Same-sex partner bereavement in older women:an interpretative phenomenological analysis

Objectives: Due to the lack of existing literature, the current research explored experiences of same-sex partner bereavement in women over the age of 60. Method: Semi-structured interviews were conducted with eight women. Transcripts were analysed using interpretative phenomenological analysis. Results: Three themes were identified which elaborated the experiences of older women who had lost a same-sex partner: (1) being left alone encapsulated feelings of isolation and exclusion; (2) navigating visibility centred on how homophobia led to a lack of recognition of the women's grief; and (3) finding new places to be authentic related women's need for new relationships in which they could be themselves. The findings indicate that existing models of partner bereavement may provide useful frameworks when seeking to understand the experiences of older women who have lost their same-sex partners. Conclusion: The findings indicate that in addition to the experiences of partner bereavement noted in research with heterosexual widows, older women who lose same-sex partners may face particular challenges, which can impact upon psychological well-being and adjustment to loss. These challenges appear to result from past and current homophobic and heterosexist attitudes within the UK culture. A range of interventions at individual, group, health service, and societal levels may be beneficial in improving the psychological well-being of older women who lose a same-sex partner

Effect of a bereavement support group on female adolescents’ psychological health: a randomised controlled trial in South Africa

Background Bereavement increases children’s risk for psychological disorders, highlighting the need for effective interventions, especially in areas where orphanhood is common. We aimed to assess the effects of an eight-session support group intervention on the psychological health of bereaved female adolescents in South Africa. Methods This randomised controlled trial enrolled female adolescents at 11 schools in three peri-urban towns of Free State province, South Africa. 453 bereaved ninth-grade students aged 13–17 years who had expressed interest in taking part in the group were randomly assigned (1:1) to receive the intervention or to be waitlisted for programme enrolment after the study period and serve as the control group. The intervention, Abangane (“friends” in isiZulu), is a locally derived, curriculum-based support group focused on coping with loss incorporating indigenous stories and cognitive behavioural therapy components. Weekly group sessions were facilitated by trained social workers or social auxiliary workers from a local non-profit organisation. The primary outcomes included indicators of grief and depression as reported by adolescents and behavioural problems reported by their caregivers. Grief was measured with three scales: the grief subscale of the Core Bereavement Items to assess normative grief; and the Intrusive Grief Thoughts Scale and the Inventory of Complicated Grief–Revised for Children to assess maladaptive grief symptoms in the past 4 weeks. Depression symptoms in the past 7 days were measured with the Center for Epidemiological Studies–Depression Scale for Children. Caregivers completed the Brief Problem Monitor-Parent Form to report on adolescent’s behaviour in the previous 4 weeks. Analysis was intention to treat. This study is registered with ClinicalTrials.gov, number NCT02368808. Findings Between Sept 30, 2014, and Feb 5, 2015, eligible female participants were identified, of whom 226 were assigned to the intervention, Abangane, and 227 were assigned to the waitlisted control group. Analysis included 382 adolescents who completed both surveys (193 participants assigned to Abangane and 189 assigned to waitlist). At follow up, the intervention group had significantly lower scores for primary outcomes, including intrusive grief (p=0·000, Cohen’s d=–0·21), complicated grief (p=0·015, d=–0·14), and depression (p=0·009, d=–0·21) relative to the waitlisted group, while core bereavement scores were similar between groups (p=0·269). Caregivers in the intervention group reported lower levels of behavioural problems among adolescents (p=0·017, d=–0·31). Interpretation Short-term, structured, theory-based support groups with contextually relevant content show promise in mitigating psychological and behavioural problems among bereaved adolescents. Abangane is replicable in resource limited settings, using freely available curriculum materials, existing programme structures, and appropriately trained personnel to implement it

Seeing the wood for the trees. Carer related research and knowledge: A scoping review

This NIHR-SSCR funded scoping review provides a comprehensive mapping of what is known about carers and caring, and aims to help inform policy, practice and research in relation to carers. The review was undertaken by searching 10 electronic bibliographic databases, supplemented by additional web searches to identify academic research, grey literature and wider knowledge. The analysis adopts a selective thematic approach covering: carer variables - the characteristics of different types of carer and different caring situations; types of care - the nature of needs of the cared for person and the features of the care situation; the impact of caring – resilience and coping, employment and health; and carer support and needs assessment. The final section highlights key messages identified from the review. It found that caring involves all sections and age groups of the population, with people are likely to experience one or more periods of caregiving over their lifetime. The uniqueness of each caring relationship is also highlighted. In relation to types of carers, knowledge about ‘hard to reach’ groups, such as BAME and LGBT carers, remains sparse. Older carers are also relatively invisible in policy and research terms. It found that much of the knowledge about carers identified in the review relates to their characteristics, their lived experience and the nature of their caregiving, with relatively less being known about the effectiveness of interventions to support them. The report concludes by offering suggestions for policy and practice. An appendix provides a bibliography of the 3,434 items identified in review, classified into 17 types of reference

Overcoming barriers to grief:supporting bereaved people with profound intellectual and multiple disabilities

