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Context 1
... subtypes of PGD were defined in terms of patterns of meeting diagnostic criteria for PGD at 0-6 and 6-12 mo post-loss: acute = meeting the symptom criteria for PGD at 0-6 mo, but not at 6-12 mo, post-loss; delayed = meeting the symptom criteria for PGD at 6-12 mo, but not at 0-6 mo, post-loss; and persistent = meeting the symptom criteria for PGD both at 0-6 and at 6-12 mo post-loss. In Table 2, we see that the acute temporal specification was not significantly associated with any of the examined outcomes evaluated 12-24 mo post-loss. Delayed was significantly (p,0.001) ...
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This article brings together the psychiatric and psychoanalytic views of mental illness to deepen the understanding of mental disorder. The intention is to bring to the fore the importance of loss and mourning in clinical practice. Looking for the loss event that underpins the disorder helps determine therapeutic treatment options and increases the...
Citations
... Consequently, the bereaved is riddled with the feelings of ambivalence, anger and low selfworth and becomes over attached to the lost object, leaving no room for libidinal energy to invest in other love objects (Freud, 1917(Freud, /1957. In fact, this fixation is quite resembling to the lingering anguish, pre-occupation with the lost and difficulty to move on identified in prolonged grief (Prigerson et al., 2009). Feelings of guilt, self-blame, low self-worth, emptiness, and loss of pleasure are also evident in depression (Beck, 2011) which is another psychological construct assessed to understand expression of abnormal grief (Wagner et al., 2021). ...
... The Prolonged Grief Disorder Scale (PG-13). Prolonged grief disorder scale is a self-report instrument assessing intensity of prolonged grief symptoms (Prigerson et al., 2009). The 13-item scale measures separation distress, sorrow, yearning, emptiness, emotional pain, role confusions and difficulty to move on. ...
To date, several theoretical models have been proposed to explain how the expected and natural grief processes turns into psychiatric disorders. Nevertheless, there is a paucity of empirical research examining the basic assumption of psychoanalytic theory regarding pre-death conflict and bereavement related guilt. Accordingly, the current study aimed to investigate the mediator role of bereavement related guilt in the relationship between the pre-death conflict and maladaptive grief process. The sample consisted of 447 bereaved adults who lost a loved one due to death in the last 5 years. The Unfinished Business in Bereavement (UBBS), Bereavement Guilt Scale (BGS), Beck Depression Inventory (BDI), and Prolonged Grief Disorder Scale (PG-13) scales were administered. The results indicated that the UBBS scores were positively correlated with both BDI and PG-13 scores, and BGS scores mediated these relationships. Obtained findings were discussed in relation to psychoanalytic theory and existing studies in the grief literature.
... This result may be explained by the phenomenon of adjusting to the loss over time contributing to declining grief severity (Guldin et al., 2012;Latham & Prigerson, 2004;Prigerson et al., 1997), which is substantiated by our finding of lower mean GIS scores for subjects bereaved ≥12 months compared to those bereaved <12 months. Given similarities in the risks for PGD before and after 12 months post-loss, and prior studies showing that a 6-month assessment predicts a 12-month assessment of PGD as well as other forms of future morbidity (Prigerson et al., 2009;, this suggests the need for more empirical work to examine the harms and benefits of PGD diagnosis before and after one year post-loss. ...
With the COVID-19 pandemic prompting predictions of a "grief pandemic," rates and risks for Prolonged Grief Disorder (PGD) warrant further investigation. Data were collected online from 1470 respondents between October 2020 and July 2021. Shorter time since death, deaths of siblings and "others," and deaths from accidents and homicides were positively associated with potential risk of probable PGD; deaths of extended family and from dementia were negatively associated with probable PGD. When compared directly to deaths from COVID-19, natural causes of death were associated with lower potential risk of probable PGD, while deaths from unnatural causes were associated with higher potential risk.
... Psykiatriseringen av sorg er imidlertid et definisjonsmessig komplisert omrade, ogWHOs endelige kategoriseringer er derfor en sammenfatning av et teoretisk heterogent felt (jf. Killikelly & Maercker, 2017, Prigerson et al., 2009, Standardkategoriseringen (e.g. L. Larsen et al., 2018, se figur 2) utskiller kompliserte sorgreaksjoner som et paraplybegrep for tilfeller hvor sorgreaksjonen overordnet ses som kilden til kliniske symptomer. ...
