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.     

Disenfranchised grief and nonfinite loss as experienced by the families of death row inmates

The families of death row inmates experience grief and loss issues that have been neglected by scholars and clinicians alike. The issues found in this population are unique and require our understanding. The present study uses the concepts of disenfranchised grief and nonfinite loss to uncover the pain experienced by the children and other family members who have a loved one on death row. Kenneth Doka's (1989) concept of disenfranchised grief is utilized to bring attention to the ways in which the circumstances surrounding an execution leave the family members of those condemned to death outside of the "grieving rules" that exist in the United States. Family members are disenfranchised from their grief, as society does not socially validate their pain. The loss that they feel is also nonfinite (Bruce & Schultz, 2001) in that it is continuous and denies the families all of the hopes, dreams, and expectations that they had for their loved one who now sits on death row. The qualitative interview method was utilized by the authors of this study to gather data from 26 family members of death row inmates who are incarcerated along the East Coast of the United States. The reactions of this group of family members are varied and complex, yet they include the following common responses: social isolation due to stigma and their own feelings of criminalization, intensified family conflict between family members who grieve differently from one another, diminished self-esteem, shame, diffused and specific feelings of guilt, and a chronic state of despair. This study explores virtually untapped terrain. An examination of the microlevel effects of the death penalty on families provides insight in to the area of death and dying, especially as it is related to disenfranchised loss and nonfinite grief. In addition, this study provides insight into the death penalty and its effects.     

Effects of support groups on post traumatic stress responses in women experiencing stillbirth

This research study explores the effects of support groups on traumatic stress responses of women experiencing stillbirth. Women (N = 47) responded to a mixed method questionnaire. Quantitative results utilizing the Impact of Event Scale Revised demonstrate that women who attend support group, when controlling for time, had fewer post traumatic stress symptoms than did the women who did not attend support group. Qualitative results elucidate the role of support groups in managing grief, suggesting that connectivity with other like women may be a useful strategy in reducing problematic psychological outcomes.     

Parental bereavement: a panoramic view

This study is aimed at identifying central themes of bereavement. A qualitative approach was employed in the analyses of interviews with 22 bereaved parents. The analyses yielded four central issues or themes of bereavement, each with its own set of sub-themes or categories, as the narrative demanded. The first of these themes, pertaining to the life of the family before the death of a child had taken place, was named the risk factor. Circumstances leading up to the death, surrounding the death, the cause of death, and the events following the death were coded as bereavement circumstances. The grief reactions codes were divided into categories of emotional, physical, behavioral, relational, spiritual, and cognitive reactions, as described by the participants. Finally, the mourning codes described the mechanisms employed by the participants in their attempts to survive and continue living after the death. These findings can be used in the training of support workers and the development of bereavement interventions.     

"Almost the copy of my child that's dead": Shakespeare and the loss of Hamnet

This article emphasizes the importance of studies which look at changes and similarities in mourning over time. It argues that relevant evidence can come from creative fiction as well as from other sources, provided that this is analyzed rigorously in terms of structures and patterns. As an illustration of this approach, it examines the evidence in recurring features of Shakespeare's plays that his writing was deeply and lastingly affected by the death of his only son Hamnet, a twin, at the age of 11, and identifies five motifs which support this interpretation: the resurrected child or sibling; androgynous and twin-like figures; a growing emphasis on father-daughter relationships; paternal guilt; family division and reunion. The article suggests that this approach could be applied to other instances where a body of creative writing shows traces of overt or buried grief.     

When altruism fails: reactions of unrelated bone marrow donors when the recipient dies

This article examines the responses of bone marrow donors to the death of the unrelated person to whom they donated. Data analyzed were 330 questionnaires and fifty in-depth interviews collected from donors in the National Marrow Donor Program at one year post-donation. Death of the recipient produced feelings of guilt and responsibility in the donors in only a few cases (2% of donors from questionnaire data and 2 of the 23 donors interviewed). Grief occurred often (22 of 23 donors interviewed) and was often surprisingly intense, given the fact that the recipient was a stranger. Intensity of grief varied depending on the perceived relationship with the recipient. Our data indicate that limiting contact and/or information about the recipient to the donor would be unlikely to result in more positive psychosocial outcomes. However, several strategies which might be useful in relieving donor guilt and/or grief are suggested.     

The fundamental paradox in the grief literature: a critical reflection

A key theme in the bereavement literature is the recognition that every grief experience is unique and dependent on many variables, such as the circumstances of the death, characteristics of the bereaved individual, their relationship with the deceased, the provision and availability of support, and a myriad of sociocultural factors. Concurrently, there are corresponding efforts to define "normal" grief and delineate it from "complicated" grief experiences. The discord between these two potentially opposing statements remains a paradox evident within the three major tensions within the thanatological literature--the dominance of grief theories, the medicalization of grief, and the efficacy of grief interventions. Three recommendations for moving beyond the paradox are discussed--the provision of improved grief education for service providers, the bereaved, and the wider community; the conduct of research that emphasizes the context of grief and is relevant to service provision; and the examination of current grief interventions.     

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.     

Figures of grief: metaphors from a bereavement writing group

In a community-based bereavement writing group, patterns of metaphor emerged and helped the group members identify and deal with particularly challenging aspects of death and grief, including taboo subjects such as abuse and suicide. The metaphors show how a bereavement writing group functioned to address the needs of people coping with different kinds of grief effectively and efficiently. Analysis of the specific metaphors suggests why figurative language enabled the group to bond quickly and strongly, delve into the complex emotions death elicits, and integrate experiences of loss and grief safely and productively. The patterns of metaphors the group produced in their writing about death and grief are discussed in terms of bereavement processes, and the topics the group used to elicit the figures of speech are presented for further refinement and use.     

