Identifying systems barriers that may prevent bereavement service access to bereaved carers: A report from an Australian specialist palliative care service

Background: Bereavement follow up is an integral element of palliative care. However, little is known about the systems that link bereavement services with bereaved carers. Aim: To map how effectively a specialist palliative care service linked bereavement service to bereaved carers. Methodology: A retrospective medical audit, using process mapping was undertaken within one Australian specialist palliative care service to identify the systems that linked bereavement services to a consecutive cohort of palliative care decedents (n=60) next of kin. Results: Bereavement records were located for 80% of decedents. Nearly all (98%) had a nominated next of kin, with just over half (54%) of those nominated contacted by bereavement services. Incomplete or missing contact details was the main reason (75%) that the bereavement service was unable to contact the decedents’ next of kin. Conclusion: Having access to a designated bereavement service can ensure that bereaved next of kin are contract routinely and in a timely way. However the effectiveness of this type of service is dependent upon the bereavement service having access to all relevant contact information. There are numerous opportunities to refine and strengthen the recording of palliative care next of kin details to optimize follow up

Initiation of Psychotropic Medication after Partner Bereavement: A Matched Cohort Study

Background Recent changes to diagnostic criteria for depression in DSM-5 remove the bereavement exclusion, allowing earlier diagnosis following bereavement. Evaluation of the potential effect of this change requires an understanding of existing psychotropic medication prescribing by non-specialists after bereavement. Aims To describe initiation of psychotropic medication in the first year after partner bereavement. Methods In a UK primary care database, we identified 21,122 individuals aged 60 and over with partner bereavement and no psychotropic drug use in the previous year. Prescribing (anxiolytic/hypnotic, antidepressant, antipsychotic) after bereavement was compared to age, sex and practice matched controls. Results The risks of receiving a new psychotropic prescription within two and twelve months of bereavement were 9.5% (95% CI 9.1 to 9.9%) and 17.9% (17.3 to 18.4%) respectively; an excess risk of initiation in the first year of 12.4% compared to non-bereaved controls. Anxiolytic/hypnotic and antidepressant initiation rates were highest in the first two months. In this period, the hazard ratio for initiation of anxiolytics/hypnotics was 16.7 (95% CI 14.7 to 18.9) and for antidepressants was 5.6 (4.7 to 6.7) compared to non-bereaved controls. 13.3% of those started on anxiolytics/hypnotics within two months continued to receive this drug class at one year. The marked variation in background family practice prescribing of anxiolytics/hypnotics was the strongest determinant of their initiation in the first two months after bereavement. Conclusion Almost one in five older people received a new psychotropic drug prescription in the year after bereavement. The early increase and trend in antidepressant use after bereavement suggests some clinicians did not adhere to the bereavement exclusion, with implications for its recent removal in DSM-5. Family practice variation in use of anxiolytics/hypnotics suggests uncertainty over their role in bereavement with the potential for inappropriate long term use

Do good health and material circumstances protect older people from the increased risk of death after bereavement?

This is an open access Article. Copyright @ 2012 The AuthorsAn increased risk of death in persons who have suffered spousal bereavement has been described in many populations. The impact of modifying factors, such as chronic disease and material circumstances, is less well understood. The authors followed 171,120 couples 60 years of age or older in a United Kingdom primary care database between 2005 and 2010 for an average of 4 years. A total of 26,646 (15.5%) couples experienced bereavement, with mean follow up after bereavement of 2 years. In a model adjusted for age, sex, comorbid conditions at baseline, material deprivation based on area of residence, season, and smoking status, the hazard ratio for mortality in the first year after bereavement was 1.25 (95% confidence interval: 1.18, 1.33). Further adjustment for changes in comorbid conditions throughout follow up did not alter the hazard ratio for bereavement (hazard ratio = 1.27, 95% confidence interval: 1.19, 1.35). The association was strongest in individuals with no significant chronic comorbid conditions throughout follow up (hazard ratio = 1.50, 95% confidence interval: 1.28, 1.77) and in more affluent couples (P = 0.035). In the first year after bereavement, the association between bereavement and death is not primarily mediated through worsening or new onset of chronic disease. Good health and material circumstances do not protect individuals from increased mortality rates after bereavement.This study was funded by a grant from the Dunhill Medical Trust

Long-term prevalence and predictors of prolonged grief disorder amongst bereaved cancer caregivers: A cohort study