... Medsorg som enavgjort lidelsesfullopple-velse er det nzrliggende 4 betrakte fenomenet som et potensielt klinisk anliggende. Rasjonalet bak medikaliseringen av sorg ligger som nevnt i 4skulle innramme patologiske lidelseserfaringer, og sorg utgjgriden sammenheng en potensiell patologi (Prigerson et al., 2009). Det patologiske sorguttrykket ved VSL er imidlertid ikkekvalitativt forskjellig fra 'normal' sorg. ...
Innføringen av en selvstendig diagnose forpatologisk sorg har vært kontroversiell. Den legefaglige gestaltingen av behandlingskrevende sorglidelse (i.e. medikalisering) er klinisk sett tilforlatelig, men risikerer samtidig å underkjenne sorgfenomenets mange øvrige dimensjoner. Kritikere av ‘sorgdiagnosen’ ser fortrinnsvis medikaliseringen som uhensiktsmessig, eller som en mindre fruktbar mate å håndtere sorgerfaring og lidelse på. I denne artikkelen argumenterer vi for at kritikken ikke burde orientere seg mot den faktiske diagnosen for patologiske sorgreaksjoner eller innholdet av denne. Vi hevder at fokus heller må settes på hva som har aktualisert den kliniske iakttagelsen overhodet, det vil si hvilke bevegelser og tankesett i samtiden som har drevet våre betraktninger av sorgreaksjoner dit hen hvor en diagnose er mulig og tjenlig. Artikkelen tar for seg psykiatriske diagnosers funksjonalitet i samfunn med økt investering i individuell helse og velbefinnende, og undersøker sorglidelse i denne kontekst. Med den psykiatriske diagnosen tilbys definitive beskrivelser av grunnleggende ambivalente opplevelser. Ettersom den politiske plattformen for å imøtekomme sorglidelse understreker betydningen av psykisk velbefinnende, er det kun i kraft av diagnosen at sorgen kan håndteres med antatt legitimitet.I behandlingsøyemed noterer innføringen av en definitiv diagnose for patologisk sorg følgelig en betinget progresjon hvor diagnosens nytteverdi bygger på et problematisk mandat. Denne nyansen viser hvordan kontroversen om sorgdiagnosen primært omhandler forutgående betingelser for sorgdiagnostisering, nemlig diagnosers funksjonalitet i terapeutiske kulturer.
... To facilitate the identification of nursing staff grief situations, an instrument to measure the grief of nurses is needed. Several measuring instruments on grief exist, but these focus on patient families, caregivers, and general healthcare workers, namely: the Grief Support in Healthcare Scale (K. A. Anderson et al., 2010), Prolonged Grief Disorder-13 questionnaire (Prigerson et al., 2013), and the Revised Grief Experience Inventory (Lev et al., 1993). ...
... As grief has gained interest for researchers, Prolonged Grief Disorder (PGD) was included as a new mental disorder to the 11 th edition of the International Classification of Diseases (ICD-11) (Killikelly & Maercker, 2017). The PGD was diagnosed using PGD-13 by Prigerson et al. (2013) based on the criteria of experiencing significant yearning and having at least five symptoms, which involve functional impairment on a daily basis beyond six months after the mourned death. PGD-13 is commonly used to measure grief experienced by people who have lost significant others, such as the loss of family members (Prigerson et al., 2013), losing children (Pohlkamp et al., 2018), losing a spouse (Kim et al., 2020;Schaal et al., 2010), and losing parents (Schaal et al., 2010). ...
... The PGD was diagnosed using PGD-13 by Prigerson et al. (2013) based on the criteria of experiencing significant yearning and having at least five symptoms, which involve functional impairment on a daily basis beyond six months after the mourned death. PGD-13 is commonly used to measure grief experienced by people who have lost significant others, such as the loss of family members (Prigerson et al., 2013), losing children (Pohlkamp et al., 2018), losing a spouse (Kim et al., 2020;Schaal et al., 2010), and losing parents (Schaal et al., 2010). ...
Frequent exposure to patient deaths prompts nurses to experience grief. Unresolved grief leads to harmful consequences of nurses’ mental health and quality of nursing care. A cross-sectional study using an online survey was conducted to determine the psychometric properties of the Grief traits and State Scale for Nurses. Exploratory factor analysis revealed two factors measuring the level of nurses’ grief traits (Cronbach’s alpha: 0.84) and two factors in grief state (Cronbach’s alpha: 0.86). Nurses’ feelings of unable to provide good care were associated with a higher risk of grief (odds ratio (OR): 4.30, 95% confidence interval (CI): 1.45–12.75), uncomfortable feeling toward deaths (OR: 11.29, 95%CI: 1.48–85.91), and emotional exhaustion (OR: 7.12, 95%CI: 1.63–30.99). Results indicated that the scale was reliable in determining the levels of their grief. Nurse managers can use the scale to identify their nurses’ levels of grief, creating opportunities to influence the resolution of the grief experiences.
