Bereavement: an incomplete rite of passage

A bereavement ritual observed during anthropological fieldwork in Peru gives basis to this article which asserts that bereavement has become an incomplete rite of passage. The article reviews the role of ritual and rites of passage, examines other anthropologic examples of death and bereavement rituals, and identifies the lack of post-funeral ritual for many bereaved individuals in the United States. While funerary rituals which end with the funeral and burial of the dead are helpful in providing immediate structure for the bereaved, they are not congruent with the long-term emotional needs and reconstruction of meaning within grief. The author acknowledges value of both private ritual and reunions of the community of mourners, and recommends that bereavement counselors and/or the funeral industry offer to help bereaved construct a "ritual of remembrance and new meaning" after time has allowed them to move along in meaning reconstruction processes of making sense, finding benefits, and identity change.     

Growing up with grief: revisiting the death of a parent over the life course

In the era of managed care, evidence-based practice, and short term, solution focused interventions, clinicians in agency based settings generally do not have the luxury of long-term contact with bereaved children. Although a substantial, yet controversial, literature argues that children cannot fully resolve early loss until adulthood, limited attention is given to how children's understandings of early loss shift as their cognitive capacities mature. This article argues the emotional experience of grief shifts: 1) as children grapple with both normative life changes and the tasks of mourning, and 2) as their cognitive and emotional development allow them to understand and question aspects of their deceased parent's life and death in new ways. This article will present an overview of longitudinal and cross-sectional research on the long-term impact of childhood grief. We then suggest the ways bereaved children and adolescents revisit and reintegrate the loss of a parent as their emotional, moral, and cognitive capacities mature and as normative ego-centrism and magical thinking decline. To demonstrate these ideas, we draw on the case of a parentally bereaved boy and his family presenting across agency-based and private-practice work over the course of 14 years. This case suggests the need for coordinated care for children who are moving beyond the initial trauma of parental loss into various stages of grief and reintegration. While the loss of a parent is permanent and unchanging, the process is not: it is part of the child's ongoing experience. (Worden, 1996, p. 16).     

Perinatal loss and parental grief: the challenge of ambiguity and disenfranchised grief

Following perinatal loss, a type of ambiguous loss, bereaved couples struggle with and experience distress due to various forms of ambiguity. Moreover, the juxtaposition of their grief with society's minimization often disenfranchises them from traditional grieving processes. The purpose of this study was to explore sources of ambiguity and disenfranchised grief related to perinatal loss. Audio-taped interviews with 13 bereaved couples at 2, 6, and 13 months following the death of their fetus or infant were analyzed. Several categories of ambiguity and disenfranchised grief emerged, pertaining to: (a) the viability of the pregnancy; (b) the physical process of pregnancy loss; (c) making arrangements for the remains; and (d) sharing the news. This study uncovers the many sources of ambiguity and disenfranchised grief that bereaved couples face in interactions with family, friends, society, and healthcare professionals. These insights may inform healthcare professionals in their attempts to ease distress related to perinatal loss.     

Complicated grief symptoms in caregivers of persons with lung cancer: the role of family conflict, intrapsychic strains, and hospice utilization

Guided by a stress process conceptual model, this study examines social and psychological determinants of complicated grief symptoms focusing on family conflict, intrapsychic strains, and the potential moderating effect of care quality and hospice utilization. Relying on data from 152 spouse and adult child lung cancer caregiver survey respondents, drawn from an ancillary study of the Assessment of Cancer CarE and SatiSfaction (ACCESS) in Wisconsin, hierarchical multiple regression analysis was used to examine determinants of complicated grief. After controlling for contextual factors and time since death, complicated grief symptoms were higher among caregivers with less education, among families with lower prior conflict but higher conflict at the end-of-life, who had family members who had difficulty accepting the illness, and who were caring for patients with greater fear of death. Additionally, hospice utilization moderated the effect of fear of death on complicated grief. Findings suggest that family conflict, intrapsychic strains, and hospice utilization may help to explain the variability found in complicated grief symptoms among bereaved caregivers. Implications for enhancing complicated grief assessment tools and preventative interventions across the continuum of cancer care are highlighted.     