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.     

Older poor parents who lost an adult child to AIDS in Togo, West Africa: a qualitative study

This study analyzes the difficulties that poor parents faced when they lost an adult child to AIDS in Togo. The death of a child is believed to be more distressful to parents compared to the death of a spouse. Evidence also suggests that parental grief is more lasting and may be the most complicated form of grief. Furthermore, the roles played by the deceased child in the lives of the parents also affect the parental grieving process. For instance, in low income regions where parents tend to be socio-economically challenged and where filial obligations are culturally expected, losing an adult child who provided material and financial assistance to parents will be more disastrous. Four kinds of difficulties were identified: financial and social difficulty, psychological difficulty, caregiving difficulty, and disclosure difficulty. The socioeconomic status of the parents made these issues all the more taxing, as respondents were grieving not only the loss of their children to AIDS but also the loss of financial providers. Policy implications of the findings are discussed.     

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.     

The grief experiences of certified nursing assistants: personal growth and complicated grief

The grief that certified nursing assistants (CNAs) experience following the deaths of nursing home residents has received scant attention in past research, particularly from an empirical standpoint. The purpose of this quantitative study was to investigate the grief experiences of CNAs in the nursing home setting and to identify and evaluate factors that may mediate or exacerbate grief. Participants (N=136) from 12 nursing homes completed self-administered surveys. Regression analyses revealed that CNAs with lower levels of perceived disenfranchised grief reported higher levels of personal growth, while CNAs with greater fear of death and those who experienced fewer deaths on the job reported higher levels of complicated grief. Practitioners and future researchers may benefit from these findings through the construction and implementation of interventions aimed at effectively enfranchising the grief experiences of this important group of healthcare workers.     

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.     

"You are weeping for that which has been your delight": to experience and recover from grief

To explore how people experience grief and what factors are perceived as facilitating successful grief work, a survey was distributed to people who had completed a grief recovery course. The results showed that emotions, cognitions, physical expressions, and behaviors all characterize grief, but that emotions are the most central component. The course brought relief and was regarded most favorably by those having at least 1 year between the grief trigger event and participation in the course. Writing a letter in which course participants express their feelings to the loss object was perceived as the most successful aspect of the course. The letter might help with grief recovery by bringing aspects that have not been dealt with into conscious awareness.     

Patterns of parental bereavement following the loss of a child and related factors

This study investigated the patterns of parental bereavement in 20 parents who have lost a child to cancer, congenital heart disease, meningitis, or drowning in the last 19 months, using semi-structured interviews and standardized questionnaires of depression and grief. Qualitative content analysis of interviews identified three bereavement patterns: The majority of parents (65%) presented uncomplicated, Integrated Grief five mothers were Consumed by Grief and one mother and one father expressed Minimal Grief. Quotes from parents exemplified these patterns. Parental gender, symptoms of depression, and pre-death relationship between parents and their deceased child differentially related to these patterns. Having surviving children, social support, and being active appeared to help to integrate grief into daily life. These findings illustrate differential patterns of parental bereavement and related factors, information that has important implications for identifying at-risk parents for complicated bereavement.     

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.     

Incorporating Message Framing into Narrative Persuasion to Curb E-Cigarette Use Among College Students

This study examines the interaction effect of message format (narrative vs. nonnarrative) and message framing (gain vs. loss) in e-cigarette prevention targeting young adults. Results of a two-way experiment (N = 439) revealed that transportation and discrete emotions mediated message effect on risk perception and behavioral intention. Compared to the gain-framed nonnarrative, the gain-framed narrative reduced feelings of guilt, and guilt was negatively related to risk perception and positively related to behavioral intention. Thus, the gain-framed narrative achieved desirable persuasive outcome through guilt—increasing risk perception and decreasing intention to use e-cigarette. Similarly, the loss-framed narrative evoked greater sadness, which also led to increased risk perception and decreased behavioral intention. Transportation and discrete emotions mediated message effect in a serial order. This research not only contributes to the literature on narrative persuasion and emotion, but also provides insight for health communication designed for e-cigarette prevention.     

Parental grief in three societies: networks and religion as social supports in mourning

How do people respond to the grief of parents over the death of their infant child? This article documents the experience of one of the authors, an American married to a Russian whose child died in England. Responses to this death by friends, colleagues and family in the USA, England, and two cities in Russia varied considerably in terms of depth and degree of engagement (emotional engagement, respect, or distance and avoidance). What factors underlie these varied responses? Two are identified, one structural, the other cultural: the strength of the social ties within social networks, and religiosity as historically sedimented within a culture. The degree of engagement is correlated with network form; but the content of engagement depends on religiosity.     

Exploring the role of experiential avoidance from the perspective of attachment theory and the dual process model

Avoidance can be adaptive and facilitate the healing process of acute grief or it can be maladaptive and hinder this same process. Maladaptive cognitive or behavioral avoidance comprises the central feature of the condition of complicated grief. This article explores the concept of experiential avoidance as it applies to bereavement, including when it is adaptive when it is problematic. Adaptive avoidance is framed using an attachment theory perspective and incorporates insights from the dual process model (DPM). An approach to clinical management of experiential avoidance in the syndrome of complicated grief is included.