The economic cost of bereavement in Scotland.

Aspects of the socioeconomic costs of bereavement in Scotland were estimated using 3 sets of data. Spousal bereavement was associated with increased mortality and longer hospital stays, with additional annual cost of around {pound}20 million. Cost of bereavement coded consultations in primary care was estimated at around {pound}2.0 million annually. In addition, bereaved people were significantly less likely to be employed in the year of and 2 years after bereavement than non-bereaved matched controls, but there were no significant differences in income between bereaved people and matched controls before and after bereavement

Recovery of health-related quality of life after burn injuries: An individual participant data meta-analysis

BACKGROUND: A prominent outcome measure within burn care is health related quality of life (HRQL). Until now, no model for long-term recovery of HRQL exists for adult burn patients which requires large samples with repeated measurements. Re-use and the combination of existing data is a way to achieve larger data samples that enable the estimation of long-term recovery models. The aim of this secondary data analysis was to assess the recovery of HRQL after a burn injury over time. METHODS AND FINDINGS: Data from ten European studies on generic HRQL assessed in adult burn patients (either with the EQ-5D or SF-36) from five different countries were merged into one dataset. SF-36 outcomes were transformed into EQ-5D outcomes. A 24-month recovery of HRQL (EQ-5D utility) was modeled using a linear mixed-effects model and adjusted for important patient and burn characteristics. Subgroups of patients with mild and intermediate burns (≤20% total body surface area (TBSA) burned) and with major burns (>20% TBSA burned) were compared. The combined database included 1687 patients with a mean age of 43 (SD 15) years and a median %TBSA burned of 9% (IQR 4-18). There was large improvement in HRQL up to six months after burns, and HRQL remained relatively stable afterwards (studied up to 24 months post burn). However, the estimated EQ-5D utility scores remained below the norm scores of the general population. In this large sample, females, patients with a long hospital stay and patients with major burns had a delayed and worse recovery. The proportion of patients that reported problems for the EQ-5D dimensions ranged from 100% (pain/discomfort at baseline in patients with major burns) to 10% (self-care ≥3 months after injury in patients with mild and intermediate burns). After 24 months, both subgroups of burn patients did not reach the level of the general population in the dimensions pain/discomfort and anxiety/depression, and patients with major burns in the dimension usual activities. A main limitation of the study includes that the variables in the model were limited to age, gender, %TBSA, LOS and time since burn as these were the only variables available in all datasets. CONCLUSIONS: The 24-month recovery model can be used in clinical practice to inform patients on expected HRQL outcomes and provide clinicians insights into the expected recovery of HRQL. In this way, a delayed recovery can be recognized in an early stage and timely interventions can be started in order to improve patient outcomes. However, external validation of the developed model is needed before implementation into clinical practice. Furthermore, our study showed the benefit of secondary data usage within the field of burns

Understanding lack of understanding: Invalidation in rheumatic diseases

The quality of life of patients with chronic rheumatic diseases is negatively influenced by symptoms such as pain, fatigue, and stiffness, and secondary symptoms such as physical limitations and depressive mood. On top of this burden, some patients experience negative responses from others, such as lack of understanding, disbelief, distrust, or being accused of exaggerating the symptoms and consequences of the disease. We call these negative responses of others ‘invalidation’. Invalidation might be due to the invisibility of symptoms for people in the social environment of the patient. Rheumatic diseases that lack objective physical or laboratory features or well-characterized pathologic findings to diagnose the illness, such as fibromyalgia, might especially provoke invalidation. However, little is known about the prevalence and consequences of invalidation as no adequate instrument exists to assess invalidation in patients with rheumatic diseases. Aim of this dissertation was to develop a questionnaire to quantify invalidation in patients with diverse rheumatic diseases and to determine its prevalence, associated variables, and consequences. First, the definition and structure of the concept ‘invalidation’ was studied. Patients described invalidation experiences as active negative social responses (denying, lecturing, and overprotecting) as well as a lack of positive social responses (supporting and acknowledging) with respect to the patient and the condition of the patient. Subsequently, this definition of invalidation was used to develop a questionnaire to measure invalidation, which we called the ‘Illness Invalidation Inventory (3*I)’. The 3*I assess invalidation from five different social environments: spouse, family, medical professionals, work environment, and social services. Patients with rheumatic diseases reported to experience more invalidation by social services, the work environment, and the family than by the spouse and medical professionals. Patients with the rheumatic disease, fibromyalgia, experienced more invalidation than patients with rheumatoid arthritis. Patients who experienced more invalidation had more severe symptoms, a worse mental wellbeing, and they were more often lonely. Emphasizing the perspective of the social environment, rheumatologists experienced little invalidation towards patients in general, but some did experience more invalidation towards patients with fibromyalgia than towards patients with rheumatoid arthritis. Spouses of patients with fibromyalgia and of patients with rheumatoid arthritis estimated the severity of the symptoms of their (patient) spouse fairly similar. This dissertation shows that invalidation can be a problem for patients with rheumatic diseases and especially for patients with fibromyalgia. Invalidation can have a negative effect on the quality of life of patients. It is therefore important to include invalidation in scientific research. Education about invalidation and its effects is important for patients as well as for people in the social environment of the patient. Future studies should focus on the causes and consequences of invalidation to be able to develop effective interventions

Waarom leidt de strijd voor rechtvaardigheid tot meer rouwklachten?

