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.

This dissertation examined the relationship between attachment insecurity and complicated grief by testing a path model of variables that were hypothesized to mediate this relationship. Three meaning-making variables were tested as potential mediators: benefit-finding, sense-making, and positive reappraisal. First, a series of principal components analyses were performed to determine the factor structure of these meaning-making variables. After these constructs were identified, a series of hierarchical regression analyses were conducted to determine the unique contribution of each of the primary variables in predicting either complicated grief or one of the meaning-making variables. As hypothesized, some of the attachment and meaning-making variables were highly associated with complicated grief. Attachment insecurity variables were also associated with some of the meaning-making variables suggesting that attachment may have some influence on how individuals use meaning-making strategies in the midst of a loss. These variables were then entered into a path analysis that accounted for other relevant risk factors. It was found that, contrary to the main hypothesis, the meaning-making variables did not appear to mediate the relationship between attachment insecurity and complicated grief. Multiple regression was used to determine the relative impact of meaning-making and attachment variables on complicated grief because these variables have not been previously included in one statistical model. The results suggested that both meaning-making and attachment insecurity variables can play an important role as risk factors for complicated grief and that these relationships are still present after accounting for the closeness that an individual reported towards the deceased. It was concluded that both sets of variables, attachment and meaning-making, should be included in models of the development of complicated grief and that both may have clinical implications in terms of how to approach counseling for individuals struggling with complicated grief. More research on this topic is needed to look at similar research questions within specific populations. It was also suggested that in the future, researchers need to find better ways to measure meaning-making constructs because the current findings suggest that meaning-making may be even more multifaceted than has been suggested in previous literature. / text

Complicated grief, or persistent complex bereavement disorder, is a condition that affects approximately 10% of bereaved individuals and is marked by intense longing and yearning for the deceased. Little is known about the neurocognitive mechanisms contributing to this syndrome, but previous research suggests that reward pathways in the brain may play a role. The present study was designed with this theory in mind, aiming to understand reward processing in those experiencing complicated and non-complicated grief as well as to differentiate the "wanting" and "liking" phases of reward processing in bereavement. Twenty-five older adults were categorized based on grief severity into one of three groups: complicated grief (CG), non-complicated grief (NCG) and non-bereaved married controls (NB). Neural activation was examined using fMRI while participants viewed a countdown on the screen (anticipation) followed by a photo of their (living or deceased) spouse. There was no significantly differential activation between the three groups for the spouse v. stranger photo contrast, nor for anticipation period v. spouse photo. However, these two contrasts were also run separately in the three groups. Each group produced significant activation, in similar and distinct regions, primarily associated with emotion and visual processing. In addition, post-hoc analyses were conducted using self-reported yearning scores as a regressor across all bereaved participants, which revealed that greater symptoms of yearning predicted greater activation in the subgenual anterior cingulate cortex (sgACC). This region of the brain has been previously linked to depression and suggests that symptoms of yearning may present an opportune place to intervene to improve outcomes in CG.

Mild Traumatic Brain Injury (mTBI) can be broken into two categories; complicated and uncomplicated. These categories are based on structural imaging scans during the assessment of the injury. If abnormalities appear in the scan, we refer to it as complicated. The present research aims at determining whether there are differences in the neuropsychological deficits in the presences of positive neuroimaging as opposed to negative neuroimaging. This was accomplished with meta-analytic techniques. It was found that neuroimaging does not predict neuropsychological functioning in the chronic state of mTBI.

Made available in DSpace on 2016-04-28T20:40:04Z (GMT). No. of bitstreams: 1 Joyce Salgueiro Migliavasca.pdf: 1540632 bytes, checksum: 2942237fb45ccf27f4927f87ba146cfd (MD5) Previous issue date: 2009-05-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The aim of this dissertation is to perform a psychoanalytic reading about Frida Kahlo´s life and her work as well. Frida Kahlo was chosen as an object of studying because, meanly, she presents, for Psychoanalyses, female hysteria symptoms. In order to make this piece of work understood we used Freudian theory and writers that contributed to Freud´s thoughts and to the female psyche constitution and also to the disarrangements that cause the neurosis hysteric. After that I did psychoanalytic interpretations about life and work of the author on target / O objetivo desta dissertação é realizar uma leitura psicanalítica a respeito da vida e da obra de Frida Kahlo. O meu intuito de utilizar a biografia e a obra de Frida Kahlo como objeto de estudo deve-se, principalmente, ao fato dela apresentar características que podem ser compreendidas, à luz da psicanálise, como histeria feminina. Para tornar claro esse entendimento, nesta dissertação, parto da teoria freudiana e de autores que com ela contribuem sobre a constituição psíquica feminina e os desarranjos que ocasionam a neurose histérica , e após isto, faço interpretações psicanalíticas acerca da vida e da obra da artista em questão