Qualitative exploration of the nature of grief-related beliefs and expectations

Societal expectations of grief impact the experience of bereavement. The congruence of societal expectations with current scientific understanding of grief is unknown. Therefore two qualitative studies explored community perceptions of grief. In study one, three small focus groups (N = 9) examined grief-related expectations associated with hypothetical scenarios of bereavement. In study two, the impact of grief-related perceptions on the lived experience of bereavement for 11 individuals was explored through semi-structured interviews. Across both studies, elements of a traditional stage model view of grief were evident, with participants viewing emotional expression of grief as important. An avoidant coping style in the bereaved was considered problematic. Findings of study two suggested that grief-related beliefs may impact the bereavement experience via appraisal of the grief response and willingness to support bereaved individuals. The studies suggested that stage model assumptions in the beliefs of the general population persist, although there was a recognition of diversity in the grief response.     

Problematic emotions and maternal grief

The study was an empirical examination of the relation of personality proneness to "problematic social emotions"--envy (Dispositional Envy Scale), jealousy (Interpersonal Jealousy Scale), and shame and guilt (Personal Feelings Questionnaire-2)--to maternal grief (Perinatal Grief Scale-33) following miscarriage, stillbirth, neonatal death, or infant/child death. The 441 women who participated in the study were enrolled from the Website, e-mail contact lists, and parent support groups of an organization that offers information and support to bereaved parents. All four problematic emotions were positively correlated with maternal grief. Envy, jealousy, and guilt made significant unique contributions to the variance in maternal grief. Overall, time lapse since the loss and the four problematic emotion predispositions explained 43% of the variance in maternal grief following child bereavement.     

Surviving grief: An analysis of the exchange of hope in online grief communities

Online grief communities represent relatively new forms of peer support. However, the degree to which they are helpful for individual grieving processes is unknown. To date, no research has evaluated the type or quality of support exchanged in online grief communities. To begin to address these questions, this study analyzed 564 messages from internet grief websites to: (1) classify the type of helping skills used, and (2) extract themes contained in the content of the messages. Messages selected for analysis were the first response to an original post, assuming they would be the first effort to provide support to a grieving individual. Results revealed a majority of responses contained self-disclosure. Themes in the messages suggested provision of more than "one-way" support; messages themes also included exchanging hope for the future by sharing one's own story, validating the grief experience, providing resources, and exchanging psychosocial support. Clinical implications and research recommendations are discussed.     

African Americans in bereavement: grief as a function of ethnicity

Few empirical studies have explored the grieving process among different ethnic groups within the United States, and very little is known about how African Americans and Caucasians may differ in their experience of loss. The purpose of this study was to examine the African-American experience of grief, with particular emphasis on issues of identity change, interpersonal dimensions of the loss, and continuing attachments with the deceased. Participants were 1,581 bereaved college students (940 Caucasians and 641 African Americans) attending classes at a large southern university. Each participant completed the Inventory of Complicated Grief-Revised, the Continuing Bonds Scale, and questions regarding the circumstances surrounding his or her loss. Results revealed that African Americans experienced more frequent bereavement by homicide, maintenance of a stronger continuing bond with the deceased, greater grief for the loss of extended kin beyond the immediate family, and a sense of support in their grief, despite their tendency to talk less with others about the loss or seek professional support for it. Overall, African Americans reported higher levels of complicated grief symptoms than Caucasians, especially when they spent less time speaking to others about their loss experience. Implications of these findings for bereavement support services for African Americans were briefly noted.     

