The diagnosis of Complicated Grief (CG) is being proposed for inclusion in DSM–5. As such, it has been the focus of several studies purporting to build evidence of its validity and its conceptual and statistical distinction from Posttraumatic Stress Disorder (PTSD) and depression (Bonanno et al., 2007; Golden & Dalgleish, 2010; Prigerson et al., 1995b). However, previous research has focused predominantly on bereavement caused by non-violent means (e.g., prolonged terminal illness). This study attempts to explore the nature of CG among a sample of students who survived a mass shooting. Exploratory and confirmatory factor analytic procedures were used to examine and confirm the factor structure of CG as reported in previous studies (e.g., Boelen & van den Bout, 2005; Dillen, Fontaine, & Verhofstadt-Denève, 2008). A refined CG scale was then used as a criterion to demonstrate how different types of traumatic exposure contribute to symptoms of CG and/or posttraumatic stress (PTS). It was hypothesized that exposure items related to bereavement would be more related to CG than to PTS, whereas direct exposure to the shootings would be more closely related to PTS than to CG. Results of exploratory and confirmatory factor analyses supported CG as a unitary construct distinct from PTS and from anxiety/depression. Logistic regression results demonstrated that bereavement status was significantly predicted by CG but not PTS: Participants who scored 1 standard deviation above the mean on the CG scale were 14.64 times more likely to have been bereaved than were those who scored at the mean. SEM analyses were used to provide an additional test of this hypothesis. The final model had acceptable fit as assessed by RMSEA = .046, CI = .043–.049, SRMR = .048, and CFI = .990; however, the Satorra-Bentler Scaled Ï 2 = 1507.82, df = 589, p < .001, did not support the model. Overall, results of SEM suggested that interpersonal loss (i.e., whether a friend was killed, injured, or escaped from the shootings) predicted CG but not PTS, whereas perceived threat predicted both CG and PTS. / Ph. D.

The purpose of this study is to determine what, if any, effect the September 11th terrorist attacks had on national suicide rates in the time following the attacks. Two schools of thought seem to give contradicting proposals. The first is the classical Durkheimian model, which predicts that the national integration brought on by the attacks should cause a decrease in anomie and consequently a decrease in suicides. The opposing view point is that of communal bereavement, which proposes an increase in suicides after a public tragedy due to the tendency of individuals to be emotionally impacted by events which do not involve them directly. To test which theoretical framework prevails, the suicide rates of one hundred days prior to September 11th, 2001 and one hundred days after were compared to the suicide rates of the days within the same time frame in the years 1999, 2000, and 2002 to test if there was a statistical change in the daily suicide rate. A series of regressions were conducted to determine if changes in suicide rates did in fact occur. Data was collected from the Center for Disease Control National Center for Health Statistics mortality database. Analysis showed that suicide rates do not change significantly after September 11th, 2001, as compared to the same time periods in 1999, 2000, and 2002. / Master of Science

Yes / Death, bereavement, and grief are experiences suffused with conflict and disenfranchisement. Intricately connected is ‘etiquette’ – the sense of ‘should’ ‘must’ ‘right’ ‘wrong’ ‘appropriate’ and ‘inappropriate’ individuals feel in death and bereavement situations. This paper is the first of two answering the question, ‘where does etiquette arise in death and bereavement situations and what does this ‘look like?’’ The theme The etiquette of communication and conversation is described, highlighting the importance of early communication for resolving conflict, what is considered ‘appropriate’ communication and support, and the social values underpinning these. Data highlighted how the CBT concept of ‘shoulding and musting’ manifests in death and bereavement situations, gave insight into etiquette’s role in disenfranchising grief through shaping conversations, and offered suggestions for bereavement support. Though the term ‘etiquette’ may be misleading out of context, the concept resonated with the bereaved community and provided language to discuss the nuances of their experiences. / Arts and Humanities Research Council (AHRC)

Yes / The aim of this article is to give an overview of some of the key dimensions of variation in cultural and religious rituals during the immediate period after a death and in the longer term, in order to inform service delivery in multi-cultural societies. For each area we give examples of different customs, and consider their functions and possible impact. Dimensions considered in the immediate period after bereavement are: The time and space given to formal rituals, expression of feelings, assertion of status and disposal of the body. In the longer term, we look at variations in remembering the deceased and in continuing bonds. Throughout we consider the interplay between individual responses and the person¿s cultural and religious context. Our objective is to provide an accessible introduction for practitioners new to working with bereavement and provide a succinct reference point for more experienced bereavement workers.

