Responding to the new International Classification of Diseases-11 prolonged grief disorder during the COVID-19 pandemic: a new bereavement network and three-tiered model of care

The field of bereavement research and care is at a tipping point. The introduction of prolonged grief disorder (PGD) in the International Classification of Diseases (ICD-11) has ignited clinical interest in this new disorder, along with debate over challenges in validating and implementing these new criteria. At the same time, the global COVID-19 pandemic has launched several local and international efforts to provide urgent support and comfort for individuals and communities suffering from grief. Recently, grief experts have called for a collective response to these complicated bereavements and possible increase in PGD due to COVID-19. Here we outline a new European network that aims to unite a community of grief researchers and clinicians to provide accessible, evidence-based support particularly during times of unprecedent crisis. The Bereavement Network Europe (BNE) has been developed with two main aims. Firstly, to develop expert agreed, internationally acceptable guidelines for bereavement care through a three-tiered approach. Secondly, to provide a platform for researchers and clinicians to share knowledge, collaborate, and develop consensus protocols to facilitate the introduction of PGD to diverse stakeholders. This article outlines the current status and aims of the BNE along with the plans for upcoming network initiatives and the three-tiered bereavement care guidelines in response to the COVID-19 pandemic. Keywords: Bereavement network Europe; COVID-19; ICD-11; Prolonged grief disorder; Three-tiered bereavement care

Acute grief after deaths due to COVID-19, natural causes and unnatural causes:An empirical comparison

Background: There are now over 800,000 registered deaths due to the COVID-19 pandemic worldwide. Researchers have suggested that COVID-19 death characteristics (e.g., intensive care admission, unexpected death) and circumstances (e.g., secondary stressors, social isolation) will precipitate a worldwide increase of prolonged grief disorder (PGD) and persistent complex bereavement disorder (PCBD). Yet, no study has investigated this. Since acute grief is a strong predictor of future pathological grief, we compared grief levels among people recently bereaved due to COVID-19, natural, and unnatural causes. Methods: People bereaved through COVID-19 (n = 49), natural causes (n = 1182), and unnatural causes (n = 210), completed self-report measures of demographic and loss-related characteristics and PGD and PCBD symptoms. Results: COVID-19 bereavement yielded higher symptom levels of PGD (d = 0.42) and PCBD (d = 0.35) than natural bereavement (but not unnatural bereavement). Effects held when limiting analyses to recent losses and those who participated during the pandemic. Expectedness of the death explained this effect. Limitations: Limitations include using a convenience sample and self-report measures. Conclusions: Higher grief levels occur among people bereaved due to COVID-19 compared to people bereaved due to natural loss. We predict that pandemic-related increases in pathological grief will become a worldwide public health concern

Self-Awareness After Brain Injury:Relation with Emotion Recognition and Effects of Treatment

Item does not contain fulltextSelf-awareness is often impaired after acquired brain injury (ABI) and this hampers rehabilitation, in general: unrealistic reports by patients about their functioning and poor motivation and compliance with treatment. We evaluated a self-awareness treatment that was part of a treatment protocol on executive dysfunction (Spikman, Boelen, Lamberts, Brouwer, & Fasotti, 2010). A total of 63 patients were included, aged 17-70, suffering non-progressive ABI, and minimum time post-onset of 3 months. Self-awareness was measured by comparing the patient's Dysexecutive Questionnaire (Wilson, Alderman, Burgess, Emslie, & Evans, 1996) score with that of an independent other. As emotion recognition is associated with self-awareness and influences the effect of rehabilitation treatment, we assessed this function using the Facial Expressions of Emotion-Stimuli and Tests (Young, Perrett, Calder, Sprengelmeyer, & Ekman, 2002). Results showed that patients in the experimental treatment group (n = 29) had better self-awareness after training than control patients (n = 34). Moreover, our results confirmed that the level of self-awareness before treatment was related to emotion recognition. Hence, self-awareness can improve after neuropsychological treatment fostering self-monitoring. Since neuropsychological treatment involves social learning, impairments in social cognition should be taken into account before starting and during treatment.8 p

Pre-job loss grief reactions and work attachment among sick-listed employees:Introduction of the imminent job loss scale

