Laut Statistischem Bundesamt (Destatis) starben allein im Jahr 2020 zirka 985.500 Menschen. Die häufigsten Todesursachen waren Herz-Kreislauf- und Krebs-Erkrankungen (vgl. Destatis 2020). Die meisten Menschen haben den Wunsch zuhause zu sterben, doch die Mehrheit stirbt in Krankenhäusern, Alten- und Pflegeheimen (vgl. DHPV 2017; Dasch et al. 2015). Der Tod eines nahestehenden Menschen kann bei Hinterbliebenen zu großen Belastungen, gesundheitlichen Problemen sowie einer gesteigerten Mortalität führen (vgl. Stroebe et al. 2007). Ziel dieser Arbeit war es, mit Hilfe von halbstandardisierten Interviews mit 30 Trauernden Faktoren herauszuarbeiten, die sich förderlich oder hinderlich auf den Trauerprozess auswirken können. Die Interviews wurden mit der Transkriptionssoftware f4transkript verschriftlicht und mittels qualitativer Inhaltsanalyse nach Mayring ausgewertet. Es entstand ein Kategoriensystem mit je vier Oberkategorien innerhalb der zwei Hauptkategorien, Förderliche und Hinderliche Faktoren. Folgende Faktoren konnten identifiziert werden: Förderliche Faktoren in der Oberkategorie Betreuung der erkrankten und trauernden Person sind eine gute Symptomkontrolle sowie der verständnisvolle Umgang mit den Nahestehenden, während mangelhafte Kommunikation wiederum hinderlich für eine positive Trauerbewältigung ist. In der Oberkategorie Intrapersonale Faktoren sind die Antizipation des Todes sowie die Auseinandersetzung mit der Trauer förderlich, während negative Gefühle (z.B. Schuldgefühle, Hilfslosigkeit) sich in besagter Hinsicht hinderlich auswirken. In der Oberkategorie Beziehung zur verstorbenen Person können die optimale Nutzung der verbliebenen Zeit sowie der offene Umgang mit der Erkrankung förderliche Faktoren darstellen, während ein “schwieriger“ Abschied sowie ungeklärte Konflikte oder offene Fragen Hindernisse für den Trauerprozess sein können. In der Oberkategorie Soziales Umfeld sind die unaufgeforderte Unterstützung, die emotionale Begleitung sowie ein flexibler Arbeitgeber förderlich. Streitigkeiten innerhalb der Familie und Unverständnis der Mitmenschen dagegen sind hinderlich. Eine gute und würdevolle Sterbebegleitung, wie sie in der Palliativmedizin in der Regel gewährleistet ist, ist von großer Bedeutung für einen gelingenden Trauerprozess. Daher sollte eine palliative Haltung disziplinübergreifend vorangebracht und ausgebaut werden. In der Gesellschaft sollte Trauernden mehr Toleranz und Verständnis entgegengebracht und offen mit dem Thema Tod und Sterben umgegangen werden. / According to the German Federal Statistical Office (Destatis), approximately 985,500 people died in the year 2020 in Germany. The most common causes of death were cardiovascular diseases and cancer (cf. Destatis 2020). Most people wish to die at home, but the majority die in hospitals and care facilities (cf. DHPV 2017; Dasch et al. 2015). The death of a close person can lead to significant difficulties, health problems, and increased mortality among the bereaved (cf. Stroebe et al. 2007). The aim of this study was to identify factors that can have a supporting or hindering effect on the grieving process by conducting semi-structured interviews with 30 mourners. The interviews were transcribed using the f4transkript transcription software and evaluated using qualitative content analysis according to Mayring. A category system was developed with four subcategories within the two main categories, Supporting and Hindering Factors. The following factors were identified: Supporting factors in the subcategory "Care of the sick and grieving person" include good symptom control and understanding treatment of the relatives, while poor communication, in turn, is a hindrance to positive grief coping. In the subcategory "Intrapersonal factors", the anticipation of death and dealing with grief are supportive, while negative emotions (e.g., feelings of guilt, helplessness) have a hindering effect in this regard. In the subcategory "Relationship with the deceased person", optimal use of the remaining time and open handling of the illness can be supporting factors, while a "difficult" farewell and unresolved conflicts or open questions can be obstacles to the grieving process. In the subcategory "Social environment", unsolicited support, emotional companionship, and a flexible employer are supporting. Family disputes and a lack of understanding from others, on the other hand, are hindering. Good and dignified end-of-life care, as is generally ensured in palliative medicine, is of great importance for a successful grieving process. Therefore, a palliative attitude should be promoted and expanded across disciplines. In society, more tolerance and understanding should be shown to mourners, and the topic of death and dying should be dealt with openly.

