Examining the role of trauma, personality, and meaning in young prolonged grievers.

PURPOSE: Younger spouses or partners have been understudied in the prolonged grief literature. The purpose of this study was to determine rates of prolonged grief in young spouses or partners and the associations between prolonged grief and personality styles (specifically, narcissistic, histrionic, and obsessive), trauma history, and the perceived meaning of the loss in the young conjugally bereaved. PARTICIPANTS AND METHOD: Participants between 20 and 50 years old who lost a spouse/partner to cancer 6 months-3 years prior to the study completed the following measures during one time point (via phone or in person interviews): Prolonged Grief-13, traumatic life events questionnaire, Millon clinical multiaxial inventory-III, and grief meaning reconstruction inventory. RESULTS: Fifty-six spouses and partners (51.8% women) completed the interviews (mean age: 44.54 ± 4.20 years). The participants (49.1%) reported elevated rates of prolonged grief and 12.3% of the participants were diagnosed with prolonged grief with the recently published diagnostic algorithm. Bivariate analyses demonstrated an association between prolonged grief and negative meaning of the loss (r = 0.73; p < 0.01) and the frequency of the traumatic events (r = 0.23; p < 0.05). Multivariate analyses revealed that negative meaning of the loss was the only significant predictor of prolonged grief (Beta = 0.71; p = 0.0001). CONCLUSION: Elevated levels of prolonged grief were found in this population, suggesting a need for further research into young spousal grief. Young bereaved spouses may lack flexibility in reconstructing their view of the world as the death may invalidate their previously held world beliefs.

Impact of treatment for depression on desire for hastened death in patients with advanced AIDS.

BACKGROUND: Despite the development of multi-drug regimens for HIV, palliative care and quality-of-life issues in patients with advanced AIDS remain important areas of clinical investigation. OBJECTIVE: Authors assessed the impact of treatment for depression on desire for hastened death in patients with advanced AIDS. METHOD: Patients with advanced AIDS (N=372) were interviewed shortly after admission to a palliative-care facility, and were reinterviewed monthly for the next 2 months. Patients diagnosed with a major depressive syndrome were provided with antidepressant treatment and reinterviewed weekly. Desire for hastened death was assessed with two questionnaire measures. RESULTS: Desire for death was highly associated with depression, and it decreased dramatically in patients who responded to antidepressant treatment. Little change in desire for hastened death was observed in patients whose depression did not improve. Although improved depression was not significantly associated with the use of antidepressant medication, those individuals prescribed antidepressant medication showed the largest decreases in desire for hastened death. DISCUSSION: Successful treatment for depression appears to substantially decrease desire for hastened death in patients with advanced AIDS. The authors discuss implications of these findings for palliative-care treatment and the physician-assisted suicide debate.

Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial.

OBJECTIVES: An increasingly important concern for clinicians who care for patients at the end of life is their spiritual well-being and sense of meaning and purpose in life. In response to the need for short-term interventions to address spiritual well-being, we developed Meaning Centered Group Psychotherapy (MCGP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace and purpose in their lives, even as they approach the end of life. METHODS: Patients with advanced (stage III or IV) solid tumor cancers (N=90) were randomly assigned to either MCGP or a supportive group psychotherapy (SGP). Patients were assessed before and after completing the 8-week intervention, and again 2 months after completion. Outcome assessment included measures of spiritual well-being, meaning, hopelessness, desire for death, optimism/pessimism, anxiety, depression and overall quality of life. RESULTS: MCGP resulted in significantly greater improvements in spiritual well-being and a sense of meaning. Treatment gains were even more substantial (based on effect size estimates) at the second follow-up assessment. Improvements in anxiety and desire for death were also significant (and increased over time). There was no significant improvement on any of these variables for patients participating in SGP. CONCLUSIONS: MCGP appears to be a potentially beneficial intervention for patients' emotional and spiritual suffering at the end of life. Further research, with larger samples, is clearly needed to better understand the potential benefits of this novel intervention.

Factors of complicated grief pre-death in caregivers of cancer patients.

PURPOSE: Over the past decade, Prigerson and her colleagues have shown that symptoms of 'complicated grief'-intense yearning, difficulty accepting the death, excessive bitterness, numbness, emptiness, and feeling uneasy moving on and that the future is bleak-are distinct from depression and anxiety and are independently associated with substantial morbidity. Little is known about complicated grief experienced by family caregivers prior to the death. This study sought to examine differences in caregiver age groups and potential risk factors for complicated grief pre-death. METHOD: Two hundred and forty eight caregivers from multiple sites nationwide (20-86 years of age) identified themselves as primary caregivers to a terminally ill cancer patient. Each caregiver was interviewed using the following measures: the Pre-Death Inventory of Complicated Grief-Caregiver Version; the Brief Interpersonal Support Evaluation List; the Structured Clinical Interview for the DSM-IV Axis I; the Life Orientation Test-Revised; the SEPRATE Measure of Stressful Life Events; the Covinsky Family Impact Survey; and mental health access questions. RESULTS: The study found that those under 60 years old had higher levels of complicated grief pre-death than caregivers 60 and older (t(246) = 2.30, p < 0.05). Significant correlations were also found between levels of complicated grief pre-loss and the following psychosocial factors: perceived social support (r = -0.415, p < 0.001); history of depression (r = -0.169, p < 0.05); current depression (r = -0.158, p < 0.05); current annual income (Spearman rho = -0.210, p < 0.01); annual income at time of patient's diagnosis (Spearman rho = -0.155, p = 0.05); pessimistic thinking (r = 0.320, p < 0.001); and number of moderate to severe stressful life events (Spearman rho = 0.218, p = 0.001). In a multi-variate analysis (R(2) = 0.368), pessimistic thinking (Beta = 0.208, p < 0.05) and severity of stressful life events (Beta = 0.222, p < 0.05) remained as important factors to developing complicated grief pre-death. CONCLUSIONS: These results suggest that mental health professionals who work with caregivers should pay particular attention to pessimistic thinking and stressful life events, beyond the stress of the loved one's illness, that caretakers experience. Additionally, although not reaching significance, mental health professionals should also consider younger caregivers at greater risk for complicated grief pre-loss.

Desire for hastened death among patients with advanced AIDS.

The recent debate over legalization of physician-assisted suicide has fueled interest in understanding factors that lead medically ill patients to seek a hastened death. The authors investigated the prevalence and predictors of desire for hastened death in 372 patients with advanced AIDS who were newly admitted to a palliative-care facility. Clinician-rated and self-report measures of desire for hastened death, depression, hopelessness, spiritual well-being, social support, pain, and physical symptom burden were administered to assess the factors that correspond to a high desire for death. The prevalence ranged from 4.6% to 8.3%, significantly lower than in previous studies of patients with advanced or terminal cancer. Multivariate models revealed significant and unique effects for both hopelessness and depression, with these variables accounting for a large proportion of the variance in each model. Authors discuss the implications of these findings for palliative care practice and the assisted-suicide debate.