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Let's Talk About Death: Applying the Disclosure Decision-Making Model to Death Planning Disclosure
Abstract
The disclosure decision-making model (DD-MM) explains an individual's decision-making process regarding whether they disclose personal health information to others and consists of three tenets (i.e., assessment of information, assessment of receiver, and disclosure efficacy). Whereas traditional DD-MM applications have focused on physiological disclosures (e.g., HIV diagnosis), this study investigates the non-visible, non-diagnosis context of disclosing desired death arrangement plans with others (i.e., how individuals wish their body to be memorialized following their death). Data from 467 individuals aged between 18 and 82 were collected through online surveys. Path analysis findings indicate that while perceptions of stigma, prognosis, and relevance to others (i.e., assessment of information) were significantly related to disclosure efficacy and anticipated response, only relevance to others was directly related to relational quality. Additionally, anticipated response and relational quality (i.e., assessment of receiver) as well as disclosure efficacy and anticipated response performed in accordance with the DD-MM. This study provides meaningful conclusions for agencies who aim to craft messages that will help resonate with, inform, and protect consumers from becoming susceptible to unethical practices in the death service industry. Limitations and future research avenues are discussed.
... Prior research proved that perception of relevance to others was positively related to disclosure efficacy, and disclosure efficacy was positively related to intention to disclose death plan decisions and people's SWB (Kuchenbecker and Bevan, 2023). In the views of most participants in this study, their lives have nothing to do with others, especially those not their family members, therefore, they are reluctant to talk about death with others. ...
Introduction
Will about talking about death bring well-being? This study aims to explore the impact of talking about death on the subjective well-being of the rural middle-aged and older adults in China’s “Aids village” from five dimensions: the way of talking about death, the attitude towards talking about death, the objects of talking about death with, the frequency of talking about death and the content of the death talk, and investigate whether social support played a mediating role during this process.
Methods
A field survey and in-depth interviews were conducted in Wen Lou village (a famous Chinese “Aids village”), and valid questionnaires were completed by the HIV/Aids-affected middle-aged and older adults. A series of linear regression analyses were conducted to detect whether the way of talking about death, the attitude towards talking about death, the objects of talking about death with, the frequency of talking about death and the content of the death talk predict the subjective well-being of the HIV/Aids-affected middle-aged and older adults. An empirical test for mediation effect was performed to examine whether social support played a mediating role during the process.
Results
It was found that the more frequent the middle-aged and older adults talk about death, the higher level of their subjective well-being is (ΔR² = 0.056, 0.05 < p < 0.10), and during which process social support played a mediating role.
Discussion
The author believes that using “talking about death” as a kind of medical intervention, carrying out corresponding life education and death education, and developing a suitable hospice care model, may be a valuable way for the HIV/Aids-affected middle-aged and older adults in the rural area.
One less explored area of research concerns the response to the ecological crisis through environmentally sustainable death practices, which we broadly define in this paper as ‘green death practices’. In this paper, interdisciplinary research and scholarship are utilized to critically analyze death practices, and to demonstrate how contemporary Westernized death practices such as embalming, traditional burial, and cremation can have harmful environmental and public health implications. This paper also investigates the multi-billion-dollar funeral industry, and how death systems which place economic growth over human wellbeing can be socially exploitative, oppressive, and marginalizing towards recently bereaved persons and the environment. Death-care as corporatized care is explicitly questioned, and the paper provides a new social vision for death systems in industrialized Western societies. Ultimately, the paper advocates for how green death practices may offer new pathways for honoring our relationships to the planet, other human beings, and even our own deepest values.
Processes of revealing, or disclosures, take various forms, and are sometimes referred to as disclosure strategies. How individuals share information influences how recipients respond, which may have important consequences that shape perceptions of the overall interaction and relationship satisfaction. This research explores mental health disclosures among friends to understand how (a) one's disclosure strategy predicts their perceptions of the recipient response, (b) perceived recipient response predicts perceptions of disclosure outcomes, and (c) perceived recipient response potentially mediates the relationships between disclosure strategies and disclosure outcomes (e.g., interaction success, relationship satisfaction). Participants were 144 individuals who had disclosed their mental health condition to a friend. Analyses revealed that when disclosing mental health information to a friend, strategy use was, in part, predictive of perceived recipient response which, in turn, predicted discloser's ratings of disclosure outcomes. This manuscript discusses implications of findings and suggests directions for future research.
