Needs for help and received help for those bereaved by a drug-related death: a cross-sectional study

Background and aims: Individuals bereaved after sudden and unexpected deaths can benefit from professional help to cope after the loss, and the bereaved call for proactive, early and flexible help from professional services. Most drug-related deaths (DRDs) happen suddenly and unexpectedly. DRDs are a significant public health issue, yet few studies have examined DRD-bereaved people’s needs and experiences with professional help. This article investigates the needs for help and received help reported by DRD-bereaved family members and friends, and suggests improvements in services based on the findings. Data and method: A heterogeneous convenience sample of DRD-bereaved family members and close friends (n = 255) were recruited for a survey from February to December 2018. Descriptive analyses were conducted for experiences with professional help, chi-square analyses to find predictors for help needs and received help, and logistic regression analysis to find predictors for satisfaction with the help provided. Results: Most DRD-bereaved individuals reported a need for professional help after the death regardless of family relation to the deceased, and about half of the participants received help. Nearly half of them were satisfied with the help. Our results indicated higher satisfaction with help among older bereaved, and the participants who received help from a crisis team or psychotherapist. The latter was particularly stated for younger participants. Few participants with children in the family reported that the children had received help, and less than one-third were satisfied with this help. Conclusion: The study shows that younger age groups and children need particular recognition, and a family perspective from services is essential. When assessing the help needs of the DRD-bereaved, relations of both psychological and biological closeness should be recognised. Help efforts should be tailored according to established knowledge of the provided help that bereaved populations deem effective.publishedVersio

The social health domain of people bereaved by a drug-related death and associations with professional help: A cross-sectional study

People bereaved by traumatic deaths are vulnerable to long-lasting impairments in social health, including the quality of social relationships and the capacity to manage their social lives. In this Norwegian study involving 255 participants bereaved by a drug-related death, we aimed to investigate their social health and associations with professional help. The results of a cross-sectional survey showed that participants on average rated their social health as poor, though with large variations within the group. Participants who reported high satisfaction with professional help reported significantly higher scores on most social health-related variables. More research is needed on professional help focusing on the social health of traumatically bereaved people.publishedVersio

Paths to positive growth in parents bereaved by drug-related death: A mixed-method study

Introduction: Drug-related deaths (DRDs) are a major public health challenge. Losing a child to a DRD can be a very stressful life event, which places parents at risk of mental and physical health problems. However, traumatic experiences like losing a child to DRD can paradoxically also lead to positive psychological changes. A mixed-method approach was used to understand the complexity of the phenomenon of post-traumatic growth experienced by parents following a DRD. Method: By combining data from a survey (n = 89) and interviews (n = 14), we explored positive growth experiences among Norwegian parents. We conducted descriptive analyses of the sample’s demographic characteristics and mean scores for Post-traumatic Growth Inventory (PTGI-SF) items. Hierarchical multiple regression was used to examine the influence of the ability to perform daily activities (WSAS), self-efficacy (GSE-SF), social support (CSS), and symptoms of prolonged grief (PG-13) on the outcome variable of post-traumatic growth (PTGI-SF). Reflexive thematic analysis was applied to analyze the qualitative data. Finally, we integrated the results of the survey and the interviews. Results: For items measuring post-traumatic growth, parents scored highest on the item “I discovered that I’m stronger than I thought I was” and lowest on the item “I am able to do better things with my life.” Self-efficacy and social support had a statistically significant relation with post-traumatic growth. Two themes were generated from the interviews: (I) new perspectives on life and (II) new paths in life. Even though the “New Possibilities” subscale had the lowest mean score for the PTGI-SF, new paths in life were important for many of the interviewed parents. Discussion: Parents described traumatic stressors associated with having a child who uses narcotics and hence experienced positive changes even before losing their child. We argue that on an individual level, the consequences of spillover stigma, low self-efficacy, and intrusive rumination can hinder potential post-traumatic growth. On a group level, enhancing network support may increase post-traumatic growth experiences. Hence, parents who have experienced a DRD can benefit from help to activate their social networks and strengthen their self-efficacy.publishedVersio