Tio psykodynamiskt inriktade legitimerade psykoterapeuter har intervjuats i syfte att undersöka vilka faktorer som bidrar till att komplicerad sorg utvecklas och vilka psykoterapeutiska interventioner som är hjälpsamma vid komplicerad sorg. I en tematisk analys framkom att komplicerad sorg innebär att den rörelse som finns i en normal sorgeprocess stannat upp och att de interventioner som terapeuterna beskriver syftar till att få igång en rörelse igen och som i sin tur leder till integrering av den som man förlorat, av den händelse man varit med om samt att ny mening och ny identitet skapas av detta. Resultatet visar att centrala interventioner är realitetsanpassning och acceptans, symbolisering och få ihop sin berättelse, att pendla mellan att vara i sorgen och i det funktionella, psykoedukation och normalisering samt den terapeutiska hållningen. Studiens resultat diskuteras i relation till den litteratur och forskning som inledningsvis beskrivs.

Trauma and grief often co-occur, however the degree to which these two constructs overlap or are distinguishable is still poorly understood. Homicidally bereaved individuals are exposed to both trauma and loss-related stressors. Previously collected data were used to explore the relationship between trauma and grief components in homicide bereavement distress, and whether homicide bereavement distress was distinguishable from that of other adverse life events. The overarching research question for this study was: Are event and loss related distress distinguishable among siblings bereaved by homicide,1 as measured on the Impact of Event Scale-Revised (IES-R)? Data from 67 individuals who lost a sibling to murder while growing up (Murder Group) were compared to data from 80 comparison individuals who grew up with a sibling (Comparison Group), but who had no experience of homicide bereavement. A cross-sectional, iterative survey design using group comparisons was used. Participants in the Murder Group reported significantly higher levels of current subjective distress compared with the Comparison Group. Among the siblings bereaved by the homicide loss of a sibling, event- and loss-related subjective distresses were highly and significantly correlated. In addition, both decreased significantly over time (years), and at similar rates. Preliminary findings from exploratory analyses of the IES-R provide insight into the avoidance, intrusion, and hyperarousal components of subjective distress following homicide loss. Findings will inform understanding of the overlap, and distinguishing features, of concurrent trauma and grief. Implications for theory and empirical research are noted, and recommendations for future research and counselling practice are discussed. / Graduate / 2017-09-13 / simpson9@uvic.ca

Background: Prolonged Grief Disorder (PGD) is now included in Section II of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM- 5-TR). To understand the health burden and then allocate economic and professional resources, it is necessary to provide epidemiological data for this new disorder. This is especially relevant since the new diagnostic criteria differ from its predecessors, which may affect the generalizability of previous findings. More information on the characteristics of people suffering from PGD is also beneficial to better identify individuals at risk. This study, therefore, aimed to estimate the prevalence of the new PGD criteria in a representative population-based sample, evaluate the factor structure, sociodemographic, and loss-related correlates of PGD caseness and explore possible predictors. Methods: Out of a representative sample of the German general population (N = 2,531), n = 1,371 (54.2%) reported to have experienced a significant loss throughout lifetime. Participants provided sociodemographic data and loss-related characteristics. PGD symptoms were measured using items from the German versions of the Prolonged Grief Scale (PG-13) and the Inventory of Complicated Grief (ICG), which could be matched to the DSM-5-TR criteria for PGD. Results: The conditional prevalence of PGD was 3.4% (n = 47). The most frequently reported symptoms were intense emotional pain and intense yearning or longing for the deceased. The confirmatory factor analysis confirmed a unidimensional model of PGD. Regression analysis demonstrated that time since the death, the relationship to the deceased, and unpreparedness for the death were significant predictors of PGD. Conclusion: Although the prevalence of 3.4% using the new diagnostic criteria is lower than the prevalence previously suggested by a meta-analysis, PGD remains a substantial disorder in the general population. In particular, the loss of a partner or child increases the risk for PGD, as does unpreparedness for the death of a loved one. Clinicians should pay particular attention to these high-risk groups. Further clinical implications are discussed.