No / This study explores the bereavement process and continuing bond in Pakistani Muslims with the focus on how culture and religion influence these processes. Ten participants were interviewed and their transcribed interviews were analyzed using a grounded theory approach. Three main domains were identified from the narratives expressed by the participants: death and the process of grieving, continuing the link with the deceased, and influencing agents. The findings indicated that Pakistani Muslims maintained their link with the deceased through cultural and religious rituals, such as performing prayers, reciting holy verses, talking and dreaming about the deceased, doing charity, visiting graves, and arranging communal gatherings. The prime purpose of many of these practices was the forgiveness of the deceased. Grief reactions seemed to be determined by the nature of death, prior relationships with the deceased, reaction of society and gender of the bereaved. Religion provided a strong basis for coping and adjustment of the bereaved, through rationalizing and accepting the death. This study has important implications for counselors and family therapists who can use religious affiliations to reduce the impact of loss and complicated bereavement.This study explores the bereavement process and continuing bond in Pakistani Muslims with the focus on how culture and religion influence these processes. Ten participants were interviewed and their transcribed interviews were analyzed using a grounded theory approach. Three main domains were identified from the narratives expressed by the participants: death and the process of grieving, continuing the link with the deceased, and influencing agents. The findings indicated that Pakistani Muslims maintained their link with the deceased through cultural and religious rituals, such as performing prayers, reciting holy verses, talking and dreaming about the deceased, doing charity, visiting graves, and arranging communal gatherings. The prime purpose of many of these practices was the forgiveness of the deceased. Grief reactions seemed to be determined by the nature of death, prior relationships with the deceased, reaction of society and gender of the bereaved. Religion provided a strong basis for coping and adjustment of the bereaved, through rationalizing and accepting the death. This study has important implications for counselors and family therapists who can use religious affiliations to reduce the impact of loss and complicated bereavement.

No

Thesis (PhD)--Universiteit van Stellenbosch, 2000. / ENGLISH ABSTRACT: Most researchers agree that for a child the death of a parent constitutes a psychological risk. Some of these children might experience the first onset of psychiatric disorder (depression, anxiety or substance use disorder) prior to age 20, with a peak age of occurrence at 18. Within the South African context children are more and more confronted with parental death due to the upsurge of violence, the increase in HIV, aids and tuberculoses, as well as many fatal traffic accidents. The need for psychological support of these children within the school system was brought to the attention of the researcher by concerned surviving parents. Society tends to expect an early (often premature) return of survivors to the activities of everyday life. The adult or child thus often finds him-/herself isolated in grief. In family context on the other hand, the single parent has to deal with the personal loss of a spouse, the children's loss of a parent and often also the grandparents' loss of a child. Furthermore, roles within the family have to be reallocated so as to accommodate the lost person's functions. The surviving parent is therefore often not adequately available for the child who, having had his/her personal world and belief system shattered, does not always understand the consequences of death, primarily due to cognitive immaturity. They may react with anxiety, irrational beliefs and suppression, thus blocking a healthier course of grief. The aim of this study was to design and implement a psycho-educational grief resolution program and to investigate the effect thereof on the mood states, coping skills and self-concepts of 17 urban adolescents who had experienced parental death. Using the General Systems Theory as metatheory and the Intervention Designand- Development research methodology (Thomas & Rothman, 1994), a model of adolescent grief resolution was devised which served as basis for the design of the program. The participants were requested to reappraise personal resolution of grief tasks and were introduced to cognitive restructuring (for example the relinquishment of suppression and the disputing of irrational beliefs). With a clearer understanding and the skills to control emotions and behaviour, they were encouraged to attribute (now with hindsight) meaning to the experience of having lost a loved one, and to incorporate the event into a personal narrative. Statistical analyses of test-retest results indicated, amongst others, that adolescents tend to prematurely avow acceptance of the loss; that the experimental group demonstrated less fatigue-inertia after attending the program than the control group; and that a high risk group, comprised of members of both the experimental and control groups, showed more depression during the re-test situation. The last finding indicates that a high risk group should rather receive psychotherapy than participate in a psychoeducational program which is not primarily of a psychotherapeutic nature. On the other hand taking part in the program caused those adolescents to become aware of their need for psychotherapy. / AFRIKAANSE OPSOMMING: Die meeste navorsers is dit eens dat die dood van 'n ouer vir die kind sielkundige risiko's inhou. Sommige van dié kinders mag voor die ouderdom van 20 jaar (met die grootste aantal teen 18 jaar) psigiatriese probleme soos depressie, angs of middelmisbruik vertoon. Suid-Afrikaanse kinders word tans toenemend aan ouersterfte blootgestel weens die toename in geweld, die Hl-virus, vigs, tuberkulose en verkeersongelukke. Agtergeblewe ouers het die behoefte aan sielkundige ondersteuning van dié kinders binne skoolverband onder die aandag van die navorser gebring. Dit blyk dat die gemeenskap 'n vroeë (dikwels voortydige) terugkeer van die treurende na die gewone daaglikse aktiwiteite verlang. Die treurende beleef hom-/haarself dus dikwels as alleen in smart. In gesinsverband word daar verder hoë eise aan die enkelouer gestel, soos om die verlies van 'n huweliksmaat te verwerk, om kinders wat 'n ouer verloor het, en moontlik ook grootouers wat 'n kind verloor het, te ondersteun. Verder moet die rolle binne die gesin herverdeel word om ook die oorledene se funksies te vervul. Die beskikbaarheid van die agtergeblewe ouer is dus ingekort, en die kind wie se leefwêreld en oortuigings aan flarde is, het weens veral kognitiewe onrypheid, selde begrip vir die nagevolge van sterwensverlies. Hulle mag reageer met angs, irrasionele denke en onttrekking wat die rouproses kan inhibeer. Die doel van die studie was die ontwerp en toepassing van 'n verliesverwerkingsprogram Cn psigo-ontwikkelingsprogram) en die bepaling van die programeffek op die gemoedstoestand, streshanteringsvaardighede en selfkonsep van 17 stedelike adolessente met ouerverlies. Met die Algemene Sisteemteorie as metateorie en die Intervensie-Ontwerp-en-Ontwikkelingsnavorsingsparadigma (Thomas & Rothman, 1994) kon 'n adolessente verliesverwerkingsmodel saamgestel word wat gedien het as basis vir die ontwerp van die program. Die deelnemers kon die eie verwerking van routake herbeoordeel en kognitiewe herstrukturering waar nodig toepas (onder meer deur die opheffing van onderdrukte gedagtes en die betwisting van irrasionele aannames). Met beter begrip vir die eie situasie en beheer oor emosie en gedrag kon ook betekenisgewing (terugskouend oor die verliesgebeure) volg en kon die ervaring geïnkorporeer word in 'n persoonlike lewensverhaal. Statistiese ontleding van die toets-hertoetsresultate het onder meer daarop gedui dat adolessente neig om voortydig aanvaarding van die verlies aan te dui; dat die eksperimentele groep, vergeleke met die kontrolegroep, minder vermoeid-lusteloos was na programdeelname; en dat hoë risikodeelnemers uit beide die eksperimentele en kontrolegroepe met die na-toetsing meer depressief voorgekom het. Laasgenoemde bevinding dui daarop dat die hoë risikogroep eerder op psigoterapie aangewese was. Diegene uit die hoë risikogroep wat wel aan die program deelgeneem het, het nogtans bewus geword van die behoefte aan sodanige terapie en dit daadwerklik opgevolg.

