To lose a friend: the relationship between professional help and grief among close bereaved friends after the terror attack, 22 July 2011.

Background: Close friends are often an overlooked group of bereaved people. This study is based on a sub-project on young adults who experienced the loss of a close friend in the terrorist attack on Utøya, Norway, on 22 July 2011.Objective: The aim of this longitudinal study was to explore the relationship between complicated grief reactions, the need for help, and help received after losing a close friend to a traumatic death.Method: In total, data from 89 people (with a mean age of 21 years, 76.4% female) were collected at one or more of the four time-points: 18, 28, 40, and 102 months after the incident. Latent growth modelling was used to analyse levels of grief reactions and change over time, experienced need for help, and help received.Results: According to the results, the bereaved friends in our study were profoundly impacted by the loss and experienced level of reactions indicating complicated grief (mean scores on the Inventory of Complicated Grief varied from 36.2 to 23.7). A need for help was related to a decrease in grief symptoms, whereas a prolonged need for help was related to no reduction or an increase in grief. Received help was not related to decrease in grief symptoms.Conclusions: These findings underscore the need for continuous professional help, and demonstrate that the present help measures used after traumatic events may not adequately meet the needs of close bereaved friends. This emphasizes the importance of acknowledging friends as bereaved and that follow-up measures should also include this group. Finally, the study highlights the need to learn more about how professional can help bereaved friends.

Young adults who experience the traumatic loss of a close friend may experience levels of grief reactions indicating complicated grief.The need for help reported after experiencing the loss of a close friend is high; this is also the case when some time has passed since the loss.Bereaved friends need more acknowledgement, and help measures after traumatic events often do not meet their need for help and follow-up after the loss.

¿Existe el duelo complicado traumático? Diferencias sintomatológicas entre el duelo complicado tras una muerte traumática y una no traumática / Is there a traumatic complicated grief? Symptomatological differences between complicated grief after a traumatic and a non-traumatic death

Objetivo: Examinar la existencia del duelo complicado traumático como un constructo diferente al de duelo complicado analizando si la sintomatología de duelo complicado y de estrés postraumático es diferente en las personas que sufren duelo complicado tras una muerte traumática y no traumática. Método: Un grupo de 89 dolientes con duelo complicado tras una muerte por atentado terrorista y un grupo de 54 dolientes con duelo complicado tras una muerte por edad o enfermedad completaron el Inventario de Duelo Complicado (IDC) y versiones de la Escala de Verificación del Trastorno de Estrés Postraumático (PCL-S o PCL-5). Resultados: ANCOVA realizados sobre las puntuaciones en los ítems del IDC y en los 16 ítems comunes a las dos versiones de la PCL revelaron que los dos grupos de dolientes no diferían en ninguno de los síntomas de duelo complicado ni de estrés postraumático, salvo en dos síntomas de duelo complicado en los cuales las diferencias iban en direcciones opuestas. Conclusiones: Aunque una muerte traumática como, por ejemplo, por atentado terrorista, incrementa la gravedad de las reacciones de duelo y la probabilidad de sufrir duelo complicado, este duelo complicado es similar al que pueden sufrir las personas tras una muerte no traumática, al menos respecto a sus síntomas y a los síntomas simultáneos de estrés postraumático. Por tanto, no se puede hablar de un duelo complicado traumático como diferente al duelo complicado (AU)

Objective: To examine the existence of complicated traumatic grief as a different construct from complicated grief, analyzing whether the symptoms of complicated grief and post-traumatic stress are different in people who suffer complicated grief after a traumatic and non-traumatic death. Method: A group of 89 mourners with complicated grief after a death from a terrorist attack and a group of 54 mourners with complicated grief after a death due to age or illness completed the Inventory of Complicated Grief (ICG) and versions of the PTSD Checklist Scale (PCL-S or PCL-5). Results: ANCOVA performed on the scores on the IDC items and on the 16 items common to the two versions of the PCL revealed that the two groups of mourners did not differ in any of the symptoms of complicated grief or post-traumatic stress, except in two complicated grief symptoms in which the differences went in opposite directions. Conclusions: Although a traumatic death, such as a terrorist attack, increases the severity of grief reactions and the probability of suffering complicated grief, this complicated grief is similar to what people can suffer after a non-traumatic death, at least concerning its symptoms and the simultaneous symptoms of post-traumatic stress. Therefore, one cannot speak of complicated traumatic grief as different from complicated grief (AU)

Shame, depression, and complicated grief among suicide loss-survivors: the moderating role of self-disclosure.

