Margaret A. Hainsworth’s research while affiliated with Rhode Island College and other places

Chronic sorrow is the presence of pervasive grief-related feelings that have been found to occur periodically throughout the lives of individuals with chronic health conditions, their family caregivers, and the bereaved. These feelings emerge in response to an ongoing disparity that results from the loss of the anticipated “normal” lifestyle of these persons. Circumstances and situations shown to trigger chronic sorrow in a variety of these populations are defined. Similarities and differences of the trigger events among groups and the implications for family nursing practice are discussed. Support that has been identified as helpful when life circumstances evoke chronic sorrow is described.

This study investigated the occurrence of chronic sorrow among individuals who experienced the death of a loved one. In-depth interviews were conducted with fourteen parents who had experienced the death of a child, ten people who had suffered the death of their spouses, and ten individuals who had had a family member die. Interviews were transcribed and data were sorted into categories, with recurring themes identified. Thirty-three (97 percent) of those interviewed evidenced chronic sorrow. Confronting disparity with social norms and situations that brought memories to mind most frequently triggered recurrence of grief-related feelings. Subjects used action-oriented, cognitive, and interpersonal coping strategies to deal with these episodes of grief. These findings bring into question the expectation inherent in traditional grief theories that emotional closure is a necessary outcome of the grieving process.

To introduce a middle-range nursing theory of chronic sorrow that presents this sorrow as a normal response to ongoing disparity due to loss. Chronic sorrow is the periodic recurrence of permanent, pervasive sadness or other grief related feelings associated with a significant loss. The theory provides a framework for understanding and working with people following a single or ongoing loss. The model of chronic sorrow includes antecedents, trigger events, and internal and external management methods. Theory is useful for analyzing individual responses of people experiencing ongoing disparity due to chronic illness, caregiving responsibilities, loss of the "perfect" child, or bereavement. The theory was developed using concept analysis, critical review of research, and validation in 10 qualitative studies of various loss situations. Chronic sorrow has been shown to explain the experience of people across the lifespan who encounter ongoing disparity because of significant loss. Nurses need to view chronic sorrow as a normal response to loss and, when it is triggered, provide support by fostering positive coping strategies and assuming roles that increase comfort.

This study was designed to examine chronic sorrow in spouse caregivers of individuals with multiple sclerosis. Chronic sorrow was defined as a pervasive sadness that is permanent, periodic, and progressive in nature. The sample comprised 10 participants: 5 males and 5 females. Data were collected through audiotaped, face-to-face interviews using the Burke/NCRCS Chronic Sorrow Questionnaire (Caregiver Version). The audiotapes were transcribed, and then analyzed by the researcher. Eighty percent of the caregivers were found to experience chronic sorrow. Milestones or events which caused the sorrow to recur were major themes. The participants also identified what was helpful and not helpful in coping with these feelings, gave practical advice for similar individuals, and offered suggestions for nurses and other caregivers.

1. Chronic sorrow is defined as a pervasive sadness that is permanent, periodic, and progressive in nature. 2. Milestones or events which caused the sorrow to recur were major themes in this study. 3. The participants identified what was helpful and not helpful in coping with these feelings, gave practical advice for similar individuals, and offered suggestions for nurses and other caregivers.

BACKGROUND: Chronic sorrow was described by Olshansky (1962) to explain a perva sive, psychologic reaction that he observed in parents of mentally retarded children. He believed that the sorrow was a normal, not a neurotic, response to their situation and relatedly, thought clinicians would intervene differently with these parents if they held a similar belief. The Nursing Consortium for Research on Chronic Sorrow (NCRCS), of which the authors are members, has conducted multiple studies to ex pand the understanding of chronic sorrow as a normal state associated with chronic or life-threatening conditions, occurring both in the individual with the condition and in family members. These NCRCS investigators have provided evidence supporting the premise that chronic sorrow is likely to occur in various chronic situations. OBJECTIVES: This study explored whether women with chronically mentally disabled husbands experienced feelings of chronic sorrow in their lives. DESIGN: Using content analysis, the transcriptsfrom interviews with 11 women were coded using the Burke/NCRCS Chronic Sorrow Questionnaire (Caregiver version) as a guide. RESULTS: All 11 women experienced feelings of chronic sorrow. Feelings of chronic sor row occurred periodically over an extended time when some event reminded partici pants of their long-term situation. Subjects identified personal strategies for coping with feelings of chronic sorrow and nursing activities that had been helpful to them. CONCLUSIONS: The findings of this study are consistent with those of other studies on chronic sorrow. Subjects identified the role of the nurse as teacher/expert as most important for helping women with chronic sorrow, specifically by providing them with knowledge that is current and specific. From these findings, interventions can be developed to increase the psychologic comfort of these caregivers. (J AM PSYCHIATR NURSES Assoc [1995]. 1, 120-124)

This qualitative nursing research study investigated the occurrence of chronic sorrow in individuals with multiple sclerosis. Using the Burke/NCRCS Chronic Sorrow Questionnaire (Individual Version), 10 participants were interviewed. Data were analyzed in collaboration with one other researcher. Of the participants, 80% evidenced the presence of chronic sorrow in their lives. Data clearly indicated that feelings of chronic sorrow occurred periodically over a protracted span of time when some event reminded participants of their chronic situation. The nursing roles of empathetic presence and caring professional helped participants the most in dealing with their feelings of chronic sorrow.

This qualitative study was designed to examine the presence of chronic sorrow in diverse populations of individuals with chronic or life threatening conditions and to identify strategies for coping with feelings of chronic sorrow. Chronic sorrow was defined as a pervasive sadness that is permanent, periodic, and progressive in nature. The sample comprised 5 infertile couples, 10 individuals with long-term cancer, 10 individuals with multiple sclerosis, 6 individuals with Parkinson's disease, and 4 spouse caregivers. Data were collected through audiotaped face-to-face or telephone interviews using the Burke/NCRCS Chronic Sorrow Questionnaire. The audiotapes were transcribed, entered into a computer analysis program, and collaboratively analyzed by the researchers. The findings indicate that 83% of the subjects experienced chronic sorrow. The four coping strategies that were identified by the subjects as being helpful to their situation were categorized by the researchers as interpersonal, emotional, cognitive, and action.

Research on the phenomenon of chronic sorrow has been limited to samples of parents of children with disabilities. The Nursing Consortium for Research on Chronic Sorrow was formed to study this concept in individuals with chronic illness and their family caregivers across the life span. Although no research on this concept has focused on a life-span approach, the level and quantity of related research indicate that a qualitative method is most appropriate. A study of parents of children with spina bifida provided a usable instrument, the Chronic Sorrow Questionnaire. The purpose of additional study is to determine when chronic sorrow occurs and what characteristics it displays in a variety of populations across the life span, how groups suffering from chronic sorrow compare with parents of children with disabilities, whether chronic sorrow is an inherent phenomenon in chronic illness situations, and how the major subconcepts of chronic sorrow theory are linked.