Context: The short-term impact of prolonged grief disorder (PGD) following bereavement is well documented. The longer term sequelae of PGD however are poorly understood, possibly unrecognized, and may be incorrectly attributed to other mental health disorders and hence undertreated. Objectives: The aims of this study were to prospectively evaluate the prevalence of PGD three years post bereavement and to examine the predictors of long-term PGD in a population-based cohort of bereaved cancer caregivers. Methods: A cohort of primary family caregivers of patients admitted to one of three palliative care services in Melbourne, Australia, participated in the study (n = 301). Sociodemographic, mental health, and bereavement-related data were collected from the caregiver upon the patient\u27s admission to palliative care (T1). Further data addressing circumstances around the death and psychological health were collected at six (T2, n = 167), 13 (T3, n = 143), and 37 months (T4, n = 85) after bereavement. Results: At T4, 5% and 14% of bereaved caregivers met criteria for PGD and subthreshold PGD, respectively. Applying the total PGD score at T4, linear regression analysis found preloss anticipatory grief measured at T1 and self-reported coping measured at T2 were highly statistically significant predictors (both p \u3c 0.0001) of PGD in the longer term. Conclusion: For almost 20% of caregivers, the symptoms of PGD appear to persist at least three years post bereavement. These findings support the importance of screening caregivers upon the patient\u27s admission to palliative care and at six months after bereavement to ascertain their current mental health. Ideally, caregivers at risk of developing PGD can be identified and treated before PGD becomes entrenched

Peer-group support for bereaved children: a qualitative interview study

Background:  While it has been shown that bereaved children can experience emotional or behavioural problems, the evidence is inconclusive regarding which children would benefit from support and the kind of support to offer. This study aimed to obtain children’s and parents’ views on their experiences following bereavement and the usefulness of a peer-group support programme. Method:  Thirty-nine families who had attended a community-based peer-group bereavement support programme within the previous 4 years were approached. Of the 23 with confirmed contact details, 17 agreed to participate. Qualitative interviews were conducted with 23 children (range 8 to 17 years) and 17 parents. Results:  Children were concerned about isolation from peers and emphasized the value of meeting other children with experiences of bereavement in the group. Parents were concerned about lack of communication within the home about the bereavement, which continued after the group. Most children and parents would have liked more support, either more groups or an ongoing link. Conclusions:  Referral to peer-group support may have the potential to improve bereaved children experiencing feelings of social isolation and help them develop coping strategies. Other family-focused support may also be needed for some children

Streams of bereavement

This article offers “streams of bereavement” narratives across time. The author seeks to present a multilayered voiced account through vignettes and poems about the loss of her father who died 20 years ago. This aims to address the complex and traumatizing nature of living with grief and the shifting and multifaceted ways a young bereaved daughter might try and make sense of such a loss. This article is in response to reading “Fathers and Sons: Bits and Pieces” and the call for more in-depth qualitative inquiries into parentally bereaved young people. These narratives are offered in the hope that humane connections are discovered that facilitate others to make sense of a similar life event

Pedagogical Techniques that Provide Educational Value to Social Work Students through Bereavement Academics and Empathetic Advancements

The lack of empathy in college students has been documented and empathy levels are reported to have declined over recent years. College student bereavement has not been well-researched (Balk, 2008) but the lack of declining college student empathy has documentation in psychological expressions (Balk, 2008). This article addresses social work students engaged in an academic bereavement assignment that incorporates student centered instruction (SCI) and “teaching through relationships.” Using an untimely social work students’ death, students utilize research, reflection, cooperative small group learning, and applied theory, to compose a writing assignment. Intentionally introducing the “sorrowful empty chair” in the bereavement assignment led to reflective thoughts that are equal to empathy and shows a reflection model in production. Applying theoretical framework to current events aids students understanding of theory. While current events’ research improves student research skills as well as their theoretical understanding, the application of theoretical frameworks and current events with research, leads to an increase in student devotion and commitment to produce good work

Towards an understanding of bereavement in the pathway to suicide

Abstract Key Points 1. Suicide bereavement is associated with increased depression and risk of suicide. The increasing rate of suicide in Northern Ireland presents a major challenge to health and social care policy. 2. To date policy development on the topic has been hampered by a lack of local evidence. Contextually specific research reports are now emerging to strengthen the evidence-base. 3. The findings from our own study suggest that people bereaved by suicide include extended family members and members of the wider community, who can experience lengthy periods of depression and anxiety. 4. Bereaved family members and significant others, may require more nuanced, multi-dimensional interventions, provided over extended periods of time, in order to facilitate varied and complex grief processes. 5. A focus on empowerment, education and information may provide results that are as effective as increasing access to psychological services – these approaches should exist in tande

Dadless: Dead Dads In Hamlet And The Effects On Their Children

This research is a close look at the methods of grief as depicted by the children who lose their fathers in William Shakespeare’s classic, Hamlet. The goal is to track each child’s reaction to the sudden bereavement in a variety of physical and emotional manifestations. This has been done by first examining current literature on the text, followed by a review of historical context of the period in which the play was written, and finally analyzing each character’s behavior. In doing so, this research seeks to highlight the importance of the presence of fathers within Hamlet and provide insight as to how bereavement shapes the narrative of not only a series of characters, but also of hundreds of years’ worth of audiences

What are Canadian Labor Laws as They Relate to Leave Administration, Specifically Military, Disability, FMLA, Vacation and Bereavement?

Question: What are Canadian labor laws as they relate to leave administration, specifically military, disability, FMLA, vacation and bereavement? How do these laws in Alberta, Ontario and Quebec differ from U.S. laws