Background: Suicide-loss survivors (SLSs) are recognised as an at-risk population for several psychiatric complications, including complicated grief (CG) and depression (SI). However, whereas shame is known as one of the characteristics of this population, knowledge about possible psychological processes which may moderate the contribution of shame levels to CG and depression in the aftermath of suicide loss is sparse. This study examines the role of self-disclosure - the inclination to share personal information with others - as a possible moderator of the associations of shame with CG and shame with depression over time.Method: Participants were 152 suicide-loss survivors, aged 18-70, who completed questionnaires tapping CG and depression at three time points (T1- index measurement, T2-two years after T1. and T3-four years after T1) and questionnaires tapping shame and SD at T3.Results: Hierarchical regression analyses showed that shame significantly and positively contributed to CG at T3 and to depression at T3, beyond the CG/depression trajectories. Notably, two significant interactions were found: Self-disclosure moderated the contribution of shame to CG at T3 and to depression at T3. At lower self-disclosure levels, shame's contribution to CG and depression was higher.Conclusion: The study's findings highlight shame as a significant facilitator of CG and depression in the aftermath of suicide loss. Moreover, the role of interpersonal interaction on SLSs' distress levels and grieving process was underscored, as this interaction may serve as a buffer against the deleterious sequelae of the suicide of a loved one.

Shame significantly and positively contributed to CG and depression at trajectories.Self-disclosure moderated the contribution of shame to CG and depression at T3 beyond their natural trajectories.Interpersonal activities may serve as a buffer against the deleterious effects of suicide in the family.

Co-occurrence of approach and avoidance in prolonged grief: a latent class analysis.

Background: Prolonged grief disorder (PGD) has been included in the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR). Loss-related avoidance behavior perpetuates grief and effective interventions for prolonged grief symptoms target such avoidance behavior. Yet, behaviors characterized by approach of loss-related cues (i.e. rumination, yearning, proximity seeking) are also implicated in prolonged grief reactions.Objective: To solve this paradox, we will test the Approach Avoidance Processing Hypothesis, which holds that loss-related approach and avoidance behaviors co-occur in PGD, using latent class analyses (LCA).Methods: Two-hundred eighty-eight bereaved adults (92% female) completed questionnaires assessing loss-related approach behaviors (rumination, yearning, proximity seeking), loss-related avoidance behaviors (anxious avoidance, experiential avoidance) and ICD-11 and DSM-5-TR prolonged grief symptoms.Results: LCA demonstrated the best fit for a three-class solution comprising a low approach/low avoidance class (n = 98, 34%), a high approach/low avoidance class (n = 79, 27%), and a high approach/high avoidance class (n = 111, 39%). The latter class showed significantly higher prolonged grief symptom levels and higher odds of probable PGD compared to the other classes.Conclusions: Co-occurrence of loss-related approach and avoidance appears characteristic to prolonged grief reactions. Distinguishing bereaved people with these behavioral patterns from those solely experiencing loss-related approach behaviors may improve the efficacy of PGD therapies.

A latent class analysis of bereaved adults showed high approach/high avoidance, high approach/low avoidance and low approach/low avoidance classes.The high approach/high avoidance class showed highest prolonged grief symptoms and higher odds of probable prolonged grief disorder.Co-occurrence of loss-related approach and avoidance appears to characterize prolonged grief.

