The associations of grief-related rumination with prolonged grief and posttraumatic stress symptoms: A longitudinal study of bereaved after the 2011 terror attack in Norway.

After the sudden and violent death of a loved one, many bereaved experience symptoms of prolonged grief (PG) and posttraumatic stress (PTS). The present study investigated the cross-sectional and longitudinal associations of grief-related rumination with PG and PTS symptoms among bereaved parents and siblings after the Utøya terror attack in Norway on 22 July 2011 (N = 110, Mage = 43.2 years, 59.1% female). Participants' responses on the Rumination Scale, the Inventory of Complicated Grief and the Impact of Event Scale-Revised 28, 40 and 102 months after the loss were analysed. Cross-sectionally and longitudinally, grief-related rumination was positively and strongly linked with PG and PTS symptoms. When controlling for the baseline levels of PG and PTS symptoms and demographics of the sample, grief-related rumination predicted PG symptoms after 12 months but not after 74 months. Further, grief-related rumination predicted significantly the PTS symptoms of avoidance after 12 and 74 months and hyperarousal after 74 months beyond sample demographics and baseline symptoms. The results suggest that grief-related rumination is an important factor in PG and PTS symptoms after traumatic bereavement.

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.

Attachment and grief in young adults after the loss of a close friend: a qualitative study.

BACKGROUND: Although many lose a close friend each year, they are seldom the focus of grief research. However, these losses often cause severe and long-lasting reactions. Deaths among adolescents and young adults are also often caused by traumatic events, e.g. from accidents, suicides, and homicides, placing them at significant risk for complicated grief reactions. The focus of this paper is bereaved friends after the shootings at Utøya, Norway in 2011, which is among a few studies that focus on bereaved friends, exploring how attachment affects the grief process after the loss of a close friend. METHODS: This paper explores qualitative data from in-depth interviews with thirteen bereaved friends, conducted about 28 months after the loss. The interview sample consisted of eight females and five males, aged 18-31 years. The interviews were semi-structured, with a theme guide of 14 questions, and the method used for analyses was systematic text condensation. RESULTS: Two main themes were identified from the analyses of the interviews: Friendship and Grief, with the subordinate themes: The importance of the friendship, Longing and remembrance, How the loss has affected other relationships, How the loss has affected the friend's daily lives, Processing of the grief and Not being family. For most of the bereaved friends the loss and the grief had a profound effect on them and their overall lives, from daily functioning in school or at work, to changes in attitudes, and the way they were met as bereaved. CONCLUSIONS: The support, intimacy, and feelings of togetherness we share with our friends are of great importance and value for all people, but maybe especially for young people. When adolescents and young adults experience losses, their reactions are often intense and long-lasting, and especially complicated grief reactions can affect school performance and concentration, health, result in emotional problems; and disrupt development (e.g. identity formation and social skills). We don't know much about the grief of bereaved friends and how their reactions can be explained. Thus, we hope that these findings could shed light on their grief reactions, and provide new knowledge on the short- and long-term psychological impact of losses of friends.

Long-Term Reactions to the Loss of a Close Friend in an Extreme Terror Incident.

This article presents results from one of the first longitudinal studies exploring the effects of losing a close friend to traumatic death, focusing on complicated grief over time and how this is affected by avoidant behavior and rumination about the loss. The sample consists of 88 persons (76% women and 24% men, mean age = 21) who lost a close friend in the Utøya killings in Norway on July 22, 2011.Quantitative data were collected at three time-points; 18, 28, and 40 months postloss. Main findings are that bereaved friends are heavily impacted by the loss and their grief reactions are affected negatively by avoidant behavior and rumination. This indicates that close bereaved friends are a group to be aware of and that there is a need for better strategies for identifying individuals in need for follow-up.

Early intervention for bereaved children: What mental health professionals think.

People rarely specify what "early intervention" following bereavement means, so we explored the views of experienced professionals working primarily with bereaved children. In an anonymous online survey, 84 mental health professionals answered questions about the content and timeframe of early intervention. The types of interventions varied, but conversation and support were most frequent. Most considered early intervention to mean before or during the first month following the loss. Although meta-analyses show little benefit of early intervention, professionals disagree and see the need to tailor interventions to the type of death, the situation of the family, and the intensity of reactions.