Translation and validation of the Alberta Context Tool for use in Norwegian nursing homes

Purpose: Organizational context is recognized as important for facilitating evidence-based practice and improving patient outcomes. Organizational context is a complex construct to measure and appropriate instruments that can quantify and measure context are needed. The aim of this study was to translate and cross-culturally adapt the Alberta Context Tool (ACT) to Norwegian, and to test the reliability and structural validity among registered nurses (RNs) and licenced practice nurses (LPNs) working in nursing homes. Methods: This study was a validation study utilizing a cross-sectional design. The sample consisted of n = 956 healthcare personnel from 28 nursing homes from a municipality in Norway. In the first stage, the ACT was translated before being administered in 28 nursing homes. In the second stage, internal consistency and structural validity were explored using Cronbach’s alpha and confirmatory factor analysis. Results: A rigorous forward-and-back translation process was performed including a team of academics, experts, professional translators and the copyright holders, before an acceptable version of the ACT was piloted and finalized. The Norwegian version of the ACT showed good internal consistency with Chronbachs alpha above .75 for all concepts except for Formal interactions where the alpha was .69. Structural validity was acceptable for both RNs and LPNs with factors loadings more than .4 for most items. Conclusions: The Norwegian version of the ACT is a valid measure of organizational context in Norwegian nursing homes among RNs and LPNs.publishedVersio

The “special grief” of parents bereaved by drug-related death. Mixed methods research - a qualitative driven concurrent design

Introduction: This doctoral project was carried out between 2018 and 2021 at the Department of Welfare and Participation, Western Norway University of Applied Sciences. A sociological perspective is incorporated when exploring, analysing and interpreting grief and bereavement, while the psychological perspective forms an important backdrop. The research is situated within the fields of grief, bereavement, welfare and drug research. Background: Despite extensive preventive actions, reducing drug-related deaths (DRDs) remains an international major health challenge. How bereaved parents experience DRDs has scarcely been studied. Losing a child can be more intense and prolonged than other losses, and bereaved parents who experience unnatural deaths, such as DRDs, are at risk of developing grief complications. Clearly, there is a need to pay attention to the situation of parents, left behind following a DRD. Aim: The main aim was to explore how bereaved parents experience DRDs, what the consequences are for bereaved parents and how they cope with everyday life. Several research questions have been explored and investigated in four articles: Article I. A systematic review of the qualitative and quantitative literature regarding how family members experience drug-death bereavement, to understand: (1) the experience of family members before and after losing a next of kin and (2) how they perceive help and support and its influence on their bereavement processes. Article II. How do parents experience drug-death bereavement and what different kinds of help and support do they receive? Article III. How do drug-death bereaved parents adjust to life without the deceased and what seems to inhibit or promote adaptation during their grieving process? Article IV. Do Norwegian parents bereaved from DRDs suffer from prolonged grief symptoms as measured by PG-13, and if so, which predictors are key to explaining their high levels of prolonged grief symptoms? Method: The design was a qualitative driven, concurrent design, as qualitative results were used to investigate quantitative findings. This article-based thesis consists of a synopsis and four research articles: a systematic review (Article I); qualitative studies using semi-structured in-depth interviews (n=14 parents) and reflexive thematic analysis (Article II, III), and a quantitative study with a crosssectional correlational design, using survey data (n=93 parents) (Article IV). The synopsis gives an overview of the theoretical background, the applied methodology, research design, data collection methods and data analysis. The discussion integrates the findings from Articles II-IV, followed by methodological and ethical discussion. Finally, the implications for practice, policy and research are discussed. Results: The “special grief” was characterised by the processing of the overload of stress, due to extended parenthood, grief-related emotions and reactions, and perceived societal and self-stigma. How parents cope with the loss was influenced by processes on an intrapersonal (e.g., level of self-efficacy, using proactive coping strategies) and an interpersonal level (e.g., attitudes and norms). How the parents coped was an individual experience, affected by the context. The intensity of processing the overload decreased in the case of most of the bereaved as time went by. The parents who struggled the most, reported low self-efficacy, withdrawal and long-lasting grief. The findings in the “special grief” of parents bereaved by drug-related deaths was discussed with regard to (1) the complexity of the “special grief”; (2) the complications of spill-over stigma; (3) the challenges of providing and receiving support and (4) the oscillation between coping styles. Conclusion: On an individual level there is a need for immediate, proactive crises help post-loss, broad spectrum and need-related help and help over time. On a group level there is a need for support groups for those bereaved by DRD and support from social networks. Finally, there is a need to take action to reduce stigma related to drug use, enhance public recognition of those bereaved by DRD and to coordinate services on a societal level. The knowledge generated is of national and international relevance for practice, policy and for further research purposes, and may be transferable to other forms of unnatural death