Coronavirus disease 2019 (COVID-19) is a disruptive event devastating to the workplace and the global community. Drawing on terror management theory, we develop and test a model that explains how COVID-19-triggered mortality salience influences employees’ state anxiety and their responses at and outside work. We conducted an experience sampling method study using employees from an information technology firm in China when COVID-19 was surging there and two experiments using employees from a variety of industries in the United States when it became a new epicenter of the global outbreak. Results from 3 studies largely supported our theoretical hypotheses. Specifically, our research showed that mortality salience concerning COVID-19 was positively related to employees’ state anxiety (general anxiety in Study 1 and Study 2 and death-specific anxiety in Study 3). Our studies also found that servant leadership is particularly crucial in guiding employees with state anxiety associated with COVID-19 mortality salience to be engaged in their jobs and to contribute more to the broader community. Our findings offer timely, valuable implications for theory and practice.
Purpose
Research on death and dying in Western culture holds that individuals engage in a denial and repression of thoughts about death. However, this paper aims to propose that some individuals actively make attempts to exercise control over their eventual demise by engaging in decision-making to achieve an “appropriate death.” A framework is introduced that provides the basis for exploring aspects of decision-making for end of life.
Design/methodology/approach
Depth interviews were conducted with 18 consumers about their dispositions toward death and their decision-making regarding their own funerals.
Findings
An analysis of the consumer narratives suggests that individuals make efforts to prepare for end of life by reducing conflict and finishing business, enlisting identity management strategies and coming to terms with death itself. Unique consumption experiences and decisions accompany each of these efforts.
Research limitations/implications
This research provides understanding regarding how individuals cope with death by attempting to enlist control over a situation in which they have very little control. In doing so, these individuals make efforts to achieve an “appropriate death” by making explicit decisions for end of life.
Originality/value
Instead of actively engaging in defense mechanisms to deny and repress thoughts of death, this research demonstrates that individuals may recognize the inevitability of death as fulfillment of life. In doing so, they may subscribe to positive illusions regarding end of life and make attempts to exercise control over the event.
Quantitative studies have found that suicide bereavement is associated with suicide attempt, and is perceived as the most stigmatising of sudden losses. Their findings also suggest that perceived stigma may explain the excess suicidality. There is a need to understand the nature of this stigma and address suicide risk in this group. We aimed to describe and compare the nature of the experiences of stigma reported by people bereaved by suicide, sudden unnatural death, and sudden natural death, and identify any commonalities and unique experiences. We conducted a population-based cross-sectional survey of 659,572 staff and students at 37 British higher educational institutions in 2010, inviting those aged 18-40 who had experienced sudden bereavement of a close contact since the age of 10 to take part in an on-line survey and to volunteer for an interview to discuss their experiences. We used maximum variation sampling from 1398 volunteer interviewees to capture a range of experiences, and conducted individual face-to-face semi-structured interviews to explore perceptions of stigma and support. We continued sampling until no new themes were forthcoming, reaching saturation at n = 27 interviews (11 participants bereaved by suicide). We employed thematic analysis to identify any distinct dimensions of reported stigma, and any commonalities across the three groups. We identified two key themes: specific negative attitudes of others, and social awkwardness. Both themes were common to interviewees bereaved by suicide, sudden unnatural death, and sudden natural death. All interviewees reported the experience of stigmatising social awkwardness, but this may have been experienced more acutely by those bereaved by suicide due to self-stigma. This study provides evidence of a persistent death taboo in relation to sudden deaths. There is potential for anti-stigma interventions to reduce the isolation and social awkwardness perceived by people bereaved suddenly, particularly after suicide loss.
Structural equation modeling (SEM) is becoming an increasingly popular data analytic technique in communication studies. Reports of SEM analyses are published in communication journals (including Communication Research Reports) allowing for hypothesis testing with latent variables, estimation of direct and indirect causal effects, and validity testing for measurement instruments. Too often, though, serious mistakes are made by authors of SEM studies that cancel out the potential benefits of SEM. Highlighted in this work are five of the most common mistakes made by communication researchers in analyzing and reporting about structural equation models. These problems concern descriptions of model specification, model identification, and methods to evaluate the degree of model-data correspondence, or fit, and lack of replication that continue to plague the empirical SEM literature. This current work is intended as a primer, one that outlines best practices in contrast to widespread but poor practices in each of the areas just mentioned. The hope is that communication researchers yield benefits from the correct application of SEM while avoiding common pitfalls.
