ArticlePDF Available

Mediators between bereavement and somatic symptoms

Authors:
Barna Konkolÿ Thege at Waypoint Centre for Mental Health Care
Barna Konkolÿ Thege
János Pilling at Semmelweis University
János Pilling
Zoltán Cserháti at Semmelweis University
Zoltán Cserháti
Maria S Kopp
Maria S Kopp
Maria S Kopp
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Download full-text PDFDownload full-text PDF
Read full-text
Download citation

Abstract and Figures

In our research we examined the frequency of somatic symptoms among bereaved (N = 185) and non-bereaved men and women in a national representative sample (N = 4041) and investigated the possible mediating factors between bereavement status and somatic symptoms. Somatic symptoms were measured by the Patient Health Questionnaire (PHQ-15), anxiety with a four-point anxiety rating scale, and depression with a nine-item shortened version of the Beck Depression Inventory. Among the bereaved, somatic symptoms proved to be significantly more frequent in both genders when compared to the non-bereaved, as did anxiety and depression. On the multivariate level, the results show that both anxiety and depression proved to be a mediator between somatic symptoms and bereavement. The effect sizes indicated that for both genders, anxiety was a stronger predictor of somatic symptoms than depression. The results of our research indicate that somatic symptoms accompanying bereavement are not direct consequences of this state but they can be traced back to the associated anxiety and depression. These results draw attention to the need to recognize anxiety and depression looming in the background of somatic complaints in bereavement and to the importance of the dissemination of related information.
Figures - uploaded by János Pilling
Author content
All figure content in this area was uploaded by János Pilling
Content may be subject to copyright.
54e0c8b60cf29666378ef4
79.pdf
Content uploaded by János Pilling
Author content
All content in this area was uploaded by János Pilling on Feb 15, 2015
Content may be subject to copyright.
Mediators between bereavement and somatic sympto
ms.pdf
Available via license: CC BY 2.0
Content may be subject to copyright.
A preview of the PDF is not available
... Numerous studies have documented an increased prevalence of somatic symptom distress (also referred to as somatization) and associated somatoform disorders in various groups of bereaved individuals, including refugees (Steil et al., 2019), widows (Kim et al., 2017;Morina & Emmelkamp, 2012), parents who lost a child , or survivors of natural disasters (Kristensen et al., 2012). A representative survey in the general Hungarian population found that 15% (males) to 27% (females) of bereaved adults showed clinically relevant levels of somatic symptom distress (Thege et al., 2012). Moreover, in a clinical trial investigating cognitive-behavioral therapy (CBT) for prolonged grief, 54% of outpatients were diagnosed with a comorbid somatoform disorder (Rosner et al., 2014). ...
... Interestingly, Ryder and Chentsova-Dutton (2012) present the idea that somatic symptom distress in Chinese culture could reflect a 'cultural script' for depression, in other words, a somatic form of distress or symptom communication may be more culturally acceptable and provide access to support. Research in bereaved east-European adults (Thege et al., 2012) suggests that somatic symptom distress is not a direct consequence of bereavement, but rather mediated by negative affect as a core component of anxiety and depression (Clark & Watson, 1991). While a mediating effect of anxiety was found for both genders, depression only mediated the relationship between bereavement and somatic symptoms in male bereaved, indicating a gender-sensitive influence. ...
... The first objective of this study was to estimate the prevalence of self-reported somatic symptom distress and PGD symptoms in a large, cross-cultural sample who experienced the death of a significant other. Based on previous survey studies in various cultural samples of bereaved people, we expected a high level of somatic symptom distress, particularly in individuals with a high probability of PGD (Kristensen et al., 2012;Thege et al., 2012;Zhou et al., 2020). Secondly, we explored the relationship between somatic symptom distress and PGD symptoms, which would have implications for a shared vulnerability (Brennstuhl et al., 2015;McAndrew et al., 2019) and the role of somatic symptom distress in PGD diagnosis . ...
Somatic symptom distress and ICD-11 prolonged grief in a large intercultural sample
Article
  • Sep 2023
Background: Grief is a multi-faceted experience including emotional, social, and physical reactions. Research in ICD-11 prolonged grief disorder (PGD) in different cultural contexts has revealed different or potentially missing grief symptoms that may be relevant. Objective: This study thus aimed to explore the prevalence of somatic symptom distress and its associations with grief and negative affect in a culturally diverse sample of bereaved individuals with symptoms of PGD. Methods: Based on cross-sectional survey data from the Measurement and Assessment of Grief (MAGIC) project, this study included 1337 participants (mean age 23.79 yrs, 76.1% female) from three regions (USA: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%), who experienced a loss of a significant other. Associations between somatic symptom distress (Somatic Symptom Scale, SSS-8), symptoms of PGD (International Prolonged Grief Disorder Scale, IPGDS-33), anxiety (Generalized Anxiety Disorder Questionnaire, GAD-7), depression (Patient Health Questionnaire, PHQ-9) as well as demographic and loss related characteristics were investigated. Three hundred and thirteen participants (23.4%) scored above the proposed cut-off for clinically severe PGD. Results: ‘High’ or ‘very high’ levels of somatic symptom distress were more frequent in a possible PGD group (58.2%), than in a non-PGD group (22.4%), p < .001, as divided per cut-off in the IPGDS. In a multiple regression analysis, PGD symptoms were significantly but weakly associated with somatic symptom distress (β = 0.08, p < .001) beyond demographics, loss-related variables, and negative affect. Negative affect (anxiety and depression) mediated the relationship of PGD symptoms with somatic symptom distress and the indirect effect explained 58% of the variance. Conclusions: High levels of somatic symptom distress can be observed in a substantial proportion of bereaved across cultures. Our findings suggest that PGD is related to somatic symptom distress partly and indirectly through facets of negative affect.
