Parent-child triangles and family loyalties as psychological arenas of grief manifestation among adults who lost a parent at a young age.

The current qualitative interpretative phenomenological study explored the intricate experiences of Israeli adults who lost a parent during childhood and subsequently navigated the challenges of adapting to a stepfamily dynamic. Through semistructured interviews, nine participants revealed three key themes: "Unbreakable Bonds: Loyalty to the Deceased Parent," illustrating efforts to preserve the original family structure amid changes; "Replacement Bonds: Loyalty to the New Parent," depicting the loyalty conflicts arising when connecting with a stepparent; and "Harmonic Bonds: Loyalties to All Three Parents," showcasing instances in which bereaved children successfully maintained connections with their deceased parent while forming meaningful relationships with their stepparent and living biological parent. The study findings informed a model elucidating the dialectical stance family members may adopt in response to such complexities. The model emphasizes the prioritization of orphaned children's emotional needs in a pyramid-shaped family structure, in which the psychological presence of the deceased parent remains integral.

Prenatal twin-less twins: The congenital loss experience of individuals who lost a twin sibling in utero.

Congenital loss involves the loss of an immediate family member, specifically a parent or sibling, either during or prior to birth, and bears unique bereavement-related challenges. The current study investigated the unique congenital loss experiences of those who lost a twin sibling in utero. Through analysis of interviews with 18 Jewish Israeli participants who encountered this type of twin loss, a more comprehensive understanding of their experiences was attempted. The research employed a hybrid methodology, combining two qualitative thematic analysis methods: deductive and data-driven inductive approaches. The analysis revealed four themes: incoherency and uncertainty, ownership over a limited story, continuing an unborn bond, and the identity of a "twin-less" twin. The findings underscore the unique nature of twin loss in utero.

Navigating the paradox: Strategies utilized by pregnant widows in an attempt to reconcile life and death.

Losing a spouse is a traumatic experience, especially at a younger age. This experience is arguably more intense and complex if the woman becomes a widow while pregnant. In the current study, we examined the strategies Israeli women who became widows while pregnant utilized to reconcile life and death. Twelve adult women who became widows while pregnant participated in this study, which involved in-depth semi-structured interviews. A thematic analysis of the interview content revealed four main strategies utilized to reconcile their simultaneous paradoxical experience of both life and death: Passiveness - focusing on neither life nor death; Segregation - focusing on either life or death; Continuum - perceiving life and death are the same; and Integration - coming to terms with both life and death. The women commonly utilized multiple strategies while navigating this paradox, with most participants using all four at some point during their attempted reconciliation process.

Psychological distress during the COVID-19 pandemic: An integrative perspective.

Informed by socio-ecological psychology and the conservation of resources model, the present study proposes an integrative perspective on the association between psychological distress and a constellation of factors, during the COVID-19 outbreak in Israel. Our sample, comprised of 991 adult participants, was measured for psychological distress, locus of control (internal/ external), resilience, loneliness, social support, dimensions of citizens' trust in government organizations (perceived competence, benevolence, and integrity), and demographic characteristics. The findings showed that women, non-religious people, and the unemployed reported higher levels of psychological distress. Internal locus of control, resilience, social support, and the extent to which citizens perceive government organizations as benevolent were negatively associated with psychological distress. Self-reported loneliness and external locus of control positively predicted the level of respondent psychological distress. No association was detected between age, competence and integrity and psychological distress. An overview of the research findings indicates that individuals with greater resources were less likely to suffer from psychological distress during the COVID-19 outbreak. These findings call upon mental health care practitioners to help as well as to enable clients to attain resources in order to lower their levels of psychological distress. Policies developed by policymakers during periods of acute crisis should consider the specific needs and vulnerabilities of certain population groups, including women and the unemployed who may be more susceptible to psychological distress. It is also important for policymakers to be aware that the perception of democratic governments as benevolent can serve as a buffer against psychological distress during times of crisis.

The mediating role of self-compassion and the moderating role of restrictive emotionality in gender role discrepancy and depression.