... An episode of grief can potentially last as long as two years (Wilson, Cohen, MacLeod, & Houttekier, 2018;Zhang, El-Jawahri, & Prigerson, 2006). However, as 20% or more of mourners develop chronic or permanent grief (He et al., 2014;Holland, Currier, & Gallagher-Thompson, 2009;Middleton, Burnett, Raphael, & Martinek, 1996;Prigerson et al., 2009), it is important to recognize that many more people than previously thought are actively grieving the death of one or more beloved persons now. Although bereavement is generally considered a naturally occurring and normal response to the death of someone who was cared about and, for some, a frequently experienced life event (Wilson et al., 2018), the health of bereaved people is often negative affected by their grief (Prigerson et al., 2009). ...
... However, as 20% or more of mourners develop chronic or permanent grief (He et al., 2014;Holland, Currier, & Gallagher-Thompson, 2009;Middleton, Burnett, Raphael, & Martinek, 1996;Prigerson et al., 2009), it is important to recognize that many more people than previously thought are actively grieving the death of one or more beloved persons now. Although bereavement is generally considered a naturally occurring and normal response to the death of someone who was cared about and, for some, a frequently experienced life event (Wilson et al., 2018), the health of bereaved people is often negative affected by their grief (Prigerson et al., 2009). Bereavement should consequently be considered not only a common but significant health concern. ...
A study of the bereavement programs provided by hospices in Ireland and the Canadian province of Alberta was done to determine if and how these are evaluated for efficacy. All but one hospice offered multiple different bereavement programs, with routine in-house evaluations of all programs performed. In all cases, staff and client unsolicited and solicited comments made during and at the end of each program provided data for continuing program refinement. Most hospices also routinely employed a self-devised questionnaire to gain specific sought information to retain or change programs. Other information, including news about program developments elsewhere, was also actively sought for program adoption or for the improvement of existing programs. With most bereavement programs having been in place for many years, participants were confident their programs are needed, safe, and effective. Their continuing quest for high-quality programming, however, meant they were active in monitoring these programs and in seeking developments in this field.
... While the loss that an involuntarily childless individual faces may be considered as a loss of hope, it is a loss similar to that people face with the death of a loved one. Although the loss of hope cannot be pathologised, involuntarily childless people experience ongoing grief (Schultz and Harris, 2011), which may result in prolonged grief disorder (PGD) (a newly introduced category in the 11th edition of the International Classification of Diseases, see Prigerson et al., 2009;Killikelly and Maercker, 2018). While one diagnostic criterion for PGD refers to the loss 'of a significant other', clinicians may need to be aware of the potential association involuntarily childless individuals have with PGD. ...
Study question:
What is it like for women to be involuntarily childless in midlife?
Summary answer:
Involuntarily childless women may be suffering from prolonged grief due to its ambiguous and intangible nature; however, they are also striving to find ways of dealing with their internal pain in order to live with their loss.
What is known already:
Many studies examining issues around human reproduction have tended to place childlessness in the realm of medicalised infertility and report generalised mental issues, such as depression and psychological distress, existing amongst women undergoing fertility treatments. Few studies, however, have focused on the individual with regard to the experiential significance of involuntary childlessness and living beyond the phase of trying for a baby.
Study design, size, duration:
A phenomenologically oriented person-centred qualitative design was used. In-depth semi-structured interviews were conducted with 12 White British women, who identified themselves as involuntarily childless, recruited via three leading childless support networks in the UK.
Participants/materials, setting, methods:
In order to retain an idiographic commitment to the detailed account of a person's experience, a homogeneous and purposive sampling was used applying the following criteria: women aged between 45 and 55; in long-term heterosexual relationships with no adopted children, stepchildren or children of a partner from a previous marriage or relationship; and no longer trying to have a child. Considering the homogeneity of ethnic background and wishing to respect cultural differences, this study focused on White British women living in the UK. Of the 12, one woman was found to not meet the criteria, and therefore, the experiential data of 11 interviews were used for the study and analysed using interpretative phenomenological analysis (IPA).