View
... The loss of a loved one is a recognized risk factor for the onset or worsening of a range of mental health problems including depression (Zisook & Shear, 2009), anxiety (Shear & Skritskaya, 2012), and a range of distressing somatic symptoms such as headaches, chest pain, and dizziness (Joaquim et al., 2021;Konkolÿ Thege et al., 2012). A recent meta-analysis investigating the prevalence of common mental disorders in widowed people at any point in time since their loss reported a pooled prevalence rate of 46% for depression and 27% for anxiety . ...
... Third, it was not possible to explore the role of potential mediating factors in explaining the association between loss-related variables and depression, anxiety, and somatization. For instance, research has shown that both depression and anxiety mediate the association between bereavement and somatization (Konkolÿ Thege et al., 2012), and hence this would be an interesting avenue for exploration in future studies. ...
The psychological burden of bereavement in the general population of UK and Ireland
Article
This study examined the experiences of loss among bereaved adults, and the association between loss-related factors and mental health outcomes. Participants were 2023 bereaved adults from the United Kingdom and Ireland who completed measures of their bereavement experiences and symptoms of depression, anxiety, and somatization. The highest proportion of participants and those at greatest risk of meeting criteria for all disorders were those with less time since loss, who were in contact with the deceased every day or not at all in the year prior to their death, experienced sudden unnatural death, and those who lost a partner/spouse or a child. Age of the deceased was negatively correlated with meeting criteria for depression, anxiety, and somatization. Overall, depression, anxiety, and somatization were common in the bereaved population. Identifying key loss-related variables-such as time since bereavement and nature of death-will help target those needing urgent psychological support.
View
... Les symptômes anxieux et d'ordre post-traumatique semblent être deux prédicteurs principaux dans l'apparition de symptômes somatiques. Enfin, les travaux de synthèse sur les symptômes somatiques parentaux ne montrent pas de différence significative entre les mères et les pères dans l'apparition des symptômes somatiques [28]. L'objectif de l'étude est d'examiner l'intensité des symptômes somatiques chez les parents d'un enfant en rémission de cancer et de déterminer ses potentielles relations avec les niveaux de détresse du parent. ...
Évaluation des symptômes somatiques et de la détresse des parents d’un enfant en rémission de cancer
Article
  • Jul 2020
Résumé Introduction Les études sur les symptômes somatiques des parents d’un enfant en rémission de cancer sont moins développées dans la littérature. L’objectif de l’étude est d’examiner l’intensité des symptômes somatiques (symptômes physiques aggravés par des facteurs émotionnels ou psychiques) ainsi que ses associations avec les symptômes anxiodépressifs et les inquiétudes. Méthodes Dans cette étude transversale et quasi expérimentale, 61 parents d’un enfant en rémission de cancer (de quatre à six ans de rémission) participent à l’étude. Les parents remplissent trois questionnaires cliniques évaluant leurs symptômes anxiodépressifs, somatiques et leurs inquiétudes quant à l’évolution de la santé de leur enfant. Résultats Les parents souffrent principalement d’une perte d’énergie et d’insomnies en milieu de nuit. Des corrélations significatives entre les symptômes somatiques et les symptômes anxiodépressifs sont observées. Enfin, les symptômes dépressifs semblent être un prédicteur significatif pour expliquer l’intensité des symptômes somatiques. Conclusion Des recommandations ont été publiées concernant la prise en charge des parents d’un enfant en rémission de cancer, mais des études longitudinales centrées sur le parent sont encore nécessaires afin d’améliorer les initiatives de prévention et de prise en charge de ces familles.
View
View
Bereavement care in primary care: A systematic literature review and narrative synthesis
Article
Full-text available
  • Jan 2011
  • BRIT J GEN PRACT
Over half a million people die in Britain each year and, on average, a GP will have 20 patients die annually. Bereavement is associated with significant morbidity and mortality, but the research evidence on which GPs and district nurses can base their practice is limited. To review the existing literature concerning how GPs and district nurses think they should care for patients who are bereaved and how they do care for them. design systematic literature review. Searches of AMED, BNI, CINAHL, EMBASE, Medline and PsychInfo databases were undertaken, with citation searches of key papers and hand searches of two journals. Inclusion criteria were studies containing empirical data relating to adult bereavement care provided by GPs and district nurses. Information from data extraction forms were analysed using NVivo software, with a narrative synthesis of emergent themes. Eleven papers relating to GPs and two relating to district nurses were included. Both groups viewed bereavement care as an important and satisfying part of their work, for which they had received little training. They were anxious not to 'medicalise' normal grief. Home visits, telephone consultations, and condolence letters were all used in their support of bereaved people. A small number of studies were identified, most of which were > 10 years old, from single GP practices, or small in size and of limited quality. Although GPs and district nurses stated a preference to care for those who were bereaved in a proactive fashion, little is known of the extent to which this takes place in current practice, or the content of such care.