Masculine gender role discrepancy is men's perception of themselves as people who fail to conform to traditional masculine norms. There is solid scientific evidence that gender role discrepancy is related to grave mental health outcomes such as depression. Yet, the mechanisms that explicate the relationship between masculine gender role discrepancy and masculine depression remain unclear. As individual differences in men are suggested to be associated with depression, the current study aimed to examine the mediating role of self-compassion and the moderating role of restrictive emotionality in the association between masculine gender role discrepancy and masculine depression. For the purpose of the current study, a structured questionnaire was distributed through online means, resulting in a sample of 954 men aged 18 and older. The results revealed that self-compassion partially mediates the relationship between gender role discrepancy and masculine depression. Moreover, a positive effect of gender role discrepancy on masculine depression was found to be more pronounced at higher levels of restrictive emotionality. The contemporary empirical evidence underscores the significance of individual variances in adhering to conventional masculine gender norms concerning the nexus between gender role discrepancy and masculine depression. Moreover, this research accentuates the salience of gender role matters in shaping the mental well-being of men.

Intolerance to uncertainty and self-efficacy as mediators between personality traits and adjustment disorder in the face of the COVID-19 pandemic.

In April 2020, early in the COVID-19 outbreak, governments restricted public gatherings and ordered social distancing. These demands led to challenging adaptations, which in some cases resulted in mental health issues, including adjustment disorder. Guided by the transactional stress model, the current study aimed to examine the relations between personality traits and adjustment disorder in crisis situations and vagueness and the role of intolerance to uncertainty and self-efficacy in these relations. During Israel's first lockdown, 673 Israeli adults completed self-reported e-version questionnaires regarding Big Five personality traits, adjustment disorder, intolerance to uncertainty, self-efficacy, and background variables. The study was designed to examine the association between personality traits and adjustment disorder and the potential mediation of intolerance to uncertainty and self-efficacy in associations. The findings revealed that intolerance to uncertainty and self-efficacy mediated the association between personality traits and adjustment disorder. The results are consistent with the transactional stress model. They shed light on the role of intolerance to uncertainty and self-efficacy as cognitive mechanisms that promote the development of adjustment disorder. Recommendations for future studies and practice are discussed.

Adjustment Disorder in the Face of COVID-19 Outbreak: The Impact of Death Anxiety, Media Exposure, Fear of Contagion and Hypochondriasis Symptoms.

Based on the theoretical view of Terror Management Theory, the current research examines whether higher levels of death anxiety symptoms, in the face of the COVID-19 outbreak, increase the extent to which participants are exposed to information regarding the spread of the pandemic, as well as the fear of contagion and symptoms of hypochondriasis, which all in turn increase symptoms of adjustment disorder. A total number of 302 participants filled out self-report questionnaires regarding death anxiety, adjustment disorder, the extent of exposure to information regarding COVID-19, fear of contagion, hypochondriasis, and demographic information. Structural Equation Modeling analysis indicated a very good fit of the theoretical model with the data, confirming the mediation effect of exposure to information, fear of contagion, and symptoms of hypochondriasis on the association between death anxiety and adjustment disorder symptoms. Implications for practice are discussed.

Mitigating Loss and Trauma: The Continuing Bonds Experience of Daughters Bereaved to Intimate Partner Femicide.

The current study sheds light on the continuing bonds experience of adult Israeli daughters whose mothers were murdered by their fathers. Through 11 semi structured interviews, common externalized and internalized continuing bonds with the deceased mothers were closely examined. The interpreted results supported the existence of bonds, yet revealed a unique manifestation; the bonds were purposefully and defensively restricted, which seemed to be an adjustive compromise in light of the strong traumatic component of the loss. Our results contribute to the theoretical and clinical understanding of the restrictive effect that trauma components have on loss components in cases of traumatic bereavement.

A Trisonance: Identities of Women Whose Mothers Were Murdered by Their Fathers.

The current qualitative study aimed to examine the narrative identities of women bereaved to intimate partner femicide. Eleven adult Israeli female offspring whose biological mothers were murdered by their biological fathers were interviewed for the purpose of this study. Due to the uniqueness of their loss experience and circumstances, participants' identity is narrated as a "trisonance": They are not like their fathers, their mothers, nor as society perceives them. This very particular route for identity reconstruction as a means of psychological survival is discussed in light of the literature on identity construction and bereavement and derives recommendations for practice.

Congenital loss: Loss of an immediate family member prior to or during one's birth.

