Psychometric Properties of the Grief Cognitions Questionnaire for Children (GCQ-C)

Negative thinking is seen as an important mediating factor in the development of prolonged grief disorder (PGD), a syndrome encompassing debilitating symptoms of grief. No measure of specific grief related cognitions is available yet. Based on an adult measure of negative thinking in adults we developed a questionnaire for children, the Grief Cognitions Questionnaire for Children (GCQ-C). This study investigated several psychometric properties of the GCQ-C. Both reliability and validity were investigated in this study, in which hundred fifty-one children and adolescents (aged 8–18 years) participated. Findings showed that items of the GCQ-C represented one underlying dimension. Furthermore, the internal consistency and temporal stability were found to be adequate. Third, the findings supported the concurrent validity (e.g., significant positive correlations with self-report indices of PGD, depression and posttraumatic stress disorder), convergent and divergent validity of the GCQ-C. This study provides further evidence for the importance of negative thinking in PGD in children and adolescents

Comparison of DSM-5 criteria for persistent complex bereavement disorder and ICD-11 criteria for prolonged grief disorder in help-seeking bereaved children

BackgroundPersistent complex bereavement disorder (PCBD) is a disorder of grief that newly entered DSM-5. Prolonged grief disorder (PGD) is a disorder of grief included in ICD-11. No prior studies examined and compared the dimensionality, prevalence, and concurrent validity of both conditions among bereaved children.MethodsWith data from 291 help-seeking bereaved 8-–18 year old children, we used confirmatory factor analysis to evaluate the fit of different factor models for PCBD and PGD. In addition, we determined diagnostic rates for probable PCBD and PGD and calculated associations of PCBD and PGD caseness with concurrently assessed symptoms of overall disturbed grief, depression, posttraumatic stress, and parent-rated problem behavior.ResultsFor PCBD and PGD, one-factor models—with all symptoms forming a unidimensional factor of disturbed grief—fit the data best. The prevalence of probable DSM-5 PCBD (3.4%) was significantly lower than ICD-11 PGD (12.4%). Both PCBD and PGD were significantly associated with concurrently assessed overall disturbed grief, depression, and posttraumatic stress; associations with parent-rated problems were moderate.LimitationsFindings were based on self-reported ratings of symptoms, obtained from three different scales not specifically designed to assess PCBD and PGD. The use of a help-seeking sample limits the generalization of findings to bereaved children generally.ConclusionsFindings support the validity of DSM-5 PCBD and ICD-11 PGD. Prevalence rates of both constructs differ. This needs further scrutiny

A prospective, multicentre study to assess frailty in elderly patients with leg ulcers (GERAS study)

Background: Although leg ulcers are a burdensome disease most common in those aged 65 years and older, frailty in this population has not yet been well established. Objectives: The aim of this study was to prospectively explore and compare the presence of frailty in elderly patients with chronic leg or foot ulcers by applying different validated frailty screening methods in three healthcare settings and to assess the feasibility of frailty screening. Methods: We compared frailty of leg ulcer patients referred to an academic hospital with a non-academic hospital, leg ulcer patients receiving (primary) homecare, and a dermato-oncology patient population (control group). Frailty and quality of life were assessed using four validated questionnaires: the Groninger Frailty Indicator, Geriatric-8, Mini-Cog and Wound Quality of Life. To analyse data multiple (non)-parametric tests were performed. Results: Fifty of 60 included leg ulcer patients (83%) scored “frail” on at least one frailty questionnaire (GFI, G8 or Mini-Cog). The number of patients scoring “frail” on two or three out of three applied frailty questionnaires were significantly higher in the academic and homecare ulcer population compared with the non-academic ulcer population and control group (p = 0.002). In the academic ulcer population mean Wound Quality of Life scores were 30.2 (SD 17.6), compared with 17.7 (SD 13.1) in the non-academic and 15.0 (SD 10.4) in the homecare ulcer population (p = 0.002). Conclusion: The majority of patients suffering from leg ulcers in this study was frail. The highest frailty prevalence was observed in the academic and homecare ulcer populations. The largest impaired quality of life was reported in the academic ulcer population. In dermatology practice, implementing frailty screening and initiating appropriate (paramedical) supportive care should be considered to improve patient outcomes.</p

Child Posttraumatic Stress after Parental Cancer: Associations with Individual and Family Factors