Purpose: With this study, we aimed to explore the emotional experiences of sick-listed employees facing imminent job loss, as this emotional distress may hinder successful job search outcomes. The study had two objectives: (1) to develop and validate the Imminent Job Loss Scale (IJLS) for assessing pre-job loss grief reactions and (2) to examine its relationship to work attachment.Method: Development of the IJLS was carried out using feedback from an expert panel. The psychometric properties of the IJLS were evaluated, and its association with work attachment was examined using data from 200 sick-listed employees facing imminent job loss. Results: The IJLS demonstrated strong internal consistency and temporal stability, distinctiveness from depression and anxiety symptoms, and solid convergent validity. Work-centrality and organizational commitment were positively related to pre-job loss grief reactions, while work engagement and calling showed no significant associations.Conclusion: This study provides valuable insights into pre-job loss grief reactions and shows the potential utility of the IJLS for screening and monitoring purposes. Understanding pre-job loss grief reactions can improve the re-integration and job prospects of sick-listed employees. In future research, explorations of these dynamics should continue to provide better support to sick-listed employees during this challenging period

Patterns, predictors, and prognostic validity of Persistent Complex Bereavement Disorder (PCBD) symptoms in recently bereaved adults:A latent class analysis

Persistent complex bereavement disorder (PCBD) entered DSM-5. No studies have yet examined the nature, prevalence, prognostic validity, and underlying mechanisms of PCBD symptom-patterns in recently bereaved people. Knowledge on these issues could improve the early identification and treatment of disturbed grief. Latent class analysis was used to identify subgroups characterized by different PCBD symptompatterns among recently (≤6 months) bereaved adults (N = 476). In a subgroup (N = 251) we assessed associations of class-membership with PCBD-severity and functional impairment assessed three years later. Associations between classmembership and socio-demographic and cognitive-behavioral variables were also examined. We identified a Resilient (50.0%), Separation Distress (36.1%), and High PCBD Symptoms (13.9%) Class. Class-membership had prognostic value as evidenced by associations with PCBD-severity and functional impairment assessed three years later. Deaths of partners/children, unexpectedness of the loss, and maladaptive cognitions and avoidance behaviors were also associated with membership of the pervasive symptom classes

Trajectories of grief, depression, and posttraumatic stress in disaster-bereaved people

Background: Previous latent trajectory studies in adult bereaved people have identified individual differences in reactions postloss. However, prior findings may not reflect the complete picture of distress postloss, because they were focused on depression symptoms following nonviolent death. We examined trajectories of symptom-levels of persistent complex bereavement disorder (PCBD), depression, and posttraumatic stress disorder (PTSD) in a disaster-bereaved sample. We also investigated associations among these trajectories and background and loss-related factors, psychological support, and previous mental health complaints. Methods: Latent class growth modeling was used to identify distinct trajectories of PCBD, depression, and PTSD symptoms in people who lost loved ones in a plane disaster in 2014. Participants (N = 172) completed questionnaires for PCBD, depression, and PTSD at 11, 22, 31, and 42 months postdisaster. Associations among class membership and background and loss-related variables, psychological support, and previous mental health complaints were examined using logistic regression analyses. Results: Two PCBD classes emerged: mild (81.8%) and chronic (18.2%) PCBD. For both depression and PTSD, three classes emerged: mild (85.6% and 85.2%), recovered (8.2% and 4.4%), and chronic trajectory (6.2% and 10.3%). People assigned to the chronic PCBD, depression, or PTSD class were less highly educated than people assigned to the mild/recovered classes. Conclusions: This is the first latent trajectory study that offers insights in individual differences in longitudinal symptom profiles of PCBD, depression, and PTSD in bereaved people. We found support for differential trajectories and predictors across the outcomes

The importance of harmonising diagnostic criteria sets for pathological grief

Five diagnostic criteria sets for pathological grief are currently used in research. Studies evaluating their performance indicate that it is not justified to generalise findings regarding prevalence rates and predictive validity across studies using different diagnostic criteria of pathological grief. We provide recommendations to move the bereavement field forward

Feasibility and predictors of change of narrative exposure therapy for displaced populations:a repeated measures design

