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PubMed2004

Traumatic grief among adolescents exposed to a peer's suicide.

OBJECTIVE: The phenomenology of grief among children and adolescents is not well studied. A syndrome of traumatic grief, distinct from depression and anxiety, has been described among bereaved adults. The purpose of this study was to describe the symptoms and course of traumatic grief among adolescents exposed to a peer's suicide and to examine the relationship between traumatic grief and depression and posttraumatic stress disorder (PTSD) in this population. METHOD: A total of 146 friends and acquaintances of 26 suicide victims were included in this study. Subjects were interviewed at 6, 12-18, and 36 months after the peer's suicide. A subgroup was also interviewed 6 years afterward. The Texas Revised Inventory of Grief was administered at 6, 12-18, and 36 months; the Inventory of Complicated Grief was administered at the 6-year assessment. RESULTS: Principal component analysis of the Texas Revised Inventory of Grief resulted in two factors: one assessing a traumatic grief reaction and another assessing a milder or even normal grief reaction. The occurrence of traumatic grief was found to be independent from that of depression and PTSD. Traumatic grief at 6 months predicted the onset or course of depression and PTSD at subsequent assessments. CONCLUSIONS: Similar to adults, adolescents experience a traumatic grief reaction after exposure to a peer's suicide. Clinicians should be alerted to the occurrence of traumatic grief reactions among adolescents and the need to assess these reactions and address them in their treatment approaches.

Adaptation, Psychological↗
PubMed2006

Relation between grief and subsequent pregnancy status 13 months after perinatal bereavement.

AIMS: The present longitudinal study sought to explore the relationship between parental grief following perinatal bereavement and subsequent pregnancy, according to the particular facets of grief and pregnancy state being considered. METHOD: The study participants were 63 couples who had been bereaved by stillbirth (n = 31) or neonatal death (n = 32). The relationship of self-reported grief (Perinatal Grief Scale-33 Active Grief, Difficulty Coping and Despair) 1 month and 13 months after the loss to subsequent pregnancy status (Pregnant, n = 20, Live Baby, n = 10, Trying, n = 11, Not Trying, n = 22) at 13 months was investigated with repeated measures analysis of variance. RESULTS: There were statistically significant main effects for Active Grief and Difficulty Coping in women and men and Despair in women, but not in men. There was a statistically significant Active Grief by pregnancy status interaction in women (F(3, 59) = 2.89, P = 0.04), but not in men. Simple main effects analysis indicated a statistically significant decrease in Active Grief in women who were pregnant (F(1, 59) = 52.8, P < 0.0005), women who were not pregnant and not trying to conceive (F(1, 59) = 27.5, P < 0.0005), and women who had had a live baby (F(1, 59) = 9.62, P = 0.003). There was no statistically significant decrease in Active Grief in women who were not pregnant but trying to conceive (F(1, 59) = 3.44, P = 0.07). The Difficulty Coping in women and men and Despair in women by pregnancy status interactions were not statistically significant. None of the between-subjects main effects for pregnancy status was statistically significant in women or men. CONCLUSION: The relation between grief and subsequent pregnancy differed with the sex of the parent and the particular facets of grief and pregnancy state being considered. Subsequent pregnancy was related to Active Grief in women, but not to Difficulty Coping or Despair that are known to be predictors of chronic grief.

Adaptation, Psychological↗
PubMedDate not supplied

Grief and depression after miscarriage: their separation, antecedents, and course.

Bereavement is a major risk factor for physical illness, grief, depression, and anxiety. In contrast to recent tendencies in the psychiatric literature to equate grief and depression, we propose that a careful discrimination between the two must be made for diagnostic, therapeutic, and investigative purposes. We report the results of a longitudinal study of a frequent but neglected event, miscarriage early in pregnancy, to make this point. Clinical criteria for differentiating grief and depressive reactions were developed based on phenomenological criteria and theoretical considerations. We hypothesized that the detrimental psychological and physical consequences occur only when the miscarriage was not mourned and resulted in a depressive reaction, but not in a grief reaction. In a controlled, representative study, 125 consecutive women were assessed shortly after their miscarriage (before the 20th week of gestation) and 6 months (N = 94) and 12 months (N = 90) later. Assessments included standardized questionnaires for life events, depression, physical complaints, anxiety, and a specific, multidimensional grief scale (Munich Grief Scale) that we had developed previously. Immediately after the miscarriage, the average anxiety and depression scores were elevated when compared with 80 pregnant and 125 age-matched community controls. Twenty percent of the patients who had miscarried showed a grief reaction, 12% showed a depressive reaction, and 20% responded with a combined depressive and grief reaction. The remaining women (48%) reported no changes in their emotional reactions. As predicted, longer-lasting psychological, social, and health status changes followed the initial depressive, but not the grief reactions. Depressive reactions were predicted by a history of previous depression, a lack of social resources, and an ambivalent attitude to the lost fetus. The grief measures were reliable and made it possible to discriminate between grief and depression.

Abortion, Spontaneous↗
PubMed2001

Prevalence of loss and complicated grief among psychiatric outpatients.

OBJECTIVE: This study examined the prevalence of significant loss through the death of another person as well as complicated grief among patients at two psychiatric outpatient clinics for one year. METHODS: A total of 729 patients were interviewed about significant losses through death during their lives. Standard questionnaires were used to classify 235 patients who had experienced such losses into three groups: those who had minimal disturbance, those who had moderate complicated grief, and those who had severe complicated grief. Multivariate and univariate analyses of variance were used to test for differences in loss-specific variables (for example, pathological grief) and variables that were not specific to loss (for example, depression) among the three groups. RESULTS: More than half of the 729 patients reported that they had experienced one or more significant losses through death. About a third of all patients who came to the clinics met the criteria for either moderate or severe complicated grief. The average time since the loss was about ten years, indicating that these patients had long-term complicated grief. Significant differences in loss-specific variables and variables that were not specific to loss were detected among the three groups. Patients who had severe complicated grief scored higher than patients in the other two groups on both types of variables. Patients with moderate complicated grief had higher scores than those with minimal disturbance. CONCLUSIONS: Clinicians should routinely assess outpatients for loss and complicated grief and should consider addressing loss and complicated grief in treatment. Rather than a single classification of complicated grief, different levels should be considered.

Adolescent↗
PubMed2002

[Grief].

Grief is not a mental disorder, it is a painful and unexpected process in response to the death of a family member or a loved one (bereavement), or a significant loss. Despite the fact that grief is not a mental disorder, consultations about grief are fairly frequent in clinical practice, which is why clinicians must be trained for these situations. Every consultation about grief must be taken into account and evaluated carefully in order to define the kind of therapy to be followed and whether or not a consultant psychiatrist should intervene. It is important to bear in mind that not every process of grief follows a normal development and reaches a satisfactory solution, and this is where health care professionals must be qualified to recognise when grief is becoming a pathological disease; they must be more alert to these cases and intervene in an opportune and appropriate way. It is also important to stress that grief is not a synonym for depression, but many grief-stricken people may enter a depressive state, and they therefore require early treatment in order to avoid complications that might arise from the unsuitable treatment of a depressive episode, such as suicide for example. Finally, the relationship between grief and psychopathological disorder has been demonstrated. It is also known that grief that is insufficiently elaborated, or which follows an abnormal development, may give rise to a psychopathological disorder, generally a major depressive episode, just as an established mental disorder may hinder the elaboration of a process of working through grief.

English Abstract↗