(1) Background: The aim of the present study was to examine symptom classes of major depressive disorder (MDD), prolonged grief disorder (PGD), and posttraumatic stress disorder (PTSD) in a sample of suicide-bereaved individuals, while accounting for loss-related characteristics. (2) Methods: A latent class analysis was conducted to identify classes of the suicide bereaved, sharing symptom profiles, in a German suicide-bereaved sample (N = 159). (3) Results: Our analyses revealed three main classes: a resilient class (16%), a class with high endorsement probability for PGD symptoms (50%), and a class with high endorsement probability for combined PGD/PTSD symptoms (34%). Prolonged grief and intrusive symptoms emerged across all classes, while MDD showed low endorsement probability. Our results indicate an association between class membership and time passed since the loss; however, this applies only to the comparison between the PGD and the resilient class, and not for the PGD/PTSD class. (4) Conclusions: Our results may provide information about the predictability of symptom clusters following suicide bereavement. The findings also represent a significant step towards tailoring treatments based on the needs of relevant suicide-bereaved subgroups through a symptom-level approach. Time passed since loss might explain differences between symptom clusters.

Refugees from war zones often have missing significant others. A loss without confirmation is described as an ambiguous loss. This physical absence with simultaneous mental persistence can be accompanied by economic, social or legal problems, boundary ambiguity (i.e., uncertainty about who belongs to the family system), and can have a negative impact on mental health. The aim of this study was to identify sociodemographic and loss-related predictors for prolonged grief, anxiety, depression, post-traumatic stress disorder (PTSD) and somatization in treatment-seeking Syrian refugees with post-traumatic stress symptoms in Germany experiencing ambiguous loss. For the present study, data were based on the treatment-seeking baseline sample of the “Sanadak” randomized-controlled trial, analyzing a subsample of 47 Syrian refugees with post-traumatic stress symptoms in Germany experiencing ambiguous loss. Sociodemographic and loss-related questions were applied, along with standardized instruments for symptoms of prolonged grief (ICG), anxiety (GAD-7), depression (PHQ-9), PTSD (PDS-5) and somatization (PHQ-15). Linear regression models were used to predict mental health outcomes. Having lost a close family member and higher boundary ambiguity showed a statistically significant association with higher severity in prolonged grief. The overall model for somatization reached statistical significance, while no predictor independently did. Boundary ambiguity showed a statistically significant positive association with depression, while the overall model showed no statistically significant associations. Boundary ambiguity and missing family members seemed to be important predictors for prolonged grief. These findings support the importance of reunification programs and suggest an inclusion of the topic into psychosocial support structures, e.g., including psychoeducational elements on boundary ambiguity in support groups for traumatized individuals and families experiencing ambiguous loss. Further research is needed for a more detailed understanding of the impact of ambiguous loss on refugee populations.

The sudden or violent death of a loved one (e.g., suicide, homicide, accident, etc.) poses unique challenges for the bereaved. Research has found such losses to be associated with higher levels of chronic psychological distress, now termed Persistent Complex Bereavement Disorder in the DSM-5 and Prolonged Grief Disorder in the forthcoming ICD-11. The present study, developed through the lens of Multidimensional Grief Theory (MGT; Kaplow et al., 2013), explored underlying mechanisms and risk and protective factors for both prolonged grief and posttraumatic growth. With a mixed college and community sample of 374 traumatically bereaved adults, results of a path analysis suggest that insecure attachment strategies play a significant role in prolonged grief symptoms through the mediators of identity distress and shattered assumptions. Faced with the traumatic loss of a loved one, the ability and desire to effectively access relationships facilitating intentional processing that promotes cognitive reorganization is predicated on the bereaved's internal working model of attachment. Specifically, attachment anxiety in relation to close others and God, and attachment avoidance in relation to close others, were indirectly associated with prolonged grief. However, attachment avoidance in relation to God was negatively associated with both prolonged grief and posttraumatic growth, and there was no evidence for mediation. One explanation for this could be that individuals endorsing divine attachment avoidance are less likely to make negative religious attributions about the death, which have been associated with chronic psychological distress, but are also less likely to be able to utilize the sacred as a context for growth. By considering traumatically bereaved individuals' internal working model of attachment, level of identity distress, and potentially shattered assumptions, our model accounted for each of MGT's three domains of distress thought to impact post-lost adjustment. That these domains were both inter-related and associated with differential outcomes speaks to the complex nuances of each grief journey and the importance of attending to more than global levels of distress. These results inform the assessment and treatment of individuals bereaved through sudden or violent means.

