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

Cautioning Health-Care Professionals:Bereaved Persons Are Misguided Through the Stages of Grief

Science and practice seem deeply stuck in the so-called stage theory of grief. Health-care professionals continue to "prescribe" stages. Basically, this perspective endorses the idea that bereaved people go through a set pattern of specific reactions over time following the death of a loved one. It has frequently been interpreted prescriptively, as a progression that bereaved persons must follow in order to adapt to loss. It is of paramount importance to assess stage theory, not least in view of the current status of the maladaptive "persistent complex bereavement-related disorder" as a category for further research in DSM-5. We therefore review the status and value of this approach. It has remained hugely influential among researchers as well as practitioners across recent decades, but there has also been forceful opposition. Major concerns include the absence of sound empirical evidence, conceptual clarity, or explanatory potential. It lacks practical utility for the design or allocation of treatment services, and it does not help identification of those at risk or with complications in the grieving process. Most disturbingly, the expectation that bereaved persons will, even should, go through stages of grieving can be harmful to those who do not. Following such lines of reasoning, we argue that stage theory should be discarded by all concerned (including bereaved persons themselves); at best, it should be relegated to the realms of history. There are alternative models that better represent grieving processes. We develop guidelines to enhance such a move beyond the stage approach in both theory and practice

Stages of Grief Portrayed on the Internet:A Systematic Analysis and Critical Appraisal

Kübler-Ross’s stage model of grief, while still extremely popular and frequently accepted, has also elicited significant criticisms against its adoption as a guideline for grieving. Inaccurate portrayal of the model may lead to bereaved individuals feeling that they are grieving incorrectly. This may also result in ineffectual support from loved ones and healthcare professionals. These harmful consequences make the presentation of the five stages model an important area of concern. The Internet provides ample resources for accessing information about grief, raising questions about portrayal of the stages model on digital resources. We therefore conducted a systematic narrative review using Google to examine how Kübler-Ross’s five stages model is presented on the internet. We specifically examined the prominence of the model, whether warnings, limitations and criticisms are provided, and how positively the model is endorsed. A total of 72 websites were eligible for inclusion in the sample. Our analyses showed that 44 of these (61.1%) addressed the model, indicating its continued popularity. Evaluation scores were calculated to provide quantitative assessments of the extent to which the websites criticized and/or endorsed the model. Results indicated low criticalness of the model, with sites often neglecting evaluative commentary and including definitive statements of endorsement. We conclude that such presentation is misleading; a definitive and uncritical portrayal of the model may give the impression that experiencing the stages is the only way to grieve. This may have harmful consequences for bereaved persons. It may alienate those who do not relate to the model. Presentation of the model should be limited to acknowledging its historical significance, should include critical appraisal, and present contemporary alternative models which better-represent processes of grief and grieving

Why dieters fail: testing the goal conflict model of eating

A new theory of eating regulation is presented to account for the over-responsiveness of restrained eaters to external food-relevant cues. According to this theory, the food intake of restrained eaters is characterized by a conflict between two chronically accessible incentives or goals: eating enjoyment and weight control. Their difficulty in weight control is due to their behavioral sensitivity to eating enjoyment and its incompatibility with the eating control goal. Accordingly, exposure to food-relevant stimuli primes the goal of eating enjoyment in restrained (but not unrestrained) eaters, resulting in an inhibition of weight control thoughts. Three studies are reported that support these assumptions. Study 1 demonstrates a substantial relation between Eating Restraint and measures of ambivalence towards eating. Studies 2 and 3 show that priming eating enjoyment decreases the accessibility of eating control concepts. The results are discussed in the context of current research on the psychology of obesity and restrained eating

From fed by the world to food security : Accelerating agricultural development in Africa

