Losing a loved one – a child or a spouse –is described as one of the most stressful or negative experience of a person’s life. Aging is associated with a higher risk of the death of close family members, yet few studies have investigated the impact of such losses on different health outcomes either by type of loss or by the combined loss of both a child and a spouse. This thesis is based on three studies examining the effect of bereavement on the health of older adults who have lost a child, spouse, or both and whether the different losses were associated with Life Satisfaction (LS) or mortality. The sample was collected from the Swedish National Study of Aging and Care (SNAC). The results showed that the loss of a child, spouse or both was experienced as among the three most important negative life events in the bereaved groups. About 70% of those bereaved of a child or a spouse mentioned these losses as among their three most important negative life experiences. In the child-and-spouse-bereaved group, 48% mentioned both losses while 40% mentioned only the loss of a child or a spouse, but not both. However, only marginally effects on LS and mortality after child, spouse or child-spouse bereavement in older adults was found. Longer time since the loss was associated with higher LS and lower mortality risk, and type of loss did not seem to determine LS or mortality. Gender differences were found: child-, spouse and child-and-spouse-bereaved men had lower LS than the corresponding groups of bereaved women, and furthermore, child-bereaved men had an increased mortality risk compared to child-bereaved women. Finally, significantly more women in the child-and-spouse-bereaved group compared to the men in this group, mentioned the loss of their child but not the spouse, among the three most important negative life events.

This thesis examines the narrative reconstructions taken from extended conversations with 25 bereaved individuals, who volunteered their experiences of losing a loved one. By considering the interaction between self and other to be the source of knowledge, these interview conversations provided a vehicle through which the human encounter with death and loss not only found expression but came into being. Bereavement is approached as a ‘cultural object’, so as to capture prevailing ideas, norms and beliefs about how this should be handled and provide further insight into the place of death in contemporary British Society. Such ‘norms’ are taken to be co-constructed through discursive practice, and continually evolving through negotiation between the individual and social processes. Attention is therefore drawn to the way people use available cultural forms to construct and express meanings that are particular and personal to them. This study demonstrates the value of an interactive approach for gaining a fuller understanding of the complexity of social life, thereby contributing to methodological and ethical debates on the implications of using qualitative, interactive methods, particularly with sensitive topics. It highlights the co-constructed nature of the data and the crucial role of self-reflexivity in managing the emotional impact of the research on the researcher as well as the participants. An analysis of interview narratives has revealed how deceased loved ones retained a significant social presence in the life of survivors regardless of other social factors. It has highlighted the diversity of meanings people gave to their experiences, which convey how bereavement interacted with other agendas and priorities to shape their day to day social life and sense of identity. Such findings revise and extend current understandings of the ‘continuing bonds’ people forge with their dead and the nature of ‘personhood’ in contemporary British society.

The current study investigates whether the ability to enhance and suppress emotional facial expressions display cross-sectional associations with feelings of loneliness among spousal bereaved individuals 1.5 to 3 years after a loss. We compare bereaved individuals to a demographically similar married control group to examine whether the relationship between loneliness and emotional expression regulation is moderated by grief after controlling for the effects of relationship satisfaction and symptoms of PTSD/depression. We evaluate three dimensions of loneliness: emotional loneliness, social loneliness, and collective loneliness.

SIGNIFICANCE: Complicated and persistent grief reactions afflict 10% of bereaved individuals, and are associated with severe disruptions of functioning. These maladaptive patterns were tentatively included in the DSM-5 as Persistent Complex Bereavement Disorder (PCBD). The condition has been studied using network analysis, showing how symptoms activate and reinforce each other into psychopathological configurations. This approach offers unique insights to inform clinical practice and define psychopathology. Despite these strengths, previous studies were based on self-report information from a single archival dataset. To overcome these limitations, we collected clinical data from a community sample of newly bereaved individuals who suffered loss of a spouse (N=305). Symptoms of PCBD from semi-structured clinical interviews were analyzed via a network approach. METHODS: Ising model Networks of PCBD were generated from symptoms diagnosed at 3 months, 14 months, and 25 months after the loss. Comorbidities with DSM-5 symptoms of Major Depressive Disorder, and PTSD were also explored. The role of risk factors was also assessed. Lastly, longitudinal VAR networks were generated combining the three temporal observations. RESULTS: Symptoms from the Social/Identity PCBD cluster were central in the network configurations. Yearning and Emotional Pain appeared less strongly interconnected compared to previous research. Meaninglessness activated a cascade of further PCBD symptoms over time. Loneliness, difficulties trusting others and meaninglessness bridged with comorbid depressive and trauma symptoms. CONCLUSIONS: Symptoms related to loss of identity and meaninglessness were identified as salient candidates for targeted interventions. The network approach showed potential for an improved understanding of psychopathological distress reactions following potentially traumatic events.

