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.     

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.     

Introducing the 3-A grief intervention model for dementia caregivers: acknowledge, assess and assist

With our aging population, it is estimated that in the near future there will be an overwhelming increase in the number of individuals dealing with Alzheimer's disease or a related dementia (ADRD). From the time that symptoms begin to insidiously emerge, it can take well over ten years for the disease to run its course. In addition to the crippling effect for those inflicted, this lengthy duration can have an ongoing debilitating effect on the family members who are grieving while providing care. Researchers have claimed that the manner in which family members experience and manage their grief reactions to the pre-death losses can influence both caregiving outcomes and adjustment to bereavement once those with the disease have died. Given the relevance of grief management, this article provides answers to such questions as: How do family caregivers of individuals with ADRD manifest their grief? How can healthcare professionals intervene in assisting with grief management? The answers are provided introducing the 3-A grief intervention model for family caregivers of individuals with ADRD. The 3-A model enfranchises the caregiver grief experience through Acknowledging, Assessing, and Assisting in grief management. In doing so, different grieving styles are identified and the role that denial and respite plays in adapting to the family caregiver's grief experience is recognized. Clinical strategies to assist in grief management are also provided.     

Cultural influences on parental bereavement in Chinese families

The purpose of this study was to explore the bereavement experiences of parents who had experienced the death of a child in Chinese families. In-depth interviews were conducted with 10 bereaved parents in Macau, China. Narrative accounts of Chinese parents' experience in the loss of a child were explored to understand how their connection to the deceased child and their worldview were influenced by cultural beliefs and values. Study themes related to parental connections with the deceased child included the use of object linking, memorializing acts, and avoidance of traditional funeral processes, with clear patterns of Chinese cultural influence. Additionally, themes related to impacts on parental worldview included use of the concept of fate as a rationale for child loss and influences on religious orientation. The influence of cultural beliefs and background on Chinese parents as they deal with the issue of a child's death was apparent. Further research is needed and will benefit our understanding of parental bereavement in Chinese families.     

The social relations of bereavement in the Caribbean

The objectives of this article are to discuss the various types of behaviors associated with grief and bereavement, and to examine the relationships, consequences, and outcomes of bereavement practices among the various religious and ethnic groups in the English-speaking Caribbean Islands of Jamaica, Trinidad, Grenada, and Barbados. The rituals associated with death and grief differs across cultures and is greatly influenced by religious beliefs and traditions. How these rituals are played out depend on the culture of origin and level of acculturation of the various groups into mainstream society. In the Caribbean region, expressions of grief represent religious and cultural traditions that may have a significant impact on social relations, particularly in multi-ethnic and multicultural societies. In the English-speaking Caribbean Islands of Jamaica, Trinidad, Grenada, and Barbados, mourning follows the patterns of traditional religious practices which have remained consistent over time. While families and friends may offer social support before and after burial or cremation, the social aspects of bereavement may also have implications for inter-group relations. Insights into bereavement practices and what it holds for ethnic and religious groups in contemporary Caribbean are presented.     

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.     

Exploring the "Psychometric Paradigm": Comparisons Between Aggregate and Individual Analyses

The "psychometric paradigm" developed by Slovic, Fischhoff, and Lichtenstein was a landmark in research about public attitudes toward risks. One problem with this work, however, was that (at least initially) it did not attempt to distinguish between individuals or groups of people, except "experts" vs. "lay people." This paradigm produced a "cognitive map" of hazards, and the assumption seemed to be that the characteristics identified were inherent attributes of risk. This paper examines the validity of this assumption. A questionnaire survey similar to those designed by Slovic et al. was conducted, but the data were analyzed at both the aggregate level, using mean scores, and at the level of individuals ( N = 131 Norwich residents). The results reported here demonstrate that (1) individuals vary in their perception of the same risk issue; (2) individuals vary in their rating of the same risk characteristics on the same risk issue; and (3) some of the strong intercorrelations observed between risk characteristics at the aggregate level are not supported when the same data are analysed at the level of individuals. Despite these findings, the relationship between risk characteristics and risk perceptions inferred by the psychometric paradigm did hold true at the level of individuals, for most—but not all—of the characteristics. In particular, the relationship between "lack of knowledge to those exposed" and risk perceptions appears to be a complex one, a finding which has important implications for risk communication strategies.     