Living beyond the unanticipated sudden death of a partner: a phenomenological study

This research project explored grief and its impact upon men and women who have experienced the sudden and unanticipated death of his or her partner. It included what grief meant to them, how it was manifested in his or her everyday lives and how his or her partner's death had impacted upon his or her relationship with themselves, with others and the world. A Husserlian phenomenological approach was used to explore the experiences of the ten women and five men whose partner had died up to five years prior to being interviewed. The need for the surviving partner to continue to participate in everyday life placed great strain upon the internal resources of the surviving partner. The surviving partner needed to reinvent him or herself, in an attempt to become independent and regain functionality, whilst dealing with the sadness and loss that they had experienced. The surviving partner discovered that a new life order emerged that included hope, optimism, planning for the future and perhaps the prospect of a new relationship. The death of a partner left the surviving partner with a loss that would always be a part of them, with the memories of his or her relationship being maintained within them that will never be replaced by somebody else. The results of this research project reinforce the need for ongoing education of the community in grief and bereavement issues in order to increase the awareness of the support needs of the bereaved person. The length of time and amount of energy required to incorporate the experience into the survivor's life, is greatly underestimated by the community, and perhaps by some of the health and caring professionals. Colonial and hospital based bereavement support services need to be established and be proactive using outreach programs, actively offering the suddenly bereaved partner and family support and information.     

Adolescent grief: relationship category and emotional closeness

Bereaved adolescents (N = 90) who had experienced relatively common death losses (e.g., grandparent, friend) completed the Texas Revised Inventory of Grief and the Emotional Closeness Scale and Continuum. Results indicated that present grief was significantly higher for friend than for grandparent death loss. A MANOVA revealed that those in the high closeness group reported significantly higher mean scores on past and present grief than those in the low closeness group. Finally, in a hierarchal multiple regression, after demographic variables were entered (e.g., age, present at death), emotional closeness added significant variance to the prediction of past and present grief. This research contributes to the understanding of grief intensity following adolescents' most common death losses and highlights the importance of counselors' intentionally and directly assessing bereaved adolescents' perceived emotional closeness to the deceased as part of grief-related counseling.     

Considerations for grief interventions: eras of witnessing with families

This article describes research that was conducted to articulate interventions with families experiencing grief. Using an interpretive methodology framed by philosophical hermeneutics allowed for a depth of understanding of these therapeutic conversations. The research findings offer explanations of the role of time in relation to grief, particularly the timing of interventions, and describe the significance of working with multiple family members during therapeutic interventions. This research was unique in that it approached grief counseling with a family focus, the participants were interviewed for this study several years after the therapeutic encounter, and the underlying theoretical framework for the interventions focused on grief as a lifelong, life-changing experience, rather than a finite, pathology-laden event.     

Participants with prolonged grief--how do they benefit from grief group participation?

Data analyzed in this article is part of a study conducted to explore grief support groups in Norway. Participants that fulfilled the criteria of Prolonged Grief Disorder (PGD) were compared with participants that did not in order to explore whether they differed on satisfaction and experiences with participation. To allow for comparison, a subsample of 22 participants that fulfilled the criteria of PGD were drawn from the total of 262 participants. Demographic and loss-related variables were analyzed to explore factors associated with PGD. Fulfillment of PGD was then analyzed to explore the group's effect on life quality and overall satisfaction. The main finding is that participants who fulfill the criteria of prolonged grief are in general less satisfied with the groups and report less positive effect on life quality. We also found age- and gender-differences regarding fulfillment of PGD, with older bereaved women especially at risk of developing symptoms of PGD.     

ICT服务业资本存量及其产出弹性估算研究

21世纪以来,ICT发展已经深刻地影响着中国经济社会。为检验中国ICT资本是否存在"生产率悖论",本文运用PIM系统估算了2003-2016年期间全国层面和地区层面ICT服务业和非ICT服务业资本存量及其产出弹性。研究发现,中国ICT服务业存在明显的"投资不足",但在2012年以后有所缓和;ICT服务业资本存量在各地区表现非均衡分布,但其差距趋于收敛;ICT服务业资本对中国经济增长具有显著的促进作用,产出弹性在0.1605-0.1705之间;从时间趋势来看,考察期间内ICT服务业资本对中国经济增长的影响效果不断增强,从区域差异来看,ICT服务业资本产出弹性在东、中和西部呈依次递减趋势。本文研究证实中国ICT资本不存在"生产率悖论"。     