Background: Displaced victims of interpersonal violence, such as refugees, asylum seekers, and victims of sexual exploitation, are growing in numbers and are often suffering from a post-traumatic stress disorder (PTSD). At the same time, these victims are known to benefit less from trauma-focused therapy (TFT) and to be less compliant to treatment. The objective of this paper is to describe the rationale and research protocol of an ongoing trial that aims to evaluate different variables that might influence the feasibility of TFT for the study population. Specifically, perceived daily stress, emotion regulation, and mood are investigated as predictors of change in PTSD symptoms during a trauma-focused therapy (narrative exposure therapy (NET)). The feasibility of administering measures tapping these constructs repeatedly during treatment will also be evaluated. Methods/design: Using an observational treatment design, 80 displaced victims of interpersonal violence will be measured before, during, and after partaking in NET. Several questionnaires tapping PTSD plus the aforementioned possible predictors of PTSD change will be administered: Post-traumatic Stress Disorder Checklist-5, Perceived Stress Scale, Difficulties in Emotion Regulation Scale-18 (pre-test, post-test, and follow-up),subscale impulsivity of the Difficulties in Emotion Regulation Scale-18, Perceived Stress Scale short version, Primary Care Post-traumatic Stress Disorder and a single Mood item (each session). Multilevel modelling will be used to examine the relation between the possible predictors and treatment outcome. Discussion: The present study is the first to examine the interplay of facilitating and interfering factors possibly impacting treatment feasibility and effectiveness in displaced victims of interpersonal violence with PTSD receiving NET, using repeated measures. The current study can help to improve future treatment based on individual characteristics. Trial registration: Netherlands Trial Register: NTR7353, retrospectively registered. Date of registration: July 11, 2018

Valid measurement of DSM-5 persistent complex bereavement disorder and DSM-5-TR and ICD-11 prolonged grief disorder:The Traumatic Grief Inventory-Self Report Plus (TGI-SR+)

Introduction: When grief reactions after bereavement are so intense that they impair daily functioning, a diagnosis of disturbed grief may apply. Slightly differing criteria-sets for disturbed grief are included in the ICD-11, the DSM-5, and its forthcoming text revision, DSM-5-TR. We examined psychometric properties of a new self-report measure, the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+), that assesses these criteria sets for Persistent Complex Bereavement Disorder (PCBD) as per DSM-5, and Prolonged Grief Disorder (PGD) as defined in ICD-11 and DSM-5-TR. Material and methods: We examined the: i) factor structure, ii) internal consistency, iii) temporal stability, iv) convergent validity, v) known-groups validity, vi) probable caseness, and vii) optimal clinical cut-off scores in two Dutch bereaved samples. Sample 1 consisted of 278 adults, bereaved by various causes. Sample 2 included 270 adults who lost loved ones in a traffic accident. Results: We found support for a 3-factor PCBD model, 1-factor DSM-5-TR model, and 1-factor ICD-11 PGD model. The DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD items demonstrated good internal consistency and temporal stability. Associations between disturbed grief symptoms and posttraumatic stress and depression levels supported convergent validity. Associations between demographic/loss-related variables and disturbed grief symptoms supported known-groups validity. Optimal clinical cut-offs for the TGI-SR+ total score were ≥ 75, ≥71, and ≥ 75 for probable caseness of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD, respectively. Discussion: While replication of our findings in diverse bereaved samples is needed, we conclude that the TGI-SR+ is a reliable and valid measure to assess symptoms of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD

Reciprocal Associations Among Symptom Levels of Disturbed Grief, Posttraumatic Stress, and Depression Following Traumatic Loss:A Four-Wave Cross-Lagged Study

Objective Disturbed grief, operationalized as persistent complex bereavement disorder (PCBD), correlates with, yet differs from posttraumatic stress disorder (PTSD) and depression symptoms. However, knowledge about temporal associations between these symptoms is limited. We aimed to enhance our understanding of the aetiology of loss-related distress by examining temporal associations between PCBD, PTSD, and depression symptom levels. Methods Dutch people (N=172) who lost significant other(s) in a plane disaster completed questionnaires for PCBD, PTSD, and depression 11, 22, 31, and 42 months post-disaster. Results Cross-lagged analyses revealed that changes in PCBD symptom levels have a greater impact on changes in symptom levels of PTSD and depression than vice versa. Conclusion Our findings contradict the notion that PTSD and depression symptoms should be addressed before grief in treatment. Pending replication of our findings in clinical samples, we tentatively conclude that screening and treatment of grief symptoms has potential value in preventing long-lasting distress