Objectives: Engaging people with profound intellectual and multiple disabilities (PIMD) in relation to issues of bereavement and loss is often seen as a complex therapeutic challenge. The author examines the barriers preventing them from engaging with the grieving process in supported ways. Methods: Through the lens of Worden’s Tasks of Grief model, the author provides an assessment of the social, emotional, and physical constraints that impact on the person’s experience of bereavement. Results: Although there are some similarities between people with PIMD and their more able peers, there are some additional factors which may place people with PIMD at greater risk of complicated grieving. In addition, this paper identifies the socio-contextual factors that can mediate experiences of and reactions to loss in this group. Within this framework, the limitations of a purely cognitivist approach to this area are demonstrated. Conclusion: This conceptual paper encourages therapeutic practice with people with PIMD, which partly focuses on enabling the grieving process. Suggestions and approaches for support, including multi-sensory methods, are offered

Self-regulation and wellbeing when facing a blocked parenthood goal: a systematic review and meta-analysis

Developmental regulation theories claim that continuing to pursue a goal when it becomes blocked contributes to poorer wellbeing. This consequence is expected to lead to the use of self-regulation strategies in the form of higher disengagement from the goal and higher reengagement in other meaningful goals. The use of these strategies is expected to lead to better wellbeing. A systematic-review and meta-analyses were conducted to test the major predictions of developmental regulation theories for blocked parenthood goal and to investigate possible moderator variables, particularly type and degree of blockage. A total of eight meta-analyses were performed using random-effects models. Moderation was tested with subgroup analysis. After searching eight databases, 4977 potential relevant manuscripts were identified but only six met inclusion criteria. From the eight meta-analyses conducted, only two were significant. In line with prediction, higher goal blockage was related to higher negative mood and reengagement in other life goals was associated to higher positive mood (p < .001). From a total of eight subgroup analyses performed, results showed that disengaging had a positive impact on wellbeing for people experiencing an unanticipated type of blockage (i.e., infertility) but not for those with an anticipated one (i.e., postponing parenthood; X2 = 4.867, p = .03). From the total of twelve sensitivity analyses performed only one suggested that results might differ. The association between disengagement and mood varied according to study quality. When only average studies were included this association was negative, although non-significant. The evidence obtained did not fully support developmental regulation theories for the pursuit of parenthood goal, but primary research had too many methodological limitations to reach firm conclusions. Future studies aimed at investigating blocked parenthood goal are required to evaluate the value of developmental regulation theories

The marginalisation of religion in End of Life Care: signs of microaggression?

Service users very often interpret and respond to their experiences of death, dying and bereavement through a religious or spiritual lens. However, recent trends in religion and belief have influenced how professionals respond to indicators such as faith. Since the post-war years in Britain, and due to the transfer of services from church to state, as well as the change in the religious landscape, language has largely secularized. When people start addressing religion and belief again, they lack the appropriate literacy to do so; this is termed religious literacy by Dinham (2015). This paper explores how professionals in end of life care respond to service users’ religious and spiritual indicators, through the lens of religious literacy. The paper draws from an ethnographic study undertaken across hospices in England, UK. In this study healthcare professionals were observed for one calendar year. Results show that lack of religious literacy on the part of healthcare professionals may lead to subtle and unintentional microaggression. Three types of indications of microinvalidation have been noted: verbal, non-verbal and environmental

Bereavement in Times of COVID-19:A Review and Theoretical Framework

A review of the literature on adaptation to bereavement during the COVID-19 pandemic was conducted to assess the current state of knowledge. Scopus, Web of Science and Google Scholar databases were searched for studies published during the first 6 months of the COVID-19 outbreak. 44 articles were included in the review. Narrative synthesis showed that knowledge was largely based on expert assessments of prior bereavement research and professional experience; there is so far absence of empirical evidence linking features of COVID-19 bereavement situations to health outcomes. Severe negative consequences have been consistently predicted by authors. There is still relatively little consideration of positive or compensatory processes or the possibility that these could alleviate the effect of the shocking, traumatic circumstances. With two notable exceptions, there has been lack of attention to the role of theoretical models for guiding research and practice. A theoretical perspective (the Dual Process Model, DPM) was applied to the information derived from the available articles. Two features of the DPM framework illustrated its relevance: 1. It enables systematic assessment of the range of loss- and restoration-related challenges for the bereaved; 2. It speaks for extension of psychotherapeutic intervention to manage secondary, restoration- as well as primary, loss-oriented stressors; studies have demonstrated that this may increase the effectiveness of intervention. Directions for future research and DPM application are suggested

Restoration-oriented stressors of bereavement

Background and objectives: The Dual Process Model of Coping with Bereavement holds that bereaved people who respond flexibly to loss-oriented stressors (i.e., relating to the loss; to the deceased person) and restoration-oriented stressors (i.e., secondary to loss; daily-life changes, taking on new roles) adapt better to bereavement. Despite growing interest in the Dual Process Model, systematic analyses of the prevalence, characteristics, and correlates of restoration-oriented stressors are lacking. Therefore, we aimed to chart restoration-oriented stressors and their relationship with post-loss adaptation. Design and methods: A community sample of 181 bereaved adults (63% women) completed the 20-item expert-construed Restoration-Oriented Stressors Inventory (ROSI) and questionnaires assessing background characteristics, worry, and prolonged grief and depression symptoms. Results: Main findings were that younger people, and those who lost a parent, partner, or child (vs. other relationship) experienced more restoration-oriented stressors and appraised these as more stressful. Stressors’ perceived stressfulness, but not their quantity, related positively to worry. Perceived stressfulness predicted prolonged grief and depression symptoms beyond background characteristics, worry, and the number of stressors. Conclusion: Restoration-oriented stressors and their appraisal vary and relate to coping and post-loss mental health. Future research should clarify temporal interrelations between stressors, coping mechanisms, and outcomes