Syftet med studien har varit att undersöka varför, hur och med vilket resultat en del sörjande söker professionellt samtalsstöd efter en närståendes död. Som forskningsdesign valdes en kvalitativ deskriptiv studie omfattande halvstrukturerade intervjuer med fem sörjande. Datamaterialet analyserades enligt Tema Analys. Studiens resultat pekar på att deltagarna har upplevt att deras sorg och behov av en längre sjukskrivning i sorgearbetet inte tagits på allvar av varken läkare, försäkringskassan eller arbetsgivare, vilket har orsakat dem onödig stress som försämrat sorgearbetet. Samtalsstödet inom den offentliga vården hos sjukhus, akutmottagning och vårdcentral har upplevts som icke tillfredställande p.g.a. personalens bristande förmåga att bemöta, informera och stödja sörjande.  Man har också upplevt att behandlingsmetoderna inte anpassas efter patienters specifika behov av hjälp utan utifrån politiska krav på lönsamhet och effektivitet. Den KBT-behandling som erbjuds upplevs inte vara lämplig för att kunna bearbeta en komplicerad sorg. Sörjande efterfrågar i stället psykodynamisk kris-/sorgterapi individuellt och/eller i grupp, som de upplevt positivt från privata vårdgivare, men som anses för dyrt. Svenska kyrkans kostnadsfria sorggrupper har också upplevts positivt, men icke troende och de som har en annan tro tvekar inför att söka sig dit. Det finns ett starkt behov av förbättringar inom professionellt samtalsstöd som idag erbjuds sörjande i Sverige. Det vore önskvärt att fler läkare utbildas till psykoterapeuter så att sörjande skulle kunna få både medicinsk och psykoterapeutisk behandling av en och samma person. Detta skulle bidra till ökad trygghet som är positivt i sorgearbete. Införande av den diskuterade diagnosen förlängt sorgesyndrom i det kommande DSM-V och ICD11, skulle förmodligen underlätta för sörjande att få rätt till sjukskrivning och ge enklare tillgång till lämplig och subventionerad samtalsbehandling. Detta skulle kunna bidra till bättre hälsa och snabbare återgång till arbetslivet, vilket är positivt både ur mänskligt såväl som samhällsmässigt perspektiv.

Frågan om ”normal” respektive ”patologisk” sorg har under en lång tid varit ett omdiskuterat ämne inom psykologin och psykiatrin. En grupp forskare har tagit fram kriterier på ett syndrom som fått benämningen ihållande sorg (”prolonged grief”). Studier har visat på att ihållande sorg är ett distinkt syndrom separat från depression, posttraumatisk stressyndrom och generaliserat ångestsyndrom. Ihållande sorg föreslås ingå som en diagnos i de kommande versionerna av de diagnostiska manualerna DSM och ICD. Syftet med denna studie var att översätta självskattningsinstrumentet Prolonged Grief Disorder (PG-13) till svenska, och undersöka dess reliabilitet och validitet genom bland annat en explorativ och konfirmatorisk faktoranalys. Studien genomfördes på ett annonsrekryterat heterogent sample (n=162 varav 90 % var kvinnor) vad gäller typ av dödsfall och relation till den avlidne. Respondenterna besvarade en webb- eller pappersenkät som bestod av 75 items. PG-13 bedöms ha en hög reliabilitet, god begrepps- och samtidig validitet samt en måttlig diskriminativ validitet.