Abstract Epidemiological and clinical data suggest that acute appendicitis might have two different forms with different disease severities. Uncomplicated and complicated acute appendicitis appear to be distinct entities instead of consecutive events. Appendicitis does not always inevitably progress to perforation and most cases are uncomplicated by nature. This supports the importance of an accurate differential diagnosis between uncomplicated and complicated acute appendicitis enabling treatment optimization. This thesis consists of three studies. The first study evaluated the possibility to differentiate between uncomplicated and complicated appendicitis using only clinical symptoms and laboratory markers with a special focus on predicting the presence of an appendicolith without the use of modern imaging. We found neither sufficiently reliable to accurately estimate the severity of acute appendicitis or to determine the presence of an appendicolith, supporting the use of computed tomography imaging to assess the disease. The second study focused on clarifying the histopathological differences between uncomplicated acute appendicitis and acute appendicitis presenting with an appendicolith; a calcified deposit of faecal material in the appendiceal lumen. It’s presence has been shown to predict perforation and failure of conservative treatment. This study evaluated the histopathological findings of computed tomography diagnosed uncomplicated acute appendicitis and appendicolith appendicitis without perforation. Acute appendicitis presenting with an appendicolith was histopathologically different from uncomplicated acute appendicitis on all the assessed histological parameters, indicating the potentially complicated nature of appendicolith appendicitis. The third study was a randomized, multicentre clinical trial comparing interval appendectomy with follow-up with magnetic resonance imaging after successful initial non-operative treatment of complicated acute appendicitis presenting with a periappendicular abscess. The study hypothesis was that an interval appendectomy might not be necessary based on the previously reported low appendicitis recurrence rate after a periappendicular abscess. The original study hypothesis was left unresolved, as an unexpectedly high rate of appendiceal neoplasms was detected in the study population and the study was prematurely terminated. The neoplasm rate after a periappendicular abscess in this prematurely terminated study was high (20%). All the neoplasms were detected in patients over 40 years of age, strongly supporting an interval appendectomy for all patients over 40 years of age if this rate of neoplasms is validated in future studies. / Tiivistelmä Aiemmat tutkimukset viittaavat siihen, että on olemassa kaksi erillistä akuutin umpilisäkkeen tulehduksen muotoa: komplisoitumaton ja komplisoitunut. Nämä muodot eivät ole toistensa jatkumo: umpilisäkkeen tulehdus ei aina johda umpilisäkkeen puhkeamiseen, vaan valtaosa umpilisäkkeen tulehdustapauksista on komplisoitumattomia. Oikean hoitotavan valinta edellyttää tarkkaa erotusdiagnostiikkaa tautimuotojen välillä Tämä väitöskirjatyö koostuu kolmesta osatyöstä. Ensimmäisen osatyö selvitti, onko komplisoitumaton ja komplisoitunut umpilisäkkeen tulehdus mahdollista erottaa ilman kuvantamista kliinisin löydöksin ja laboratoriokokein painottaen ulostekiven olemassaolon ennustamista. Umpilisäkkeen tulehduksen vaikeusasteen tai ulostekiven olemassaolon ennustaminen ei ollut mahdollista pelkästään kliinisten löydösten tai laboratoriokokeiden perusteella. Tämä korostaa tietokonetomografian merkitystä taudin vaikeusasteen arvioinnissa. Toinen osatyö selvitti histologisia eroja komplisoitumattoman umpilisäkkeen tulehduksen ja ulostekiven sisältävän äkillisen umpilisäkkeen tulehduksen välillä. Ulostekiven tiedetään ennustavan umpilisäkkeen puhkeamaa ja konservatiivisen hoidon epäonnistumista. Tutkimuksessa selvitettiin histologisia löydöksiä potilailla, joilla oli tietokonetomografiatutkimuksella varmistettu komplisoitumaton äkillinen umpilisäkkeen tulehdus tai ulostekiven sisältävä äkillinen umpilisäkkeen tulehdus ilman puhkeamaa. Tutkimuksessa todettiin, että ulostekiven sisältävät tulehtuneet umpilisäkkeet poikkeavat kaikkien tutkittujen parametrien osalta komplisoitumattomasta umpilisäkkeen tulehduksesta. Tämä tukee käsitystä ulostekiven sisältävän umpilisäkkeen tulehduksen komplisoituneesta luonteesta. Kolmas osatyö oli randomoitu monikeskustutkimus, jossa verrattiin toisiinsa rauhallisessa vaiheessa tehtyä umpilisäkkeen poistoa ja seurantaa magneettiresonanssikuvauksella potilailla, joilla oli onnistuneesti hoidettu konservatiivisesti umpilisäkkeen ympäryskudoksen paise. Hypoteesina oli, että myöhempi umpilisäkkeen poisto ei ole tarpeen, koska tulehduksen uusiutumisen riski umpilisäkkeen vieruskudoksen paiseen hoidon jälkeen on aiemmin raportoitu matalaksi. Tutkimushypoteesi jäi avoimeksi, koska tutkimuksen aikana havaittiin runsaasti umpilisäkkeen kasvaimia, mikä johti tutkimuksen ennenaikaiseen keskeyttämiseen. Umpilisäkkeen kasvainten ilmaantuvuus oli 20 %, kaikki yli 40-vuotiailla potilailla. Mikäli tutkimuksen tulokset vahvistuvat tulevissa tutkimuksissa, kaikille yli 40-vuotiaille potilaille tulisi suositella umpilisäkkeen poistoa sairastetun umpilisäkkeen vieruskudoksen paiseen jälkeen.