View
An Inventory for Measuring Depression
Article
  • Jun 1961
  • ARCH GEN PSYCHIAT
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
View
View
Development of the Grief Experience Questionnaire
Article
  • Jun 1989
  • SUICIDE LIFE-THREAT
The development of the Grief Experience Questionnaire (GEQ) is reported. This questionnaire is an instrument for measuring various components of grief, including somatic reactions, general grief reactions, search for explanation, loss of social support, stigmatization, guilt, responsibility, shame, rejection, self-destructive behavior, and reactions to a unique form of death. Initial results with the GEQ suggest its potential to differentiate grief reactions experienced by suicide survivors from those experienced by survivors of accidental death, unexpected natural death, and expected natural death. Conclusions support its use in redressing common methodological criticisms of suicide survivor research. Six additional benefits derived from use of this instrument are discussed.
View
Patients presenting with somatic complaints: Epidemiology, psychiatric co-morbidity and management
Article
  • Feb 2003
Somatic symptoms are the leading cause of outpatient medical visits and also the predominant reason why patients with common mental disorders such as depression and anxiety initially present in primary care. At least 33% of somatic symptoms are medically unexplained, and these symptoms are chronic or recurrent in 20% to 25% of patients. Unexplained or multiple somatic symptoms are strongly associated with coexisting depressive and anxiety disorders. Other predictors of psychiatric co-morbidity include recent stress, lower self-rated health and higher somatic symptom severity, as well as high healthcare utilization, difficult patient encounters as perceived by the physician, and chronic medical disorders. Antidepressants and cognitive-behavioural therapy are both effective for treatment of somatic symptoms, as well as for functional somatic syndromes such as irritable bowel syndrome, fibromyalgia, pain disorders, and chronic headache. A stepped care approach is described, which consists of three phases that may be useful in the care of patients with somatic symptoms. Copyright © 2003 Whurr Publishers Ltd.
View
Somatic Symptom Reporting in Women and Men
Article
  • Dec 2001
  • J GEN INTERN MED
Women report more intense, more numerous, and more frequent bodily symptoms than men. This difference appears in samples of medical patients and in community samples, whether or not gynecologic and reproductive symptoms are excluded, and whether all bodily symptoms or only those which are medically unexplained are examined. More limited, but suggestive, literature on experimental pain, symptom reporting in childhood, and pain thresholds in animals are compatible with these findings in adults. A number of contributory factors have been implicated, supported by varying degrees of evidence. These include innate differences in somatic and visceral perception; differences in symptom labeling, description, and reporting; the socialization process, which leads to differences in the readiness to acknowledge and disclose discomfort; a sex differential in the incidence of abuse and violence; sex differences in the prevalence of anxiety and depressive disorders; and gender bias in research and in clinical practice. General internists need to keep these factors in mind in obtaining the clinical history, understanding the meaning and significance that symptoms hold for each patient, and providing symptom relief.
View
Complicated grief and related bereavement issues for DSM‐5
Article
Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally, grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence, some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This article focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders. Depression and Anxiety, 2011. © 2011 Wiley-Liss, Inc.
View
The Hospital Anxiety And Depression Scale
Article
  • Jun 1983
  • ACTA PSYCHIAT SCAND
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
View
Acceptance and Commitment Therapy versus Tinnitus Retraining Therapy in the treatment of tinnitus: A randomised controlled trial
Article
  • Aug 2011
The study compared the effects of Acceptance and Commitment Therapy (ACT) with Tinnitus Retraining Therapy (TRT) on tinnitus impact in a randomised controlled trial. Sixty-four normal hearing subjects with tinnitus were randomised to one of the active treatments or a wait-list control (WLC). The ACT treatment consisted of 10 weekly 60 min sessions. The TRT treatment consisted of one 150 min session, one 30 min follow-up and continued daily use of wearable sound generators for a recommended period of at least 8h/day for 18 months. Assessments were made at baseline, 10 weeks, 6 months and 18 months. At 10 weeks, results showed a superior effect of ACT in comparison with the WLC regarding tinnitus impact (Cohen's d=1.04), problems with sleep and anxiety. The results were mediated by tinnitus acceptance. A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact (Cohen's d=0.75) and problems with sleep. At 6 months, reliable improvement on the main outcome measure was found for 54.5% in the ACT condition and 20% in the TRT condition. The results suggest that ACT can reduce tinnitus distress and impact in a group of normal hearing tinnitus patients.
View