Programa piloto de tratamiento psicológico grupal en duelo complicado / A Pilot program of group psychological treatment in complicated grief

Objetivo: evaluar la efectividad de un programa piloto de tratamiento psicológico en duelo complicado. Método: se realizó una terapia grupal de duelo complicado en 20 sesiones, con frecuencia quincenal. Las participantes fueron 6 mujeres que recibían tratamiento psicológico en la Unidad de Gestión Clínica de Cuidados Paliativos. El grupo era homogéneo en cuanto a gravedad, tipo de proceso y tiempo del fallecimiento. Se las evalúo antes, durante y después de la intervención mediante escalas psicométricas: el Inventario de Duelo Complicado, la Escala de Ansiedad Depresión Hospitalaria y la Escala de Desesperanza de Beck. Resultados: se encontraron mejorías significativas en sintomatología de duelo y síntomas de depresión desde línea base al postratamiento de depresión, cuatro de los seis participantes estaban asintomáticos en postratamiento. Conclusiones: la intervención grupal puede ser eficaz para el duelo complicado (AU)

Objective: To evaluate the effectiveness of a pilot program of psychological treatment in complicated grief. Material and Method: A group therapy of complicated grief carried out in 20 sessions, with biweekly frequency. The participants were 6 women received psychological treatment in the Palliative Care Unit. The group was homogeneous in terms of severity, type of process and chronology of the loss. They have been evaluated before, during and after the intervention with the following psychometric scales: Inventory of Complicated Grief, Hospital Anxiety Depression Scale and Beck Hopelessness Scale. Results: Significant improvements in complicated grief and depression symptoms were found from baseline to depression posttreatment, four of the six participants were asymptomatic at posttreatment. Conclusions: group intervention can be effective for complicated grief.Keywords: Complicated grief, group therapy, tasks of mourning, emotional support (AU)

Aprendiendo de la experiencia del duelo en el contexto de la pandemia por COVID-19 / Learning from the grief experience during the COVID-19 pandemic

Introducción: Este estudio transversal descriptivo con metodología cualitativa pretende aproximarnos a la comprensión de la experiencia de los familiares de pacientes fallecidos durante la pandemia por el COVID-19, así como detectar aquellos aspectos que desempeñan un papel protector ante el impacto emocional de la pérdida. Material y métodos: Se realizó, vía telefónica, una entrevista semiestructurada para la evaluación, desde la perspectiva de los familiares, de distintas variables asociadas con su proceso de acompañamiento al final de la vida y de muerte del paciente (tareas relativas a las circunstancias de la muerte, factores protectores y de riesgo de duelo con complicaciones, satisfacción con el soporte psicológico, e interés en recibir información sobre un Servicio de Soporte al Duelo). Resultados: Un análisis de contenido de 126 entrevistas permitió acercarnos a los principales factores que: 1) dificultaron la vivencia (estado de alarma y sus restricciones, pérdidas múltiples y secuenciales, y la percepción de la vulneración de una muerte digna), 2) facilitaron la vivencia (soporte familiar, recursos propios, la búsqueda de un sentido y la consideración del paciente como fuente de soporte) o 3) factores que dificultaron y facilitaron, en función de si pudieran o no estar presentes (presencia y cuidado, la atención sanitaria y la realización de rituales). Discusión: Los resultados se discuten en base a los recientes hallazgos encontrados en la literatura científica, concluyendo en la necesidad de una atención sanitaria sistémica integral e integradora. (AU)

Introduction: This descriptive, cross-sectional study with a qualitative methodology aimed to gain insight into the experience of relatives of patients who died during the COVID-19 pandemic, as well as to detect those aspects that play a protective role against the emotional impact of losing a loved one. Material and methods: A semi-structured interview was carried out by phone to assess, from the perspective of family members, a number of variables associated with the end of life process and death (tasks related to the circumstances of death, protectors and risk factors of complicated grief, satisfaction with psychological support, and interest in receiving information about a Grief Support Service). Results: A content analysis of 126 interviews allowed us to approach the main factors that (1) complicated the experience – state of alarm and its restrictions, other losses and concomitant circumstances, and perceived violation of a dignified death; (2) eased the experience – family support, own resources, search for meaning, and consideration of the patient as a source of support; or (3) factors than either complicated or eased the experience, depending on whether they were present – presence and care, health care, and performance of rituals. Discussion: The results are discussed based on recent findings collected from the scientific literature, concluding on the need for a comprehensive, integrative, systemic health care model. (AU)