End of life care and reactions to death in African-American and white family caregivers of relatives with Alzheimer's disease

Family caregivers for relatives with Alzheimer's Disease (AD) often experience significant stress-related problems in mental and physical health. Patients with AD often survive for protracted periods of time, placing an extensive burden of care on the caregiver prior to the patient's death. The present study addresses ethnic differences in the experience of AD caregivers around the time of their loved one's death, including life-sustaining treatment decisions and reactions to death. The results showed that, in our sample, more patients died in their homes than has been reported for deaths in the United States. African-American and White caregivers differed substantially in their reports of end of life care and subjective reactions to the death. Compared with White caregivers, African-American caregivers were less likely to make a decision to withhold treatment at the time of death, less likely to have their relative die in a nursing home, and reported less acceptance of the relative's death and greater perceived loss. Results suggest that death after AD caregiving deserves further study, and that ethnic differences in end of life care and bereavement may be of particular importance.     

Family members' experiences with viewing in the wake of sudden death

Sudden deaths leave families in crisis and interacting with many professionals from notification through to burial. Whether to view the deceased is often central to discussion. Practice guidelines have evolved over time regarding where, when, how, and why viewing should or should not occur. Unfortunately, there is much contradiction in existing recommendations and a marked absence of a supporting evidence base for the practice of viewing itself, and the influence of this practice on the overall bereavement process. Using a qualitative approach, this study explored the perspectives and experiences of the suddenly bereaved with respect to: viewing or not having viewed; whether or not their viewing experiences have impacted on their bereavement process; and explored particular aspects of their experience such as interactions with various professionals. Results of this study are clustered and presented under three core themes: viewing specifics; intrapersonal responses; and professional interactions.     

Altruistic Preferences for Life-Saving Public Programs: Do Baseline Risks Matter?

Cost-benefit analyses of life-saving public programs typically focus on the number of expected deaths avoided (statistical lives saved) as the metric for evaluating benefits. Although this measure of population risk is clearly important, it ignores the distribution of underlying individual risks. A similar number of lives can be saved by protecting relatively large populations with relatively low baseline risk as can be saved by protecting smaller populations faced with higher baseline risks. Should the value of saving a statistical life be sensitive to the baseline levels of risk to exposed individuals? This paper addresses this issue by focusing specifically on individuals’ altruistic values with regard to life-saving programs. Using results from a survey, this study finds that when individuals are asked to state their preference for equally costly life-saving programs that will only affect others’ level of risk, they prefer those that save more lives. More importantly, however, controlling for the number of lives saved, they also prefer programs that affect smaller populations facing higher levels of baseline risk. Furthermore, the results suggest that each order-of-magnitude increase in the level of baseline risk to others approximately doubles the altruistic value component of a statistical life saved.     

The "moment of death"

The "moment of death," once a dominant concept in preparing for a "good death", has been eclipsed by a focus on the wider concept of the "dying trajectory". However, findings from interviews with 25 bereaved individuals suggest that dying loved ones' final moments may still be experienced as highly significant in their own right. In some accounts the dying individual's final moments did not feature or made little impression, either because the survivor was not present, or there was no obviously definable moment, or because other, usually medical factors, such as whether to resuscitate the person, took precedence. However, in six cases such moments were constructed as profound, special, and memorable occasions. These constructions are explored in relation to achieving a good death, the dying trajectory as a whole, and making sense of the bereavement experience. Their implications for sociological theories of identity and embodiment are also considered.     