The current study assessed 125 conjugally bereaved persons using multiple self-report measures as indicators of personal adjustment and bereavement distress across three times of testing (initial, 6-month, and 3-year follow-up). Cross-lagged panel analyses were conducted to examine the causal relationships between adjustment and bereavement distress indicators and overall factors. Exploratory factor analyses indicate measures of adjustment load on a single Adjustment factor and measures of bereavement distress load on a single Grief factor. Considering results using composite scores for each variable, adjustment was significantly more predictive of bereavement distress than bereavement distress was predictive of adjustment for both Time 1 to Time 3 and Time 2 to Time 3. Adjustment issues measured by indicators such as the UCLA, POMS, HSC, BDI, and RSES significantly influenced the extent of grief symptoms as measure by the BEQ and the severity of scope of grief symptoms as assessed by the IOLQ.

The purpose of the present study was to examine the applicability of a model of bereavement to the long-term adjustment to loss. Based on Allen's (1990) model, it was predicted that the variables experienced competence, perceived resources, and the impact of the loss would contribute strongly to overall long-term bereavement adjustment. It was also predicted that time and multiple losses would impact adjustment to loss.

Four hundred and thirty-eight participants who had lost a close friend or family in the last 2 years completed questionnaires regarding their experiences with the funeral. Results indicated individuals emotionally close to the deceased person reported higher levels of participation in funeral rituals and greater levels of bereavement adjustment. Those emotionally distant from the deceased person reported greater satisfaction with the funeral. Individuals who viewed the deceased person as a central figure in their lives had greater participation in the funeral. Those who viewed the deceased person as a peripheral figure had higher levels of bereavement adjustment. Additionally, those who viewed the death as unpreventable reported greater satisfaction with the funeral, and had higher levels of bereavement adjustment.