Complicated grief, unusual perceptual experiences, and hope in widowhood / Luto complicado, experiências perceptivas incomuns e esperança na viuvez / Duelo complicado, experiencias perceptuales inusuales y esperanza en la viudez

The overall objective of this study is to assess grief in religious widows and hope, and the frequency of unusual perceptual experiences after the death of the spouse. It is hypothesized that (H1) religious widows will experience a less complicated grief, (H2) a greater hope, and (H3) a higher frequency of unusual perceptual experiences than non-religious widows. Three instruments, the Complicated Grief Inventory, the Hope Scale, and the Hallucinations Questionnaire were administered to a sample consisting of religious widows and a control group (non-religious widows). The results showed that religious widows experienced less complicated grief than non-religious widows, and fewer feelings of pessimism about the death of the loved one. Religious widows who showed higher feelings of hope, compared to non-religious ones, tended to have fewer indicators of complicated grief. Furthermore, those religious widows who displayed feelings associated with remembering the deceased tended, for example, to hear voices and smell perfumes. It is possible that these occurrences may even be functional and adaptive in order to cope with the negative feelings of grief and loss, rather than resulting in a resource deficit mechanism for dealing with pain and hopelessness.

O objetivo geral deste estudo é avaliar o luto e a esperança em viúvas religiosas, e a frequência de experiências perceptivas incomuns após a morte do cônjuge. A hipótese é que (H1) viúvas religiosas experimentarão um luto menos complicado, (H2) mais esperança e (H3) maior frequência de experiências perceptivas incomuns do que viúvas não religiosas. Três instrumentos, o Inventário do Luto Complicado, a Escala de Esperança e o Questionário de Alucinações, foram administrados a uma amostra composta por viúvas religiosas e um grupo de controle (viúvas não religiosas). Os resultados mostraram que as viúvas religiosas experimentaram um luto menos complicado do que as viúvas não religiosas e menos sentimentos de pessimismo em relação à morte de um ente querido. As viúvas religiosas que mostraram maior senso de esperança, em comparação com as viúvas não religiosas, tendem a ter menos indicadores de luto complicado. Além disso, aquelas viúvas religiosas que demonstravam sentimentos associados à memória do falecido tendiam, por exemplo, a ouvir vozes e cheirar perfumes. É possível que essas ocorrências possam até ser funcionais e adaptativas para lidar com os sentimentos negativos de luto e perda, em vez de ser um mecanismo de déficit de recursos para lidar com a dor e a desesperança.

El objetivo general de este estudio es evaluar el duelo en viudas religiosas y la esperanza, y la frecuencia de experiencias perceptuales inusuales después de la muerte del cónyuge. Se hipotetiza que (H1) las viudas religiosas experimentarán menor grado de duelo complicado, (H2) mayor esperanza y (H3) mayor frecuencia de experiencias perceptuales inusuales que las viudas no religiosas. Se administraron tres instrumentos, el Inventario de Duelo Complicado, la Escala de Esperanza, y el Cuestionario de Alucinaciones a una muestra integrada por viudas religiosas y un grupo control (viudas no religiosas). Los resultados mostraron que las viudas religiosas experimentaban menos duelo complicado que las viudas no religiosas, y menos sentimientos de pesimismo en torno a la muerte del ser querido. Las viudas religiosas que mostraron mayor sentimiento de esperanza, en comparación con las no religiosas, tendieron a menos indicadores de duelo complicado. Además, aquellas viudas religiosas que mostraban sentimientos asociados al recuerdo del difunto tendían, por ejemplo, a oír voces y oler perfumes. Es posible que estas ocurrencias puedan incluso ser funcionales y adaptativas para afrontar los sentimientos negativos del duelo y la pérdida, en lugar de resultar un mecanismo de déficit de recursos para lidiar contra el dolor y la desesperanza.