Objective This study aimed to examine the severity of posttraumatic stress disorder (PTSD) symptoms in children of parents with cancer and to identify individual and family factors associated with these symptoms. Methods The sample consisted of 175 children (52% girls, aged M ¼ 11.98, SD ¼ 3.20, range ¼ 6–20 years) from 92 families, of which 90 parents with a current or past cancer diagnosis and 71 healthy co-parents also completed questionnaires. Children reported on PTSD symptoms, trauma-related cognitions, emotion regulation difficulties, general family functioning, and family communication. Both parents reported on their own PTSD symptoms. Associations were investigated using multilevel regression. Results Twenty-seven percentage of the children showed clinically relevant PTSD symptoms. Intraclass correlations indicated that children from the same family showed little overlap in these symptoms. Multilevel analyses showed that child trauma-related cognitions and emotion regulation difficulties were related to higher levels of PTSD symptoms at the individual level. General family functioning was only related to child PTSD symptoms at the family level. Child PTSD severity was unrelated to parental PTSD symptoms and family communication at the family level when taking into account the other factors. Conclusions The current study highlights the psychological impact of parental cancer on children. Individual factors contributed more strongly to child PTSD symptoms than family factors. Trauma-related cognitions and emotion regulation difficulties might be targeted through specific psychoeducation for children and parents, family-oriented support and interventions, and evidence-based treatments for child PTSD

Child Posttraumatic Stress after Parental Cancer: Associations with Individual and Family Factors

Objective This study aimed to examine the severity of posttraumatic stress disorder (PTSD) symptoms in children of parents with cancer and to identify individual and family factors associated with these symptoms. Methods The sample consisted of 175 children (52% girls, aged M ¼ 11.98, SD ¼ 3.20, range ¼ 6–20 years) from 92 families, of which 90 parents with a current or past cancer diagnosis and 71 healthy co-parents also completed questionnaires. Children reported on PTSD symptoms, trauma-related cognitions, emotion regulation difficulties, general family functioning, and family communication. Both parents reported on their own PTSD symptoms. Associations were investigated using multilevel regression. Results Twenty-seven percentage of the children showed clinically relevant PTSD symptoms. Intraclass correlations indicated that children from the same family showed little overlap in these symptoms. Multilevel analyses showed that child trauma-related cognitions and emotion regulation difficulties were related to higher levels of PTSD symptoms at the individual level. General family functioning was only related to child PTSD symptoms at the family level. Child PTSD severity was unrelated to parental PTSD symptoms and family communication at the family level when taking into account the other factors. Conclusions The current study highlights the psychological impact of parental cancer on children. Individual factors contributed more strongly to child PTSD symptoms than family factors. Trauma-related cognitions and emotion regulation difficulties might be targeted through specific psychoeducation for children and parents, family-oriented support and interventions, and evidence-based treatments for child PTSD

Prolonged grief in children and adolescents: Assessment, correlates, and treatment

Approximately 6400 children and adolescents lose a parent in the Netherlands and even more children are confronted with other types of loss such as the death of a close friend or grandparent. The death of a loved one is one of the most devastating events that can occur in children’s and adolescents’ lives. There is growing recognition of a syndrome that children can develop post loss, referred to as Prolonged Grief Disorder (PGD). This dissertation project had three aims: (I) to increase our understanding of the phenomenology and correlates of PGD, (II) to enhance knowledge on the role of negative thinking in the development of PGD in children and (III) to develop an intervention for children who suffer from loss and to examine its feasibility an potential efficacy. Three studies were conducted to investigate the first aim. First we developed the Inventory of Prolonged Grief for Children (IPG-C) and the Inventory of Prolonged Grief for Adolescents (IPG-A). Findings suggest that both inventories have good internal consistency, stability and concurrent validity. Both can be used for the assessment of PGD in children and adolescents who suffer from loss and also for treatment studies among bereaved children. In a second study we found that PGD, depression and Posttraumatic Stress Disorder (PTSD) are distinct constructs in children who suffer from bereavement. Our third study suggested that avoidance symptoms of bereavement-related PTSD may better be conceived as two separate clusters of effortful avoidance and symptoms of emotional numbing. Beside those main findings we found that correlations between children’s ratings and parent-ratings on grief related feelings are moderate. This indicates that it is important that children report about their own grief instead of solely relying on their parents’ observations of the suffering following a loss. In order to understand why some children cope with loss more easily than others (our second aim), it is also important to study the role of negative thinking among bereaved children. However, no measure was available. To fill this gap, we developed the Grief Cognition Questionnaire for Children (GCQ-C). Findings suggest that it is a reliable and valid tool to examine negative grief related cognitions in children and adolescents. Despite the fact that some children suffer from grief related problems and that there is a growing recognition of PGD, hardly any effective treatments are available. We therefore developed Grief-Help, a cognitive behavioural treatment that consists of nine (weekly) sessions for the child and five separate (two-weekly) sessions for their parent(s). We tested Grief-Help in two separate pilot studies. Based on those studies the treatment appears promising enough to warrant evaluation in a controlled trial. Such a multicentre Randomised Controlled Trial therefore is currently being conducted in the Netherlands