This study applied the disclosure decision-making model (DD-MM) to explore how individuals plan to disclose nonvisible illness (Study 1), compared to planning to disclose personal information (Study 2). Study 1 showed that perceived stigma from the illness negatively predicted disclosure efficacy; closeness predicted anticipated response (i.e., provision of support) although it did not influence disclosure efficacy; disclosure efficacy led to reduced planning, with planning leading to scheduling. Study 2 demonstrated that when information was considered to be intimate, it negatively influenced disclosure efficacy. Unlike the model with stigma (Study 1), closeness positively predicted both anticipated response and disclosure efficacy. The rest of the hypothesized relationships showed a similar pattern to Study 1: disclosure efficacy reduced planning, which then positively influenced scheduling. Implications of understanding stages of planning for stigmatized information are discussed.
Genetic test results reveal not only personal information about a person's likelihood of certain medical conditions but also information about the person's genetic relatives. Given the familial nature of genetic information, one's obligation to protect family members may be a motive for disclosing genetic test results, but this claim has not been methodically tested. Existing models of disclosure decision making presume self-interested motives, such as seeking social support, instead of other-interested motives, like familial obligation. This study investigated young adults' (N = 173) motives to share a genetic-based health condition, alpha-1 antitrypsin deficiency, after reading a hypothetical vignette. Results show that social support and familial obligation were both reported as motives for disclosure. In fact, some participants reported familial obligation as their primary motivator for disclosure. Finally, stronger familial obligation predicted increased likelihood of disclosing hypothetical genetic test results. Implications of these results were discussed in reference to theories of disclosure decision-making models and the practice of genetic disclosures.
Four orthogonal factors were identified by principal component factor analysis: Fear of Death/Dying, Approach-Oriented Death Acceptance, Escape-Oriented Death Acceptance, and Neutral Death Acceptance. Theta estimates of the internal consistency of the factor scales ranged from fair (.60) to good (.89). An elderly sample (n = 50) showed less fear of death and more acceptance (all three kinds of acceptance) than the middle age (n = 50) and the young (n = 50) samples. As predicted, Fear of Death/Dying was negatively related to happiness, but positively related to hopelessness, whereas Escape-Oriented Death Acceptance was positively related to hopelessness, thus providing some evidence of concurrent validity of the DAP.
HIV+ African Americans face many challenges that may be addressed by increased social support. This manuscript presents the Brief Disclosure Intervention and explores strategies to tailor the intervention to facilitate disclosure, increase social support, and ameliorate health disparities among HIV+ African Americans. The disclosure decision-making model served as the theoretical framework. HIV+ African Americans (N = 43) in New Jersey participated in structured interviews at 2 time points and half received the intervention. The intervention group reported increased disclosure efficacy and decreased disclosure anxiety and worry. Qualitative themes for disclosure issues included distress in social network, concern for others, and institutional support. Implications for theory and research, use and tailoring of the intervention, and decreasing health disparities are discussed.
Because organ donation does not take place without the consent of next-of-kin and because family discussion is known to be the strongest predictor of consent to donate, transplant advocates have promoted family communication about organ donation, but without much success. Fewer than half of all people who are willing to be organ donors discuss their wishes with family members. Family discussions about donation in the African-American community are especially critical because the need for organs in this ethnic group dramatically outstrips the availability, thus leading to a disproportionate number of deaths among African Americans. This study, grounded in the Organ Donation Model, surveyed 311 African-American adults about their attitudes and behaviors regarding family discussions about organ donation. Logistic and multiple regression analyses revealed that, as hypothesized, family talk attitudes and behaviors were predicted by attitudes, knowledge, and social norms associated with organ donation. In addition, variables such as bodily integrity, medical mistrust, religiosity, and altruism were found to contribute significantly to the explained variance. The implications of these findings for health communication researchers and campaign organizers are discussed.
Nearly every family has secrets. Some of these secrets are told; others are carefully hidden. Why is it that some people reveal their family secrets while others choose to conceal them? Two studies were conducted to investigate this issue by examining the association between the likelihood of revealing family secrets and (a) the topic of the secret, (b) the function of the secret, (c) satisfaction with one's family, and (d) the quality of the relationship with the potential target of the revelation. The correspondence between the number and function of family secrets and family satisfaction was also investigated. The data suggested that the function of secrets, family satisfaction, and the relationship people had with the target of their disclosure were related to whether family members were likely to reveal their secrets. The link between secret topic and the tendency to reveal secrets was unreliable, but there was an association between family members' perceptions of topic intimacy and the likelihood of revealing secrets.