Adaptación del Inventario de Duelo Complicado en población colombiana / Adaptation of the Complicated Grief Inventory to the Colombian Population / Adaptação do Inventário de Luto Complicado na População Colombiana

Resumen Se realizó la adaptación del Inventario de Duelo Complicado (IDC) en población colombiana. Cinco jurados evaluaron el contenido y ajuste cultural del cuestionario y luego éste fue aplicado a una muestra de 120 adultos que experimentaron el fallecimiento de un familiar. Los análisis psicométricos indicaron una consistencia interna similar a la de la prueba original y superior a la de la adaptación española, buena estabilidad temporal, asociaciones positivas con pruebas de depresión y ansiedad usadas para evaluar la validez convergente y tres factores significativos. Se concluye que la versión adaptada del IDC tiene propiedades psicométricas adecuadas por lo que puede ser usada en población colombiana, pero se recomienda realizar una validación con una muestra más grande y usar herramientas como una entrevista clínica para establecer el alcance diagnóstico del inventario.

Abstract The Inventory of Complicated Grief (ICG) was adapted to Colombian people. Five juries evaluated the language and cultural adjustment of the Spanish version and then, the questionnaire was applied to 120 adults who had lost a family member. Psychometrical analysis showed an internal consistency similar to that one found in the original ICG, but higher than the one found in the Spain application. Convergent validity showed positive correlations between ICG and depression and anxiety tests, and three significant factors were identified. In brief, this adapted spanish version of the ICG has good psychometric properties and it can be used with Colombian people, but a validation study with a larger sample and using tools such as a clinical interview to determine the diagnostic power of this inventory is recommended.

Resumo Realizou-se a adaptação do Inventário de Luto Complicado (IDC, em espanhol) na população colombiana. Cinco jurados avaliaram o conteúdo e o ajuste cultural do questionário e, em seguida, este foi aplicado a uma amostra de 120 adultos que experimentaram o falecimento de um familiar. As análises psicométricas indicaram uma consistência interna semelhante à do teste original e superior à da adaptação espanhola, boa estabilidade temporal, associações positivas com testes de depressão e ansiedade usados para avaliar a validade convergente e três fatores significativos. Conclui-se que a versão adaptada do idc tem propriedades psicométricas adequadas, portanto pode ser usada na população colombiana, mas se recomenda realizar uma validação com uma amostra maior e usar ferramentas como uma entrevista clínica para estabelecer o alcance diagnóstico do inventário.

Profissionais Paliativistas e suas Contribuições na Prevenção de Luto Complicado / Palliative care professionals and their contribution to the prevention of complicated grief / Profesionales paliativistas y sus contribuciones en la prevención del duelo complicado

Resumo Os cuidados paliativos buscam qualidade de vida baseada principalmente na prevenção e alívio do sofrimento de pacientes que possuem doenças ameaçadoras de vida, englobando as esferas de ordem física, psicossocial e espiritual. Além disso, estende-se ao pós-morte do paciente, oferecendo suporte à família no processo de luto. Esta pesquisa qualitativa teve como objetivo compreender e analisar a formação dos profissionais em relação ao processo de morrer do paciente e as percepções daqueles em relação às suas contribuições para a prevenção de luto complicado da unidade de cuidado. A Teoria do Apego fundamentou teoricamente este estudo. Participaram voluntariamente profissionais de saúde que integram formalmente equipes de cuidados paliativos. Foi utilizado um questionário autoaplicativo para obtenção de dados acadêmicos, profissionais e de cursos realizados, e uma entrevista semiestruturada. A análise das informações colhidas nas entrevistas foi realizada através de transcrição e categorização das mesmas, seguida de análise de conteúdo. Os resultados confirmaram que a formação dos profissionais em relação ao processo de morrer é escassa. Ademais, observou-se que os profissionais de saúde que trabalham em cuidados paliativos possuem comportamentos de apego, os quais são identificados como naturais nesse contexto, o que acaba por dificultar a percepção de que são importantes contribuições para a prevenção de luto complicado da unidade de cuidado. Diante desses resultados, a presente pesquisa trouxe a relevância sobre a necessidade da inserção das temáticas morte e morrer na educação dos profissionais de saúde, o que pode contribuir para melhor assistência à unidade de cuidado nos seus processos de luto....(AU)