Main results and the role of chance:
Two higher-order levels of themes that illustrate intrapersonal features were identified: the intrapersonal consequences of loss and confronting internal pain. The former explicated the depth of internal pain while the latter revealed ways in which the participants deal with it in their everyday lives. The important finding here is that both themes are co-existing internal features and dynamically experienced by the participants as they live with the absence of much-hoped-for children.
Limitations, reasons for caution:
Given the homogeneous sampling and the small number of participants, which is consistent with IPA, we want to be cautious in generalising our study findings.
Wider implications of the findings:
This study offers the view that there might be potential mental health issues surrounding involuntary childlessness that are currently overlooked. Particularly because the loss of hope cannot be pathologised, and the grief is ambiguous and intangible, it might make people's grieving process more complicated. An ongoing sense of uncertainty also may persist in that involuntarily childless people may develop symptoms similar to those diagnosed with prolonged grief disorder (PGD). The overall findings elucidate the need for clinicians, counsellors and health professionals to be aware of the possible association with PGD and promote long-term support and care in helping to maintain psychological well-being for people dealing with involuntary childlessness. Furthermore, this research points to an educational application for younger people by offering information beyond an explanation of infertility and fertility treatment, helping to understand the lived experience of involuntary childlessness.
Study funding/competing interest(s):
No funding was obtained for this study. The authors have no conflicts of interest to declare.
Trial registration number:
Not applicable.
... Although the research base for disaster mental health and posttraumatic stress disorder is much more established and extensive in the adult population (American Psychological Association Presidential Task Force on Posttraumatic Stress Disorder and Trauma in Children and Adolescents, 2008), publications focusing specifically on children's traumatic grief have identified evidence-based interventions that utilize individual and group interventions (Brent et al., 2019;Prigerson et al., 2009;Salloum & Overstreet, 2008). These interventions are typically grounded in cognitive behavioral therapy (CBT; Brent et al., 2019;Jaycox et al., 2009;Jaycox et al., 2010). ...
Historically, disaster response efforts have focused primarily on basic physical survival and safety—addressing medical emergencies and ensuring adequate shelter and supplies of food and water. However, in addition to physical survival, relief efforts must also consider strategies to promote emotional healing and psychological well-being. In particular, those who intervene must consider the acceptability of intervention strategies, taking into account survivors’ cultural background, religious customs, and spiritual beliefs. This article offers recommendations to better align school-based therapeutic interventions with children’s religious and spiritual beliefs.
... Fourth, when applying network analyses to psychological scales, the choice of the scale and the topological overlap of its items might drastically influence the structure of the resulting network (Fried & Cramer, 2017). In the present dataset, we identified variables that could have been potentially relevant to add to our network investigation, more specifically contextual information regarding the cause of death in widowed participants, reasons for separation, and the Prolonged Grief Disorder-13 (PG-13; Prigerson et al., 2009) tool, however, these variables have unfortunately not been assessed at all three waves, and therefore were not suitable to be included in our analyses. Since reactions to loss experience have been linked to these specific symptoms of Prolonged Grief Disorder (PGD; Prigerson et al., 2009), we encourage to include such variables in future studies. ...
... In the present dataset, we identified variables that could have been potentially relevant to add to our network investigation, more specifically contextual information regarding the cause of death in widowed participants, reasons for separation, and the Prolonged Grief Disorder-13 (PG-13; Prigerson et al., 2009) tool, however, these variables have unfortunately not been assessed at all three waves, and therefore were not suitable to be included in our analyses. Since reactions to loss experience have been linked to these specific symptoms of Prolonged Grief Disorder (PGD; Prigerson et al., 2009), we encourage to include such variables in future studies. Furthermore, since the network structure is based on partial correlations, excluding or combining items will lead to different network structures. ...
Background:
Prior network analyses demonstrated that the death of a loved one potentially precedes specific depression symptoms, primarily loneliness, which in turn links to other depressive symptoms. In this study, we extend prior research by comparing depression symptom network structures following two types of marital disruption: bereavement versus separation.
Methods:
We fitted two Gaussian Graphical Models to cross-sectional data from a Swiss survey of older persons (145 bereaved, 217 separated, and 362 married controls), and compared symptom levels across bereaved and separated individuals.