Research on expressive art interventions for bereavement has burgeoned in recent years. Studies have supported their effectiveness in facilitating participants’ adjustment to loss (e.g., Rosner, Kruse, & Hagl, 2010; Uttley, 2015) and have revealed the frequency with which they are clinically implemented (Thompson & Neimeyer, 2014). Clinicians and recipients of expressive art interventions advocate for their helpfulness in grief processing (e.g., Gamino, 2015). Publications have highlighted particular visual art modules that facilitate adaptive adjustment to loss by providing avenues for self-expression, meaning making and continuing bonds with the deceased (Neimeyer, 2016), but few studies have quantitatively investigated whether they improve bereavement outcomes. Efficacy of treatment modalities are especially warranted for bereaved subgroups at elevated risk for developing symptoms of complicated grief, such as socioeconomically vulnerable older adults, as they are among those most likely to benefit from intervention but face the most barriers to accessible treatment (Ghesquiere, 2013; Newson et al., 2011). This longitudinal study investigated the feasibility and efficacy of a 4-week grief support group with visual art modalities for bereaved older adults residing in government subsidized independent living facilitates in the community. Measured outcomes included meaning made from the loss, continued bonds with the deceased, perceived social support, personal growth, and negative bereavement experiences such as symptoms of complicated grief and depression. Findings from this study support the feasibility and acceptability of implementing an art-based grief support group for socioeconomically vulnerable older adults. Significant improvement was found in meaning made from the loss, personal growth, and negative grief symptoms. Depressive symptoms significantly decreased immediately following completion of the group, but these levels returned closer to baseline levels at one-month follow up. Participants who screened positively for complicated grief at baseline reported greater improvement in their negative grief symptoms and depression, consistent with the extant literature that the bereft in highest distress receive the most benefit from grief intervention. As complicated grief is more prevalent in the older adult population than other age groups, further investigation on the efficacy and effectiveness of targeted bereavement support is warranted.

In studies, grief due to the loss of a child is recognized as a complex process, one whose trajectory is influenced by a variety of factors. One factor, the age of the child at the time of death, may be an important influence in the trajectory of grief. The purpose of this interpretive phenomenological study was to explore the experiences of loss for 15 bereaved mothers and fathers whose children suddenly died between the ages of 2 and 12 years. This age range was selected to explore bereavement in parents of young and preteen children because they may feel a greater sense of daily care and responsibility for the safety of their children in comparison to bereaved mothers and fathers of older children or adults. The psychosocial transition theory was used to develop the research questions, which framed the exploration of the experiences and adaptive responses of the parent participants. There were 15 recorded semistructured interviews from which the data were collected. The transcribed data were validated with member checking. Data analysis was completed using open and hierarchical coding to identify meanings and recurrent themes in the participant narratives. Recurrent themes included that grieving was emotional and physical for these parents, and that grief made it difficult for them to do everyday tasks or care for surviving children. Mothers and fathers identified viewing their world as less safe and experienced a reevaluation or complete abandonment of their spiritual beliefs. Implications for positive social change include increasing social awareness in the general public about grief due to child death and challenging unrealistic expectations of grief trajectory. Furthermore, the findings of this study may be used by mental health professionals to create interventions specific to this type of loss.