Because revealing family secrets can have substantial influences on individuals and their interpersonal relationships, the criteria people use when they consider whether to divulge a family secret are quite important. The current study was conducted to explore these criteria and to examine the factors that encourage people to employ some criteria as opposed to others. In the first stage of the investigation, a list of criteria was generated and initial evidence was presented for an association between the criteria individuals reported using and the likelihood they would reveal a family secret. In the second stage, the list of criteria was refined, the link between the criteria and people's tendency to reveal a family secret was confirmed, and factors associated with the use of some criteria over others were examined. The results of the study yielded 10 factors characterizing the criteria people used in deciding whether to divulge secret information about their family. These factors were, in theoretically interesting ways associated with individuals' tendency to reveal a family secret. Although the topic of people's secret was not related to any of the criteria, there were significant associations between several of the criteria and individuals' perceptions of their secret. More specifically, people who closely identified with their secret and who saw their family secret as intimate or as negatively valenced were more likely to endorse a number of the criteria. Finally, the quality of individuals' relationship with the potential target of their disclosure was linked to the criteria they reported using. Feeling psychologically close to the target was associated with several of the criteria-suggesting that even those in close relationships are quite mindful of the conditions under which they divulge a family secret.
In an attempt to apply the theory of reasoned action (TRA) to the process underlying organ donor consent, participants completed questionnaires concerning their affective responses to organ donation, as well as their intentions to donate. Participants were given the opportunity to sign an organ donor card. Those who chose to sign the card had more positive attitudes about donation, perceived donation as something that their reference group would encourage, and had stronger intentions to consent to signing a card. The current investigation extends the organ donor literature by using a true behavioral outcome measure indicating consent. Moreover, the pattern of results between attitudes, norms, intention, and behavior illustrates the usefulness of applying the TRA to yet another health-related behavior.
Throughout the past few thousand years, historical accounts, philosophical treatises, and works of fiction and poetry have often depicted humans as having a need to perceive themselves as good, and their actions as moral and justified. Within the last hundred years, a number of important figures in the development of modern psychology have also embraced this notion that people need self-esteem (e.g., Adler, 1930; Allport, 1937; Homey, 1937; James, 1890; Maslow, 1970; Murphy, 1947; Rank, 1959; Rogers, 1959; Sullivan, 1953). Of these, Karen Homey most thoroughly discussed the ways people try to attain and maintain a favorable self-image. The clinical writings of Horney, and other psychotherapists as well, document the ways in which people attempt to defend and enhance self-esteem; they also suggest that difficulty maintaining self-esteem, and maladaptive efforts to do so, may be central to a variety of mental health problems. In this chapter, we will first review the research supporting the existence of a need for self-esteem. Then we will present a theory that accounts for this need and specifies the role it plays in a variety of phenomena including self-presentation.
The present study examined how perceived HIV-related stigma (how much HIV-infected persons believe that the public stigmatizes someone with HIV) influences both reasons for and against HIV disclosure and self-reports of HIV disclosure to a friend, intimate partner and a parent. The research participants were 145 men and women living with HIV. They were asked to recall when they first learned about their HIV diagnosis. Then they indicated how much specific reasons might have influenced disclosing or not disclosing about the HIV diagnosis to a friend, intimate partner and a parent. Findings, based on the total sample, indicated that perceived HIV-related stigma was associated with the endorsement of various reasons against disclosing to a friend and a parent, including concerns about self-blame, fear of rejection, communication difficulties and a desire to protect the other person. Perceived HIV-related stigma was not associated with the endorsement of any reasons for disclosing to a friend, intimate partner or a parent, including catharsis, test other's reactions, duty to inform/educate, similarity and a close/supportive relationship with the other. In addition, perceived HIV-related stigma predicted self-reports of disclosure to a parent but not to a friend or intimate partner. Specific reasons for and against self-disclosure predicted HIV disclosure based on the type of relationship with the potential disclosure recipient. The data analyses were also stratified by gender; these results were, with some exceptions, consistent with the findings with the total sample. The research introduces scales that quantify individuals' reasons for HIV disclosure and/or nondisclosure.