Does ‘time heal all wounds?’ The prevalence and predictors of prolonged grief among drug-death bereaved family members: a cross-sectional study

Despite rising rates of drug-related deaths (DRDs), the consequences of DRDs for bereaved family members are scarcely investigated. This study aimed to estimate the prevalence of prolonged grief (PG) symptoms in bereaved family members after DRDs, identify predictors of PG and examine whether symptom levels decrease with time. A cross-sectional design based on survey data from parents (n = 93), siblings (n = 78), children (n = 24) and other family members (n = 39) was conducted (n = 234). Descriptive analyses, a multivariate linear regression, and ANOVA were performed. 60 family members (26%) suffered from high levels of PG symptoms after DRDs (parents 31.2%, siblings 21.8%, children 20.9%). The strongest associations were found between a high level of symptoms and ‘months since the loss’, ‘suicidal thoughts’ and ‘withdrawal from others’. The ANOVA analyses showed that time does not always ‘heal all wounds’, and the bereaved who lost one to 2 years ago had the highest level of PG symptoms

How Do Drug-Death-Bereaved Parents Adjust to Life Without the Deceased? A Qualitative Study

Knowledge about how bereaved persons grieve can enhance quality in providing the support and potential services that they need. We aimed to identify ways in which drug-death-bereaved Norwegian parents go on with their lives and what inhibits or promotes adaptation during their grieving. Reflexive thematic analysis was used to analyze 14 semistructured in-depth interviews. We generated three themes: (I) processing grief emotions, (II) proactive coping, and (III) giving and receiving support and assistance. Processing guilt rumination, reflections on blame and a burden of grief emotions characterized grieving early on. Using cognitive strategies and functional-support-giving were found to be the most frequently used strategies. Oscillation between processing stressors and reorientation to the world promoted adjustment to ongoing life. We discuss characteristics of parents who struggle to reorient and outline important implications for policy and practice

An unknown invisible intrusion. Impact of an adult family member’s problematic substance use on family life: a meta-ethnography

Problematic substance use (PSU) has documented consequences for the person using substances and people close to that person. This meta-ethnography aims to provide insight into how families experience family life when adult family members PSU is present. The titles and abstracts of 24,423 retrieved studies were assessed against the inclusion and exclusion criteria. Fifteen qualitative primary articles, including 393 different family members experiences, were included. The included articles described families from different countries with various socioeconomic status. An unknown invisible intrusion was established as the overarching metaphor. This metaphor was accompanied by three main themes: Taking over the family life, Family survival, and An invisible family. The theme Taking over the family life reflects how PSU affected the family structures and how overwhelming the families experienced these problems. The theme Family survival reflects how family members tried to adapt to life with PSU, while An invisible family reflects how families experienced loneliness and lack of help. We suggest that professionals should move from a one-sided focus on PSU to understanding the consequences as a long-lasting intrusion into family life. This includes both disciplinary development and interventions that enhance family relational practices.publishedVersio