Results:
Separated compared to widowed individuals were more likely to perceive an unfriendly environment and oneself as a failure. Both types of marital disruption were strongly linked to loneliness, from where different relations emerged to other depressive symptoms. Amongst others, loneliness had a stronger connection to perceiving oneself as a failure in separated compared to widowed individuals. Conversely, loneliness had a stronger connection to getting going in widowed individuals.
Limitations:
Analyses are based on cross-sectional between-subjects data, and conclusions regarding dynamic processes on the within-subjects level remain putative. Further, some of the estimated parameters in the network exhibited overlapping confidence intervals and their order needs to be interpreted with care. Replications should thus aim for studies with multiple time points and larger samples.
Conclusions:
The findings of this study add to a growing body of literature indicating that depressive symptom patterns depend on contextual factors. If replicated on the within-subjects level, such findings have implications for setting up patient-tailored treatment approaches in dependence of contextual factors.
... To facilitate the identification of nursing staff grief situations, an instrument to measure the grief of nurses is needed. Several measuring instruments on grief exist, but these focus on patient families, caregivers, and general healthcare workers, namely: the Grief Support in Healthcare Scale (K. A. Anderson et al., 2010), Prolonged Grief Disorder-13 questionnaire (Prigerson et al., 2013), and the Revised Grief Experience Inventory (Lev et al., 1993). ...
... As grief has gained interest for researchers, Prolonged Grief Disorder (PGD) was included as a new mental disorder to the 11 th edition of the International Classification of Diseases (ICD-11) (Killikelly & Maercker, 2017). The PGD was diagnosed using PGD-13 by Prigerson et al. (2013) based on the criteria of experiencing significant yearning and having at least five symptoms, which involve functional impairment on a daily basis beyond six months after the mourned death. PGD-13 is commonly used to measure grief experienced by people who have lost significant others, such as the loss of family members (Prigerson et al., 2013), losing children (Pohlkamp et al., 2018), losing a spouse (Kim et al., 2020;Schaal et al., 2010), and losing parents (Schaal et al., 2010). ...
... The PGD was diagnosed using PGD-13 by Prigerson et al. (2013) based on the criteria of experiencing significant yearning and having at least five symptoms, which involve functional impairment on a daily basis beyond six months after the mourned death. PGD-13 is commonly used to measure grief experienced by people who have lost significant others, such as the loss of family members (Prigerson et al., 2013), losing children (Pohlkamp et al., 2018), losing a spouse (Kim et al., 2020;Schaal et al., 2010), and losing parents (Schaal et al., 2010). ...
... Approximately 38% (n = 66) of participants meet diagnostic criteria for PGD according to the PG-13 (Prigerson, et al. 2009). Approximately 30% (n = 55) of participants reported reexperiencing, avoidance and hyperarousal symptoms consistent with DSM-VI diagnostic criteria for PTSD. ...
... Prolonged Grief Assessment. Prolonged grief was assessed using a semi-structured interview based on the PG-13 (Prigerson et al., 2009). The PG-13 assesses for the presence of yearning, emotional distress at the lost relationship, difficulty accepting the death, shock, avoidance of reminders, numbness, bitterness, difficulty engaging in life, identity disturbance, a sense of purposelessness and meaninglessness, and functional impairment. ...
Objective:
Individuals vary in how they respond to bereavement. Those who experience poor bereavement outcomes often report symptoms from more than one diagnostic category. This study sought to identify groups of individuals who share similar patterns of prolonged grief disorder and posttraumatic stress disorder symptoms to determine whether these profiles are differentially related to negative appraisals thought to contribute to prolonged grief disorder and posttraumatic stress disorder symptomatology.
Methods:
Participants were 185 bereaved adults. Latent class analysis was used to identify subgroups of individuals who showed similar patterns of co-occurrence of prolonged grief disorder and posttraumatic stress disorder symptoms. Multinomial regression was used to examine the extent to which appraisal domains and sociodemographic and loss factors predicted class membership.
Results:
Latent class analysis revealed three classes of participants: a low symptom group, a high prolonged grief disorder symptom group, and a high prolonged grief disorder and posttraumatic stress disorder symptom group. Membership of the prolonged grief disorder group and prolonged grief disorder and posttraumatic stress disorder group was predicted by higher mean negative self-related appraisals. Demographic and loss-related factors did not predict group membership.
Conclusion:
These findings have implications for understanding co-occurrence of prolonged grief disorder and posttraumatic stress disorder symptoms following bereavement. Findings are consistent with theoretical models highlighting the importance of negative self-related beliefs in prolonged grief disorder.