Verlies van werk heeft een grote impact op psychische welzijn van mensen, wat zelfs kan leiden tot klachten rouw, depressie en angst. Hoe meer het ontslag als onrechtvaardig en onverwacht wordt ervaren, hoe groter de kans is dat de persoon vastloopt in het rouwproces bij baanverlies. De strijd voor rechtvaardigheid gaat vaak hand in hand met letselschade. Deze strijd kan ertoe leiden tot de persoon langer blijft hangen in boosheid en meer gebruik maakt van onhandige copingstijlen, en dat kan een negatieve impact hebben om de mentale gezondheid en belemmerend werken in de zoektocht naar een andere baan. Tijdige herkenning van signalen dat de persoon vast dreigt te lopen, kan dan ook veel leed besparen

Challenges in evaluating adult bereavement services

Evaluating the effectiveness of bereavement interventions presents major theoretical, ethical and practical challenges. Based on the extensive research experience of the authors, this article outlines some of the key considerations that must be addressed when seeking to demonstrate the effectiveness of an intervention. These include what methods to use, the recruitment of participants, what to measure to demonstrate effectiveness, adapting measures to reflect cultural and other diversities, and how to deal with variables likely to influence the delivery and outcomes of the intervention

Psychophysiological Consistency and Personality

Psychophysiological Consistency and Personality presents an experimental analysis of human individuality as reflected in instantaneous responses to ever-changing situations. Insight into such behavior is considered to be of crucial importance to obtain a complete view of individual functioning in everyday life, and is essential to the growth of knowledge in several areas of psychology such as emotions, information processing, stress and coping, and the etiology and maintenance of psychosomatic and psychoneurotic complaints. The broader context of the study is the area of personality psychology. The perspective is interactional. In daily life, many acts, thoughts, and feelings occur spontaneously. Consequently, more conventional assessment methods such as the questionnaire method, will often not suffice to learn more about instantaneous behavior in complex situations. In this study, films are used as stimulus material, whereas the responses studied are physiological reactions. Methods developed within the context of generalizability theory are used to estimate the amount of behavioral variation arising from multiple sources. In view of the many ambiguities still existing in this area, a large part of the book deals with measurement problems inherent to studies of psychophysiological consistency

Working through job loss: Characteristics and consequences of complicated grief following job loss

Although the majority of the individuals confronted with involuntary job loss show stable levels of healthy functioning after job loss, a significant minority develops symptoms of job loss-related complicated grief (JLCG). Research on grief following bereavement loss showed that complicated grief symptoms include reactions like separation distress, yearning, preoccupation with the loss, anger, bitterness, and the feeling that life is meaningless, causing persistent suffering and impairments in daily life. It seemed conceivable that if JLCG symptoms are in some way similar to complicated grief symptoms following bereavement loss, they could not just negatively affect one’s psychological well-being, but could also form an obstacle to re-entering the labour market. Hence, the main research question of this dissertation was: ‘What are characteristics and correlates of complicated grief symptoms following job loss?’. This research question was addressed in eight chapters drawing on various samples, study designs and statistical techniques. The findings of these studies show that individuals can experience complicated grief symptoms after involuntary job loss. Factor and latent class analyses indicated that complicated grief symptoms differ from anxiety and depression symptoms after involuntary job loss. Avoidance strategies and negative cognitions related to the job loss were repeatedly associated with the intensity of JLCG symptoms. The results of diary study indicated that when someone perceives daily activities as more useful, one will experience more fulfilment of the basic needs (e.g., the need for affiliation or the need for time structure) and less emotional distress. Based on the findings in these empirical studies, a cognitive-behavioural framework was introduced to explain the underlying mechanisms of complicated grief symptoms after involuntary job loss. Three core processes play a central role, namely 1) negative cognitions related to the job loss, 2) anxious and depressive avoidance behaviour, and 3) insufficient integration of the loss in the autobiographical memory. These three core processes can be influenced by certain risk factors, such as circumstances surrounding the job loss, personality traits, and the social environment. JLCG symptoms can lead to an increase of psychological problems, emotional distress, reduced employability, depletion of resources, and a decreased chance of re-employment. In conclusion, the majority of individuals recover well after involuntary job loss, while a significant minority remains stranded and experiences high levels of emotional stress. The work within this dissertation shows that within this minority we should not only focus on symptoms of depression and anxiety, but also pay attention to the complicated grief symptoms in order to identify and treat vulnerable individuals in an early stage after involuntary job loss