This document presents the results of a search for policies and conditions that can help accelerate agricultural development in Africa. This development has been limited in many countries, as evinced by extreme low fertilizer use, low crop yields, poverty and high food insecurity. The rate of development is quantitatively described for the period 1961–2014 for almost fifty countries, those of the African mainland plus Madagascar, on the basis of data on the average cereal yield and fertilizer use. The way the rainfall impacts on the fertilizer-yield relationship has been studied, by comparing contrasting rainfall transects in Western and Southern Africa, occupied by respectively 19 and 9 countries. On the basis of data from the period 1981–2014, it is shown that soil fertility dominated over rainfall in determining crop yields. Data on the evolution of cereal yield rates over the entire 1961–2014 period have been used for dividing the 49 countries into two main groups, subdivided into four and two classes. In the first group of countries, the yields per hectare increased, in different degrees. The second group includes one class of countries with stagnating yields since 1961, and one that at present has lower yields than in 1961. Here, any increase in food production has come from area expansion. All countries have been categorized on the basis of socio-economic as well as agro-ecological conditions. The comparison of classes enables the identification of stimuli and obstacles for agricultural development. The role of policies for change has been studied as well, with a view to identifying policies that can help accelerate agricultural development in Africa. The dominance of poor soils, often combined with difficult climates, explains in part why agricultural development has been slow. In many places, the low average natural production conditions have resulted in a population density that is much too low to allow for a financially beneficial use of fertilizer and other external agricultural inputs. The high costs of transport and trade, and of food and labor, have seriously hindered agricultural development in many African countries. Market oriented production, for the national or the international market, did not become the driver for development, in contrast to countries with more suitable climates and better soils. A hopeful tendency emerges from this study: African agricultural development is taking off in response to population growth, as is shown by the cereal yield and fertilizer use adoption trends in many countries. Three quarters of the African population lives in countries with positive yield growth rates, with some of them having reached Green Revolution growth rates. Policies and conditions are presented that enable accelerated yield growth, which is a matter of life and death for the last quarter of the population, which lives in countries with no significant or negative yield growth rates, but is also of vital importance fo

Is rumination after bereavement linked with loss avoidance? : Evidence from eye-tracking

Funding: This research was funded by a Zon-MW TOP Grant of the Dutch Society for Scientific Research (NWO) under Grant number 91208009. Website: www.zonmw.nl. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.Peer reviewedPublisher PD

On the Classification and Reporting of Prolonged Grief:Assessment and Research Guidelines

Learning Objectives: After participating in this CME activity, the psychiatrist should be better able to • Explain the steps required for diagnosis of mental disorders in diagnostic handbooks. • Identify current procedures for classifying and reporting prolonged grief disorder. Abstract Prolonged grief disorder (PGD) was added to the 11th edition of the International Classification of Diseases in 2018 and to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders in its 2022 text revision. Thus, reporting and classifying PGD according to established guidelines has become fundamental for scientific research and clinical practice. Yet, PGD assessment instruments and criteria are still being developed and debated. The purpose of this article is to examine the adequacy of current procedures for classifying and reporting PGD in research and to suggest guidelines for future investigation and dissemination of knowledge. We outline the standard steps required for diagnosis and assessment of a mental disorder (notably, the administration of clinical interviews). In order to illustrate reporting about the presence/prevalence of PGD in recent scientific articles, we conducted a search of Scopus that identified 22 relevant articles published between 2019 and 2023. Our review of the literature shows that standard classification procedures are not (yet) followed. Prevalences of PGD are based on self-reported symptomatology, with rates derived from percentages of bereaved persons reaching a certain cutoff score on a questionnaire, without clinical interviewing. This likely results in systematic overestimation of prevalences. Nevertheless, the actual establishment of PGD prevalence was often stated in titles, abstracts, and results sections of articles. Further, the need for structured clinical interviews for diagnostic classification was frequently mentioned only among limitations in discussion sections - but was not highlighted. We conclude by providing guidelines for researching and reporting self-reported prolonged grief symptoms and the presence/prevalence of PGD.</p

Клинико-психопатологические проявления депрессий у жителей сельской местности

Представлены выявленные у больных депрессией жителей сельской местности наследственная отягощенность по алкоголизму и интоксикации в анамнезе, сопутствующий алкоголизм, установлены факторы, провоцирующие развитие депрессивного эпизода, и синдромологическая структура депрессий.Family history of alcoholism and accompanying intoxication, revealed in patients with depression living in rural areas, are presented. The factors provoking development of depressive episode and syndromological structure of depressions were determined

Homesickness in social context:An ecological momentary assessment study among 1st-year university students

Homesickness is common among university students and associated with mental health problems. Most previous studies assessed homesickness as a summary of the past weeks. However, there may be significant fluctuations across situations. At the current residence, homesickness may especially be triggered during (phone) interactions with attachment figures. Dutch and international 1st-year students (n = 92) completed the Utrecht Homesickness Scale and subsequently used a smartphone application to record social interactions for 14 days (ecological momentary assessment [EMA]). For each interaction they reported the social context (e.g. location, contact type) and their affective state, including homesickness. Homesickness in the past weeks and momentary homesickness were both higher in international students than in Dutch students. Feeling homesick was highest at participants' current residency, when interacting with parents, or when using video-chat. When participants felt more homesick, they reported less pleasant and more unpleasant affect. In conclusion, EMA provided insight in cross-situational variations in homesickness