The loss of a family member is often conceptualized as a disruption in one's life story. However, when a loss occurs prior to, or during, one's birth, the bereaved life stories are not interrupted by the loss, but rather begin with loss. The paper offers a new conceptualization of these losses as "congenital losses" and captures the core aspects of this phenomenon. A qualitative phenomenological analysis of 34 in-depth semi-structured interviews with offspring and siblings whose family members died before/during their birth revealed four main challenges presented by congenital loss: incoherency and fragmentation; story-ownership; bond-establishment, and; identity challenges.

Being a parent, emotional stability, and adjustment disorder symptoms in the face of COVID-19.

Objective: The current study examines the correlation between emotional stability and symptoms related to adjustment to the stresses related to the pandemic for parents and nonparents at the initial stage of the COVID-19 outbreak in Israel. Background: At the early stage of the COVID-19 outbreak, governments prohibited public gatherings and demanded social distancing. These challenges may be especially difficult for individuals with low levels of emotional stability as adaptation difficulties may lead to stress-related outcomes, such as adjustment disorder symptoms. Additionally, in the face of a significant external threat and the demand for intensive joint familial time at home, the parental role becomes especially salient. Methods: Two hundred forty-four Israeli adults filled in self-reported e-version questionnaires regarding emotional stability, adjustment disorder symptoms, and background variables. A cross-sectional design was used to examine the association between emotional stability and adjustment disorder symptoms, as well as the potential moderation by parenting status. Results: The findings revealed that the levels of emotional stability were negatively correlated with adjustment disorder symptoms, while being a parent mitigated this correlation. This correlation was nonsignificant among parents. Conclusion and Implications: It appears that the identity salience of parental role in the current stressful situation and its associated strain may have overcome the advantage of emotional stability. The identity of being a parent has the potential to dismiss it. Here, the social role emerges as more forcible than the personality trait. Recommendations for practice are discussed.

When the times get tough the toughs get funny: Means by which humor buffers against death anxiety emerged during COVID-19 outbreak.

According to Terror Management Theory (TMT), there are three common buffers that minimize the anxiety of mortality salience: affirmation of a) one's cultural worldview, b) the self and one's personal values, and c) one's significance in the context of close personal relationships. The current study aimed at examining the contents of memes, which were distributed on social media during the COVID-19 outbreak, to explore the means by which humor buffers against death anxiety. A deductive and inductive thematic analysis captured three means by which humor buffers against death anxiety, a) humor as a means for connecting to cultural worldviews; b) humor as a means for inclusion in group; c) humor as a means to gain a sense of control. These findings are discussed through the theoretical lens of TMT.

"Out of the Depths Have I Called Thee": Jewish Israeli Undertakers' Management of Death Anxiety.

According to Terror Management Theory, there are three common buffers that minimize the anxiety of mortality salience: affirmation of one's cultural worldview, the self and one's personal values, and one's significance in the context of close personal relationships. The current study aimed to explore the manner by which Jewish Israeli undertakers manage their constant exposure to death and buffer against death anxiety. A deductive and inductive thematic analysis captured a dialectical movement between, and within, two conflicting worldviews participants were engaged in, in their attempt to manage the mortality salience effect they experience and buffer against death anxiety.

Neither here nor there and a little bit of both: The ambiguous loss experience of parents who lost a baby to sudden infant death syndrome.

Losing a baby to Sudden Infant Death Syndrome (SIDS) triggers a severe loss reaction. The severity of the loss may be attributed to the baby's age, the lack of satisfactory explanation for the death, and a lack of social recognition. The current study aimed to examine the loss experience of Israeli parents (N = 12) who lost a baby to SIDS through the theoretical lens of ambiguous loss. A deductive and inductive thematic analysis revealed that, for these bereaved parents, entities of the baby-physical and psychological-are unclear. Thus, the parents' loss is likewise unclear and ambiguous.

"You did not desert me my brothers in arms": The continuing bond experience of men who have lost a brother in arms.

This qualitative study provides an in-depth account of the continuing bond experience of bereaved Israeli men who have lost a comrade with whom they served in mandatory military service (a brother in arms). Our study findings indicate that bereaved men experienced continuing bond relationships with their deceased brothers in arms on two axes-an internal axis and an external axis. Together, the two axes connected the bereaved to the deceased. Furthermore, the bereaved constantly (re)negotiated these connecting axes vis-a-vis Israeli social norms and expectations. Implications for practice are outlined.