Risk Assessment for Aflatoxin: III. Modeling the Relative Risk of Hepatocellular Carcinoma

Estimates have been made of the cancer potency of aflatoxin exposure among the U.S. population. Risk modeling is used to assess the dose-response relationship between aflatoxin exposure and primary liver cancer, controlling for hepatitis B virus (HBV), based on data provided by the Yeh et al. study in China. A relative risk model is proposed as a more appropriate alternative to the additive ("absolute" risk) model for transportation of risk coefficients between populations with different baseline rates. Several general relative risk models were examined; the exponential model provided the best fit. The Poisson regression method was used to fit the relative risk model to the grouped data. The effects of exposure to aflatoxin (AFB1) and hepatitis B infection were both found to be statistically significant. The risk of death from liver cancer for those exposed to AFB1 relative to the unexposed population, increases by 0.05% per ng/kg/day exposure of AFB1 (p less than 0.001). The results also indicated a 25-fold increase in the risk of death from liver cancer among those infected with hepatitis B virus, relative to noncarriers (p less than 0.0001). With a hepatitis prevalence rate of 1%, the aflatoxin intake level associated with liver cancer lifetime excess risk of 1 x 10(-5) for the U.S. population was estimated as 253 ng/day, based on a liver cancer baseline rate of 3.4/100,000/yr.     

Death: the ultimate social construction of reality

Using Berger and Luckmann's thesis (1966) on the social construction of reality as rationale, this research analyzes the death drawings of 946 university students enrolled in a Death and Dying course between 1985 and 2004 to investigate the basic constructs elicited by the word "death": dying, moment of death, after death, after life, and bereavement. Consistent with earlier research, gender, race, religion, and religiosity proved to be significant factors. As expected, personal experience with grief was strongly correlated with drawings focused on bereavement. In contrast to earlier studies, fear of death was not significantly related to a particular construct. Implications for research, education, and counseling are discussed.     

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.     

Direct Inference, Probability, and a Conceptual Gulf in Risk Communication

Differences in the conceptual frameworks of scientists and nonscientists may create barriers to risk communication. This article examines two such conceptual problems. First, the logic of "direct inference" from group statistics to probabilities about specific individuals suggests that individuals might be acting rationally in refusing to apply to themselves the conclusions of regulatory risk assessments. Second, while regulators and risk assessment scientists often use an "objectivist" or "relative frequency" interpretation of probability statements, members of the public are more likely to adopt a "subjectivist" or "degree of confidence" interpretation when estimating their personal risks, and either misunderstand or significantly discount the relevance of risk assessment conclusions. If these analyses of inference and probability are correct, there may be a conceptual gulf at the center of risk communication that cannot be bridged by additional data about the magnitude of group risk. Suggestions are made for empirical studies that might help regulators deal with this conceptual gulf.     

Approximations and Heuristics for the "Cause-Modified" Life Table

Life-table analysis can help to gauge the lifetime impacts that accrue from modifications to (age-specific) baseline mortality. Modifications of interest include those stemming from risk-factor-related exposures or from interventions. The specific algorithm used in these analyses can be called a cause-modified life table (a generalization of the cause-deleted life table). The author presents an approach for approximating that algorithm and uses it to obtain remarkably simplified expressions for approximating three indices of common interest: life-years lost (LYL), excess lifetime risk ratio (ELRR), and risk of exposure-induced death (REID). These efforts are restricted to the special case of multiplicative increases to baseline mortality (modeled as an excess rate ratio, ERR). The simplified expressions effectively "break open" what is often treated as a "black-box" calculation. Several insights result. For a practical range of risk factor impacts (ERRs), each index can be related to the ERR as a function of a baseline summary statistic and a "characteristic number" specific to the population and cause of interest. Conveniently, those numbers help form "rules of thumb" for translating among the three indices and suggest heuristics for extrapolating indices across populations and causes of death.     

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.