Previous research has greatly ignored the unique stressors that homicide survivors experience following the murder of their loved one, indicating a general lack of understanding of the experiences and reactions they are subjected to or the coping mechanisms that they utilize. What little research that had been conducted has largely been made up of anecdotal insight of psychological practitioners who had worked with clients. A need exists to speak with the survivors themselves to chronicle their experiences in as much detail as possible to help researchers and practitioners wrap their mind around the totality of the loss as well as ground future research. The participants in the study consisted of twelve persons who had immediate family members who had been murdered. Participants were interviewed utilizing Lincoln & Guba?s Naturalistic Inquiry paradigm. They were initially interviewed and encouraged to discuss their loss in narrative and then were asked a series of specific questions that may or may not have been discussed during the narrative. The collected data was analyzed utilizing the constant comparison methodology. Results indicate that many homicide survivors feel overwhelmed by the changes that occur in the short and long term. None of the participants reported positive experiences interacting with mental health practitioners but virtually everyone endorsed peer-group support. There was also evidence that participants whose loved one was murdered by a person of an ethnicity that differed from their own resulted in racist feelings towards the other ethnicity. Further, there was no evidence that the process of interviewing homicide survivors was in and of itself negatively perceived or harmful; rather some participants reported feeling relieved that they were able to discuss their loss in totality without having to edit themselves. Results suggest that homicide survivors may spend an unusual amount of time reflecting on the person that their loved one may have become had they not been murdered. Suggestions also include how to best notify and support homicide survivors and how practitioners may best relate with their clients.

Background: The death of a spouse is among the most distressing life events faced by older adults and frequently follows long periods of providing extensive care and support. Although many spouses are resilient following loss, a number of bereaved spousal caregivers have poor psychological well-being and may benefit from clinical services. However, it can be difficult to determine who may most benefit from bereavement services and why some individuals are at greater risk for poor bereavement; thus, there is a need for greater understanding of the process of bereavement. Therefore, the purpose of this dissertation was to investigate a number of theoretically relevant factors within the context of bereavement after caregiving as possible predictors of psychological well-being following loss. Specifically, former caregivers' perceptions of loved ones' end-of-life suffering, rumination, and feelings of relief were investigated as possible predictors of caregivers symptoms of depression, grief, and complicated grief following loss. Method: Participants included 61 former spousal caregivers of hospice patients 50 years of age or older who lost a spouse in the last 6-18 months. Individuals completed an interview that included retrospective recall of perceptions of loved ones' physical, emotional, and existential suffering, current frequency of thoughts about loved ones' suffering, stress-reactive rumination, and feelings of relief following the death. Participants also completed measures assessing current symptoms of depression, present feelings of grief, and complicated grief. Descriptive information about care recipients was obtained via retrospective review of hospice electronic medical records following participant interview. Several regression analyses were conducted to investigate the relationship of possible predictor variables to bereavement outcomes and interactions among predictor variables. Results: Findings revealed important relationships between rumination, feelings of relief, and former caregivers' psychological well-being follow loss. Higher rumination and less feelings of relief were associated with worse bereavement outcomes. In addition, interaction analyses revealed that rumination and feelings of relief moderated the relationship between participants' perceptions of their spouses' emotional end-of-life suffering and psychological distress. Other descriptive predictors of depression, grief, and complicated grief were identified. Discussion: Participants were highly distressed former caregivers who were highly engaged in caregiving duties prior to loss. About 40% reported no feelings of relief following the loss, and over one-fourth of participants still had frequent ruminations about their loved ones' suffering. High stress-reactive rumination was an important predictor of bereaved spouses' psychological distress. Clinical interventions, such as cognitive behavioral therapy, could focus on identifying, redirecting, and reducing distressing thoughts or the negative feelings associated with them, such as ruminations associated with loved ones' end-of-life suffering. Future longitudinal research should examine the relationships between rumination, feelings of relief, perceived suffering, and bereavement outcomes in order to identify patterns that may inform clinical interventions.