Illness affects millions of Americans each year, and the disclosure of health conditions can facilitate access to social support, in addition to other physical and physiological benefits. This article tests the Disclosure Decision-Making Model (DD-MM; Greene, 2009 ) to predict factors that influence the likelihood of disclosing (and past disclosure of) nonvisible physical or mental health-related information. One hundred eighty-seven (n = 187) people were recruited for a study to report on both disclosing and not disclosing a nonvisible health condition. Measured variables included information assessment, relational quality, anticipated reactions (support, relational consequences), confidence in response, disclosure efficacy, and disclosure (likelihood of disclosure and depth of disclosure). Structural equation modeling results supported many of the proposed hypotheses, with a great deal of similarity across models. Specifically, assessing information predicted efficacy, and to some extent relational outcomes. Closeness was related to response overall and to efficacy in one model. Response predicted outcome overall and likelihood of disclosure in one model. Finally, efficacy predicted likelihood of disclosure and depth of disclosure. The article discusses the implications of the findings for understanding information, relationship assessments, and efficacy in disclosing health diagnoses.
Construal level theory proposes that temporal distance changes people's responses to future events by changing the way people mentally represent those events. The greater the temporal distance, the more likely are events to be represented in terms of a few abstract features that convey the perceived essence of the events (high-level construals) rather than in terms of more concrete and incidental details of the events (low-level construals). The informational and evaluative implications of high-level construals, compared with those of low-level construals, should therefore have more impact on responses to distant-future events than near-future events. This article explores the implications of construal level theory for temporal changes in evaluation, prediction, and choice. The authors suggest that construal level underlies a broad range of evaluative and behavioral consequences of psychological distance from events.
Reproductive health communication can greatly benefit college women by providing informational and emotional support for their reproductive sexual health. However, communication about birth control with friends and sexual partners can be difficult especially if there is stigma around the topic. Applying the Disclosure Decision-Making Model, this study employs a survey of 104 college women regarding their disclosure of birth control status to a peer (Model 1) and a sexual partner (Model 2) to understand the mechanisms of decision-making (i.e., stigma, relational quality, anticipated response, disclosure efficacy) on the depth of disclosing reproductive health information. Results suggest that for both models, relational quality and anticipated response were the predictors of disclosure depth. Although all the significant paths were equivalent in the two models, relational quality predicted anticipated response more strongly in partner model. Theoretical and practical implications of the findings are discussed.
Despite advancements in concussion treatment and management, health and sports professionals largely depend on athletes' self-reporting of symptoms to begin the process of diagnosis. With this in mind, recent scholarly attention has focused on understanding the barriers and processes of athletes' self-disclosure of symptoms. The current study applied the disclosure decision-making model to understand high school football players' disclosure decisions after experiencing symptoms of a concussion. Data obtained from 184 high school football players from across the United States demonstrated 2 significant paths by which players' disclosures of concussion symptoms during a game can be understood. First, the perceived severity of these symptoms predicted athletes' self-efficacy to disclose concussions, which subsequently predicted their intentions to disclose concussion symptoms during a game. Second, the felt stigma around disclosing concussion symptoms predicted athletes' anticipated responses from coaches to such disclosures, which subsequently predicted their intentions to disclose concussion symptoms during a game. Furthermore, the effect of perceived stigma on the anticipated responses from coaches was moderated by the quality of athletes' relationships with their coaches. These results highlight the importance of convincing athletes to take concussion symptoms seriously and the role of athlete-coach relationships in combatting stigma around concussion disclosures. These findings suggest that scholars and practitioners should acknowledge the social contexts surrounding disclosure of concussion symptom and shift educational efforts to focus on the dangers of concussions and the process by which athletes should report potential symptoms.
Within the context of mental illness disclosure between friends, this study tested the disclosure decisionmaking
model (DD-MM; Greene, 2009) to comprehensively investigate factors that predict disclosure
enactment strategies. The DD-MM describes how individuals determine whether they will reveal or
conceal non-visible health information. Processes of revealing, called disclosures, take various forms
including preparation and rehearsal, directness, third-party disclosure, incremental disclosures, entrapment,
and indirect mediums (Afifi & Steuber, 2009). We explore the disclosure decision-making process
to understand how college students select to disclose their mental illness information with a friend.
Participants were 144 students at a Midwestern university who had disclosed their mental illness
information to a friend. Structural equation modeling analyses revealed that college students choose
strategies based on their evaluation of information assessment and closeness, and that for some
strategies, efficacy mediates the relationship between information assessment and strategy. This manuscript
discusses implications of findings and suggests direction for future research.
There has been a proliferation of literature on death - in the UK mainly journalistic and very recent, in the USA mainly scholarly and covering the past thirty years. This literature has created the conventional wisdom that death is the taboo of the twentieth century. The article asks: (a) is death taboo? if so, in what sense? (b) if it is not taboo, then why the frequent announcements that it is? It is this second question that scholars have not previously attempted to incorporate into their theory.
