]

Background: Patients with terminal illnesses have different symptoms. The goal of palliative care is to alleviate the suffering induced by these symptoms. Available research on symptoms has focused on their prevalence or identification of clusters. Little is known about the central symptoms contributing to the maintenance of the whole system of symptoms or the mechanism of influence between symptoms, particularly between physical and psychosocial symptoms. Aim: The study used network analysis to explore symptom clusters among patients with terminal illnesses and identify the central symptoms, the bridge symptoms, and pathways between physical and psychosocial symptoms. Design and Setting/Participants: This is a retrospective cohort study using baseline symptom assessment of 677 adults with terminal illnesses receiving care from the Integrated Community End-of-Life Care Support Teams. Results: Three symptom clusters were identified: physical, psychological, and practical clusters. "Weakness or lack of energy" was identified as the crucial symptom affecting the changes of other symptoms, followed by depression and anxiety. Three connections between the psychological and physical symptoms were identified: anxiety-pain, depression-constipation, and perceived family anxiety-poor appetite pathways. Pathways of practical concern-peace and practical concern-depression were indicated between practical and psychological symptoms. Conclusions: This study is the first of its kind to investigate the connections and mechanism of influence between symptoms among patients with terminal illnesses. It offers clear pathways for intervention with the most influential symptoms of weakness, anxiety, and depression. [ABSTRACT FROM AUTHOR]

Bereavement during the COVID‐19 pandemic may have some unique characteristics that become potential risk factors (e.g., absence of grief rituals, no opportunity to say goodbye to the deceased and loneliness caused by social distancing) for acute grief. Avoidance processes could be significant mediators in the context of the pandemic. The current study aimed to investigate whether and how these COVID‐19‐related risk factors were related to acute grief severity. Bereaved adults (n = 319) who lost significant others during the COVID‐19 pandemic completed a self‐report questionnaire package measuring COVID‐19‐related factors, grief severity and depressive and anxious avoidance. Regression analyses suggested that among the three potential risk factors (loneliness, grief rituals and opportunity to say goodbye), loneliness was significantly associated with acute grief after controlling for basic demographic and loss‐related information. Structural equation models suggested that depressive avoidance and anxious avoidance partially mediated the associations of loneliness with acute grief severity. The findings indicate that dealing with loss during the COVID‐19 pandemic warrants further exploration concerning how potential environmental risk factors may impede adaptation to loss. Depressive and anxious avoidance processes may play important roles in grief interventions for isolated and lonely bereaved people. [ABSTRACT FROM AUTHOR]

The death of a family member affects not only individual family members but also their relationships and interactions. Grief has been studied mostly as an intrapersonal experience. Adopting the family perspective, this systematic scoping review focused on parent–child relationships in widowed families so as to identify what is already known on this topic and the research gaps for future study. The review follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) guidelines. Four databases (Web of Science, Psycinfo, PubMed, and CINAHL Plus) were searched. Search terms were combinations of two concepts: (1) loss of a parent (20 terms) and (2) parent–child (eight terms). 5,419 studies were identified during the search, of which 36 studies were included in the review following two rounds of screening. Four research themes emerged, and the aggregated findings were identified: (a) The surviving parent and children are likely to become closer following the loss of a parent, while other relevant factors need to be taken into account; (b) Better parent–child relationships play a protective role in children's adjustment to loss; (c) The surviving parent and children's adjustment to loss are interdependent; (d) Through parenting, communication style, coping strategy, and other attributes, the surviving parent can influence their children's adjustment. Gender and age differences were identified in parent–child relationships. The findings further justify the importance of a family perspective when conducting research and practice on bereavement. Several research gaps were identified. Existing studies paid insufficient attention to children's agency and bidirectional relationships, and the interaction process and its role underlying parent–child bidirectional causality. A conceptual framework of parent–child relationships in widowed families is proposed based on these findings. [ABSTRACT FROM AUTHOR]

The diverse pigmentation patterns of flower corollas probably result from pollinator-mediated selection. Previous studies demonstrated that R2R3- MYB factors may have been recruited in the regulation of corolla pigmentation. However, how R2R3-MYBs became so diverse in their regulation of different pigmentation patterns remains unclear., Here, we studied a Lamiales species, Torenia fournieri, which has elaborate zygomorphic flowers with dorsal-ventral asymmetries in corolla pigmentation. We found recent gene duplication events in CYCLOIDEA-like ( CYC-like) and RADIALIS-like ( RAD-like) genes, and functionally analyzed three dorsal-specific expression factors: Tf CYC1, Tf CYC2, and Tf RAD1., We found that the CYC- RAD module coordinates petal shape and corolla pigmentation, as ectopic expression of Tf CYC2 or Tf RAD1 disrupted the asymmetric corolla pigmentation pattern and produced strongly dorsalized flowers. Dorsal petal identity was lost when Tf CYC2 was down-regulated or when Tf RAD1 was knocked out. In T. fournieri, the diversified CYC and RAD genes have evolved regulatory loops, and Tf CYC2 binds directly to the regulatory regions of an R2R3- MYB factor gene, Tf MYB1, which might lead to its asymmetric expression and ultimately establish the asymmetric pigmentation pattern., These findings support the existence of a regulatory module that integrates dorsal-ventral patterning and asymmetric corolla pigmentation in T. fournieri. [ABSTRACT FROM AUTHOR]