"Empty Chairs at Empty Tables": Disenfranchisement by Association.

The rise in research publications over the last few decades about disenfranchised grief has deepened our understanding of this field. Importantly, it raises awareness and validates human experiences of bereavement, which are often socially ignored, muted, and stigmatized. However, while researchers in the field actively engage in the task of "enfranchisement," as they present their work at scientific conferences, they might experience what we term disenfranchisement by association in the academic sphere. Based on our own experience, this article will demonstrate the parallel pathways between disenfranchisement of bereaved individuals and disenfranchisement of disenfranchised grief researchers, as it emerges in three main expressions of disenfranchisement: reluctance to listen, shame and guilt inflicting, and demand for euphemism. A conclusive note on how to address this kind of disenfranchisement is suggested.

Naturalistic Study of Posttraumatic Stress Disorder Among Israeli Civilians Exposed to Wartime Attacks.

OBJECTIVE: Civilians who survive wartime attacks commonly experience substantial psychological distress, including acute stress reactions (ASRs) and posttraumatic stress disorder (PTSD). The authors sought to determine the level of Israeli civilian exposure to wartime attacks, prevalence of posttraumatic stress disorder (PTSD) and physical injuries, and associated medical costs over a 7-year period. METHODS: Data from the National Insurance Institute of Israel on civilian survivors of wartime attacks in the 2009-2015 period were retrospectively examined. RESULTS: Overall, 11,476 civilians were affected by 243 wartime attacks during the study period. Of these individuals, 7,561 (65.9%) received early intervention (EI) psychological treatment for ASRs, 1,332 (11.6%) were subsequently adjudicated as having a disability (all causes), and 519 (4.5%) were adjudicated as disabled by PTSD through the end of 2016. Individuals who received immediate ASR treatment were less likely to be disabled by PTSD (p=0.001). Among those without physical injuries, the EI was associated with decreased PTSD disability (2.6% of those receiving the EI developed PTSD, whereas 7.2% of those who did not receive the EI developed PTSD); however, for those with physical injuries, the PTSD rate was higher among those who received the EI (30.4%) than among those who did not receive the EI (5.2%). Individuals having a disability other than PTSD incurred higher medical costs ($7,153 in 2016 U.S. dollars) than individuals with PTSD ($1,960). CONCLUSIONS: An approach of providing case management, medical care, behavioral health screening, and EI for ASRs in the wake of wartime attacks on civilians minimized long-term PTSD-related disability.

"If only ": Counterfactual thinking in bereavement.

When grief over the death of a loved one becomes complicated, protracted and circular, ruminative counterfactual thinking in which the bereaved relentlessly but vainly seeks to somehow reverse the tragedy of the loss often plays a contributory role in sustaining the person's suffering. In this article we summarize the growing evidence implicating this cognitive process in interfering with meaning reconstruction following loss, and identify four foci for counterfactual, "if only" cognition, directed at the self, the deceased, relevant others, or the circumstances of the death itself. We then illustrate each with an actual case vignette, along with approaches to resolving, dissolving, mitigating, or redirecting such rumination, and conclude with a general principle of practice for other therapists whose clients struggle with similarly anguished and entrenched counterfactual preoccupations.

Meanings attributed by bereaved unmarried intimate partners of fallen soldiers to their loss.

The death of a partner may be stressful for unmarried intimate partners as they lack legal status vis-à-vis the partner, and, thus, lack sufficient cultural support. This qualitative study examined the meaning attributed to the loss by 12 Israeli bereaved intimate partners of fallen soldiers. Through applying a constructivist-narrative methodology, we derived three clusters from interviews with the intimate partners: (a) The relationships never ended - "an unfinished business," (b) The need to conceal the relationships - "a hidden wound," and (c) The relationship guides their lives - "a compass." Practical implications were discussed.

Designing in-depth semi-structured interviews for revealing meaning reconstruction after loss.

The recent upsurge in the use of qualitative empirical studies, aiming to provide a deeper understanding of human reactions to loss, requires a methodological account of how to conduct better qualitative research with regard to data collection. This paper offers six general interview guidelines aimed at assisting researchers to achieve quality interviews in qualitative bereavement studies, based on the theoretical framework of meaning (re)construction in loss.