Background and objective: Caring for critically-ill and dying patients is widely recognised as a central stressor in oncology and palliative-care staff. Past research in this area has mostly focused on medical staff, and the impact of patient deaths on other professionals has received only limited attention. This study aimed to explore how psychotherapists experience and cope with the death of the cancer patients in their care, and whether these experiences promote personal and/or professional growth. Methods: an exploratory sequential mixed-methods design was adopted. Participants were psychotherapists working with adult cancer- and palliative-care patients within UK hospices. In the qualitative phase, seven semi-structured interviews were conducted and examined using thematic analysis. In the quantitative phase, 28 participants completed an online questionnaire designed to evaluate the incidence within the target population of the themes identified in the qualitative phase. Findings: Grief appeared as hospice psychotherapists' main immediate response to client deaths. Participants used coping strategies aiming to facilitate emotional closure, and to foster emotional and cognitive processing. These strategies included conducting personal rituals, receiving support from colleagues and clinical supervision. Several factors hindering these coping strategies were identified, but the vast majority were shared by only a small minority of participants (e.g. feeling disenfranchised in their grief for clients). Repeated exposure to client death caused participants to feel emotionally and physically drained (and for some leading to greater fear of illness and dying). It also affected their outlook on life positively, leading to personal growth. Participants managed the negative long-term impact of their work using self-care strategies, which included working in cancer- and palliative-care settings on a part-time basis, and engaging in creative and future-oriented activities promoting a sense of hope, possibilities, and growth. Conclusion and implications: Although many hospice psychotherapists repeatedly experience grief following the deaths of their clients, most appear able to manage the immediate and long-term impacts of their work. Working in proximity to illness and death is seen as deeply challenging but at the same time as promoting personal growth, and to enhance and bring meaning to hospice psychotherapists' lives. Furthermore, the mixed-methods design adopted here provides evidence that while the qualitative methods employed produced rich data, the addition of a simple quantitative survey allowed to put these in perspective about the wider group of hospice psychotherapists. I argue that this finding supports the call, prevalent in the mixed-methods research literature, to question the segregation of qualitative and quantitative methods.

The purpose of this dissertation was to examine coping and outcomes of grief for atheist individuals during bereavement. The landscape of grief research has significantly changed since the days of Freud, and widely accepted stage theory models of grief have not held up to empirical review (Wortman & Silver, 1989). Emerging research examines factors that may lead to positive changes as a result of loss or trauma, known as posttraumatic growth. However, atheist individuals continue to be an understudied group in the psychological and bereavement literature, while people with religious beliefs continue to receive the most focus (Brewster, Robinson, Sandil, Esposito, & Geiger, 2014; D’Andrea & Sprenger, 2007). This study explored how cognitive (e.g., assumptions about the world), existential (e.g., meaning), and behavioral (active and emotional) coping methods are associated with posttraumatic growth, complicated grief, and psychological distress in a believer and atheist sample after the death of a close friend or family member. Specifically, posttraumatic growth, complicated grief, and psychological distress were regressed onto the three types of coping (cognitive, existential, and behavioral) using a hierarchical regression analysis. The first analysis controlled for demographic variables and the second analysis consisted of matched groups on demographic variables that were found to be associated with grief outcomes in prior research (e.g., Bonanno et al., 2008; Bonanno, Galea, Bucciarelli, & Vlahov, 2007). Exploratory bivariate correlations were conducted to assess interrelations between the variables of interest. Additionally, MANOVA was used to assess differences in demographic variables between the believer and atheist sample. Significant cognitive, existential, and behavioral coping methods were found to be associated with posttraumatic growth, complicated grief, and psychological distress. Furthermore, the endorsement of a belief in God(s) was significantly and positively associated with posttraumatic growth, but also significantly and positively associated with complicated grief and psychological distress. Results from this study can be used to identify appropriate clinical strategies for counselors working with grieving atheists, and will deepen the breadth of literature on bereavement and coping within diverse populations. Limitations and directions for future research are also discussed.

yes / Professionals working with patients at end of life need to feel comfortable and confident discussing death, dying and bereavement (DDB), however this is not always the case.1 2 The Continuing Bonds Project sought to explore the impact of archaeology on the confidence and comfort for health and social care professionals and students in talking about DDB.

Bereavement is an experience that most people will encounter multiple times across their lifetime. Some people who experience grief are going to seek support in this process from a therapist. The NASW Code of Ethics suggests that social workers only practice in fields in which they are competent. This study will look at the self-perceived grief competency of master’s level therapists. Demographic data and a survey designed to measure the competency of a master’s level therapist was utilized to collect data to measure the self-perceived grief competency. Data collected was analyzed using descriptive statistics, one-way between groups ANOVA, and correlation analysis. The results of this study were mixed. Overall, there was no significant difference between MSWs, MFT and other therapists in their grief experience. However, among other significant findings, years in the field is associated with higher levels of training and experience. Further research will be needed to better assess for preparedness. However, findings suggest the importance of training social workers to adequately meet the needs of grieving individuals in lieu of years of experience.

The purpose of this thesis is to (a) summarize a sample of the literature that pertains to suicidal behavior; (b) explore the benefits of the group approach for people who experience suicide-related issues; (c) provide information and models for special suicide-related groups; and (d) discuss age-variations of suicidal behavior.

Previous research has produced heterogeneous findings regarding the effectiveness of expressive writing in reducing grief symptomatology among the bereaved (e.g., Collison, 2016; Lichtenthal & Cruess, 2010; Stroebe et al., 2006). The purpose of this study was to address these mixed results by exploring the effects and linguistic characteristics of a novel writing task (i.e., the acrostic poem) among bereaved undergraduates, using an innovative data analysis technique (i.e., Linguistic Inquiry and Word Count). The current study recruited 68 undergraduates who had lost a loved one. Participants were randomly assigned to write over multiple days using the acrostic poem, emotional disclosure prompt, or a control writing prompt. Consistent with previous research, the results indicated no significant differences in grief between conditions over time; however, there were key group differences in linguistic content. Further, while all participants endorsed improvements in grief one week following the intervention, the participants returned to baseline one month later. Patterns of writing, coping, religiosity/ spirituality, physical symptoms, and grief in bereaved emerging adults were also assessed. The results suggest that while expressive writing might not be an effective intervention for the bereaved, the content of writing might provide clinicians some insight on psychological and spiritual processes at play in bereaved emerging adults.