The strengths and weakness of the taboo thesis are reviewed. Six possible modifications/critiques are offered in an attempt to resolve the difficulties: (1) that there was a taboo, but it is now disintegrating; (2) that death is hidden rather than forbidden; (3) that the taboo is limited largely to the (influential) occupational groups of the media and of medicine; (4) that the loss of a coherent language for discussing death leads to conversational unease; (5) that all societies must both accept and deny death, so pundits are able to pick whatever examples fit their thesis; (6) that it is the modern individual, not modern society, that denies death.
Building on the normative conduct theory and the extant literature of environmental marketing, this study explores whether eco-friendly consumer behavior in the apparel market is influenced by variations in social norms and by consumer's environmental concern. An online survey was administered with a total of 332 members from a U.S. consumer panel. The results confirm the significant effects of the type of social norms (i.e., injunctive versus descriptive norms) and the level of environmental concern on purchase intentions. Furthermore, the type of environmental marketing claim (i.e., extrinsic versus intrinsic claims) is shown to moderate the positive influences of injunctive norms and of the level of environmental concern on purchase intentions. Theoretical and managerial implications are discussed.
Background Affiliate stigma refers to the extent of self-stigmatization among associates of the targeted minorities. Given previous studies on caregiver stigma were mostly qualitative in nature, a conceptually based, unified, quantitative instrument to measure affiliate stigma is still lacking.
Materials and Methods Two hundred and ten caregivers of people with intellectual disability (CPID) and 108 caregivers of people with mental illness (CPMI) were recruited to validate the 22-item Affiliate Stigma Scale with caregiving stress, subjective burden and positive perceptions.
Results Exploratory factor analysis suggested that the scale was unidimensional, with excellent internal consistencies for both CPID and CPMI. It showed good predictive validity on subjective burden, after the extent of caregiving involvement and caregiving stress were controlled for.
Conclusion Implications on psychoeducation and stigma reduction were discussed. The newly developed scale provided a quantitative instrument with which affiliate stigma can be compared across different conditions.
Although virtually every person in the United States will purchase or consume a funeral-related product or service, relatively little is understood about the processes a consumer undertakes in making these expensive decisions in stressful circumstances. Regulation of the industry has been contentious from the outset, and there have been numerous questions as to regulatory effectiveness. This article outlines and discusses issues related to the death care industry with particular attention to consumer interests.
The relationship between uncertainty and information has long been at the forefront of the social scientific study of human behavior. The last decade has seen increased attention among communication scholars to the information-management process. The result has been significant widening of ideological lenses and an impressive growth of knowledge. However, a review of the literature shows that there is the need for a framework that integrates and extends these efforts. We advance the theory of motivated information-management to fill that need. The theory proposes a 3-phase process of information-management in interpersonal encounters, emphasizes the role of efficacy, and brings attention to the interactive nature of information-management in this context. We explicate the theory's propositional structure and present a graphical model intended to capture some of the overarching principles detailed in that structure.
This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
By systematically interviewing relatives of a series of hospital patients who died, the authors have delineated the symptoms of normal bereavement. Only three symptoms—depressed mood, sleep disturbance, and crying—occurred in more than one-half of the subjects. At follow-up two to four months later 81 percent were improved and only four percent were worse. Those improved dated their improvement to six to ten weeks after the death. Ninety-eight percent of these relatives did not seek psychiatric assistance during the bereavement period.
Although 69 to 75 percent of U.S. adults say they would be willing to become organ donors, half of the families that are asked to consider donating the organs of a deceased family member refuse to consent. This discrepancy is most noticeable when the refusal of a family conflicts with the known wishes of a patient. It is the practice of nearly all organ procurement organizations in the United States not to procure organs or tissue when families refuse, even if the patient's wishes have been documented. Recently, the Center for Organ Recovery and Education (CORE) adopted a controversial policy of acting on the documented wishes of individuals to donate, independent of family consent. An examination of the moral and political issues raised by this policy lead to the conclusion that the CORE policy is not only justified, but morally required.
NCHS Data Brief Publication No. 427). National Center for Health Statistics
- S L Murphy
- K D Kochanek
- J Xu
- E Arias
Grief is a journey: Finding your path through loss
- K J Doka
- Doka K. J.
The American way of death revisited
- J Mitford
- Mitford J.