Early Interventions Following the Death of a Parent: Protocol of a Mixed Methods Systematic Review.

BACKGROUND: Previous meta-analyses examined the effectiveness of interventions for bereaved children showing small to moderate effect sizes. However, no mixed methods systematic review was conducted on bereavement interventions following the loss of a parent focusing on the time since death in regard to the prevention of grief complications. OBJECTIVE: The overall purpose of the review is to provide a rigorous synthesis of early intervention after parental death in childhood. Specifically, the aims are twofold: (1) to determine the rationales, contents, timeframes, and outcomes of early bereavement care interventions for children and/or their parents and (2) to assess the quality of current early intervention studies. METHODS: Quantitative, qualitative, and mixed methods intervention studies that start intervention with parentally bereaved children (and/or their parents) up to 6 months postloss will be included in the review. The search strategy was based on the Population, Interventions, Comparator, Outcomes, and Study Designs (PICOS) approach, and it was devised together with a university librarian. The literature searches will be carried out in the Medical Literature Analysis and Retrieval System Online (MEDLINE), PsycINFO, Excerpta Medica Database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The Mixed Methods Appraisal Tool will be used to appraise the quality of eligible studies. All data will be narratively synthetized following the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. RESULTS: The systematic review is ongoing and the data search has started. The review is expected to be completed by the end of 2017. Findings will be submitted to leading journals for publication. CONCLUSIONS: In accordance with the current diagnostic criteria for prolonged grief as well as the users' perspectives literature, this systematic review outlines a possible sensitive period for early intervention following the death of a parent. The hereby presented protocol ensures the groundwork and transparency for the process of conducting the systematic review. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) CRD42017064077; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017064077 (Archived by WebCite at http://www.webcitation.org/6rMq6F0fv).

Participants' recommendations for the ideal grief group: a qualitative study.

Based on the results from the qualitative part of the study "Grief Groups in Norway" conducted in 2009-2011, this article focuses on grief group participants' recommendations for good or ideal grief groups. Participants have insightful observations about grief groups and how they can be improved, and taking their point of view seriously is one important way of ensuring that users of such group get an optimal experience from joining such groups. Using their experiences to adjust the structure and function of the groups, one can allow for practical solutions for organizations that have difficulties starting up grief support groups, for example, in areas where the population density is low. A major finding in this study was that grief group participants stressed the importance of thorough information before and at the start of grief groups. This concerned information about the aim, structure, organization, and possible effects and limitations of group participation.

Positive and negative experiences from grief group participation: a qualitative study.

This article presents qualitative interview data from the research project "Grief Support Groups in Norway" (2009-2011). The aim of this part of the study was to investigate grief group participant's experiences, benefits, and satisfaction with the grief group. Positive aspects were to meet with peers, share thoughts and feelings, normalization, exchange advice and information, and share hope. On the negative side were unfulfilled needs or expectations, additional personal stress, and unsatisfactory structure, organization, and leadership. Importantly, lack of screening caused bereaved with complicated grief to participate in groups that were non-therapeutic, leaving them with insufficient help. Also, group leaders were not always considered knowledgeable of group processes and impacts of different organizational and structural factors on groups. Conclusively, participants' needs and expectations should be considered when planning and organizing groups, in order to conduct helpful groups and increase the experience of a positive outcome.

Participants with prolonged grief--how do they benefit from grief group participation?

Data analyzed in this article is part of a study conducted to explore grief support groups in Norway. Participants that fulfilled the criteria of Prolonged Grief Disorder (PGD) were compared with participants that did not in order to explore whether they differed on satisfaction and experiences with participation. To allow for comparison, a subsample of 22 participants that fulfilled the criteria of PGD were drawn from the total of 262 participants. Demographic and loss-related variables were analyzed to explore factors associated with PGD. Fulfillment of PGD was then analyzed to explore the group's effect on life quality and overall satisfaction. The main finding is that participants who fulfill the criteria of prolonged grief are in general less satisfied with the groups and report less positive effect on life quality. We also found age- and gender-differences regarding fulfillment of PGD, with older bereaved women especially at risk of developing symptoms of PGD.