Healing components of a bereavement camp: children and adolescents give voice to their experiences

This qualitative study is the follow-up to a quantitative controlled study which showed a decrease in childhood traumatic grief and posttraumatic stress disorder symptoms in parentally bereaved children participating in a bereavement camp. The purpose of this study was to identify the healing components of this camp model. Semi-structured interviews with 19 children and 13 parents/guardians were conducted 3 to 9 months after participation in the bereavement camp. Therapeutic Interventions and Traditional Camp Activities emerged as themes. The themes are discussed in relation to previous research as are limitations of the study and the implications for theory, practice, and future research.     

Efficacy of writing for recovery on traumatic grief symptoms of Afghani refugee bereaved adolescents: a randomized control trial

Effective evidence-based intervention for traumatic bereavement is one of the current major research issues in the field of Post Traumatic Stress Disorder (PTSD) in children and adolescents. The "Writing for Recovery" group intervention is a new treatment approach developed by the Children and War Foundation for traumatized and bereaved children and adolescents after disasters. The purpose of this project was an empirical examination of this intervention with 12- to 18-year-old war bereaved Afghani refugees. Eighty-eight war bereaved Afghani refugees were screened using the Traumatic Grief Inventory for Children (TGIC). From those with the highest total score, 61 were randomly assigned to either an experimental (n = 29) or control group (n = 32). The experimental group received six sessions of group training on 3 consecutive days in their school. The difference of TGIC scores between the experimental group in pretest and posttest was significant (p = 0.001). Results of analysis of covariance also showed a significant effect of Writing for Recovery on the experimental group (p < 0.001). It is concluded that "Writing for Recovery" is an effective group intervention for bereaved children and adolescents after disasters.     

The sequential path to transformation management

The requirement for organizational transformation presents a troubling paradox for would-be leaders of change. To achieve significant and lasting transformation, everything about the organization must change. But changing everything at once is simply impossible. In seeking a way through this paradox, the article suggests a sequence of interventions. This is what needs to occur first, second, third, and so on, if transformation is to be effective. Underlying that sequence are the concepts of customer alignment and learning. Driving that sequence is a transformation in leadership style that addresses first sequentially and then simultaneously the twin demands of what Bert Spector refers to a ‘taking charge and letting go’.     

Planning health services with explicit geographical considerations: a stochastic location–allocation approach

This paper is concerned with modeling for planning health services when geographical considerations in the location of services and in the locations of patients who need services are important. Examples of geographical distribution and organization of health services are the location of hospital outpatient departments within a city, and the provision of hospital-based specialist services, such as cardiac and dental surgery, across a region. Important issues in the provision of services include the location of the service centers, service capacities, geographical distribution of patients, and ease of access to the health services. This paper describes the development of a discrete-event geographical location–allocation simulation model for evaluating various options for the provision of services. Real-life case studies will illustrate the practical importance of the modeling approach.     

Parental grief after a child's drug death compared to other death causes: investigating a greatly neglected bereavement population

This comparative survey contrasted 571 parents who lost children to various death causes: 48 to drug-related deaths and overdoses, 462 to suicide, 24 to natural death cases, and 37 to mostly accidental death cases. Groups were compared in terms of grief difficulties, mental health problems, posttraumatic stress, and stigmatization. Results did not show any appreciable differences in these respects between the suicide bereaved parents and those losing children to drug-related deaths. However, when the suicide and drug-related death survivors were specifically contrasted against accidental and natural death loss cases, a consistent pattern emerged showing the former group was consistently more troubled by grief and mental health problems than the latter two sub-groups. These differences remained when controls of time since the loss and gender differences were employed as covariates. These findings suggest that the powerful and intense stigma against drug use and mental illness, shared among the public-at-large, imposes challenges in healing of immense proportion for these parents as they find less compassionate responses from their significant others, following their losses.