Abstract Palliative care seeks quality of life based primarily on prevention and relief of suffering of patients who have life threatening diseases, encompassing physical, psychosocial and spiritual areas. Furthermore, extending the post-mortem patient, it offers support to the family in the grieving process. This qualitative study aimed to understand and analyze the training of professionals in relation to dying patients and their perceptions regarding their contribution to the prevention of complicated grief in the care unit. The Attachment Theory grounded this research theoretically. Volunteer professionals of the palliative care teams participated in this study. A self-administered questionnaire was used to obtain academic and professional data, besides their courses taken, and a semi-structured interview. The analysis of the collected data was done through transcription and categorization, followed by the content analysis. The results confirmed that the training of professionals in relation to the dying process is scarce. Moreover, it was observed that health professionals working in palliative care have attachment behaviors, identified as natural in this context, and that that ends up making it harder to realize that is an important contribution to prevent grief from becoming complicated in the care unit. The results of this research brought out the relevance of the need of inserting themes such as death and dying in the education of the professionals of this field, which can contribute to a better assistance in the care unit in the grieving process....(AU)

Resumen Los cuidados paliativos buscan la calidad de vida basada principalmente en la prevención y el alivio del sufrimiento de pacientes que poseen enfermedades amenazadoras de la vida, incluyendo las esferas de orden físico, psicosocial y espiritual. Además, se extienden más allá de la muerte del paciente y ofrecen apoyo a la familia en el proceso de luto. Esta investigación cualitativa tuvo como objetivo comprender y analizar la formación de los profesionales con relación al proceso de muerte del paciente y las percepciones de aquellos a propósito de sus contribuciones a la prevención del duelo complicado en la unidad de cuidado. La Teoría del Apego fundamentó teóricamente este estudio. Participaron voluntariamente profesionales de salud que integran formalmente equipos de cuidados paliativos. Se utilizó un cuestionario autoaplicativo para obtener datos académicos, profesionales y de cursos realizados y una entrevista semiestructurada. El análisis de las informaciones recogidas en las entrevistas se llevó a cabo a través de su transcripción, categorización y posterior análisis de contenido. Los resultados confirmaron que la formación de los profesionales con relación al proceso de muerte es escasa. Además, se ha observado que los profesionales de salud que trabajan en cuidados paliativos poseen comportamientos de apego que se identifican como naturales en ese contexto, lo que acaba dificultando la percepción de que suponen importantes contribuciones para la prevención del duelo complicado en la unidad de cuidado. Ante estos resultados, la presente investigación destacó la relevancia de la necesidad de incluir las temáticas muerte y morir en la educación de los profesionales de salud, lo que puede contribuir a una mejor asistencia a la unidad de cuidado en sus procesos de luto....(AU)

Revisión en la materia médica de 10 medicamentos útiles para el tratamiento homeopático del duelo complicado / Review in the medical field of 10 medicines useful for the homeopathic treatment of complicated grief

El duelo complicado es definido como el proceso alterado de adaptación a una nueva realidad, posterior a una perdida afectiva, en el cual se presentan síntomas anormalmente intensos y/o prolongados, generando interferencia en el funcionamiento normal de las personas, lo que puede llegar a cronificarse indefinidamente. El duelo complicado esta precedido de unos factores de riesgo ya determinados, relacionados con las características del difunto, el doliente, relación doliente - difunto y las circunstancias de la muerte, el diagnostico de duelo complicado es realizado por medio de diferentes herramientas como cuestionarios, genogramas y auto informes diseñados para tal fin; como tratamiento de primera línea es utilizada la psicoterapia dirigida para duelo complicado o psicoterapia transpersonal y como segunda opción la farmacoterapia con antidepresivos en la mayoría de los casos, el uso de la homeopatía para el manejo del duelo complicado se encontró de forma reducida. Luego de realizar una revisión de los síntomas del duelo complicado se realiza la repertorizacion homeopática, encontrando que los medicamentos más indicados para este trastorno según sus síntomas, son: Natrum ­ Muriaticum, Aurum Metallicum, Pulsatilla, Ignatia y Causticum. Teniendo en cuenta que prima la totalidad sintomática e individualidad en cada caso, para la escogencia del medicamento, con el resultado de la repertorizacion se realiza una revisión de la materia médica con énfasis en las particularidades de los síntomas mentales de cada medicamento.