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Items 1 - 8 of 8
An empirical examination of the stage theory of grief.
Maciejewski PK, Zhang B, Block SD, Prigerson HG.
Department of Psychiatry, Women's Health Research, and Magnetic Resonance Research Center, Yale University School of Medicine, New Haven, Conn.
CONTEXT: The stage theory of grief remains a widely accepted model of bereavement adjustment still taught in medical schools, espoused by physicians, and applied in diverse contexts.
Nevertheless, the stage theory of grief has previously not been tested empirically.
OBJECTIVE: To examine the relative magnitudes and patterns of change over time postloss of 5 grief indicators for consistency with the stage theory of grief.
DESIGN, SETTING, AND PARTICIPANTS: Longitudinal cohort study (Yale Bereavement Study) of 233 bereaved individuals living in Connecticut, with data collected between January 2000 and January 2003.
MAIN OUTCOME MEASURES: Five rater-administered items assessing disbelief, yearning, anger, depression, and acceptance of the death from 1 to 24 months postloss.
RESULTS: Counter to stage theory, disbelief was not the initial, dominant grief indicator.
Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from 1 to 24 months postloss.
In models that take into account the rise and fall of psychological responses, once rescaled, disbelief decreased from an initial high at 1 month postloss, yearning peaked at 4 months postloss, anger peaked at 5 months postloss, and depression peaked at 6 months postloss.
Acceptance increased throughout the study observation period.
The 5 grief indicators achieved their respective maximum values in the sequence (disbelief, yearning, anger, depression, and acceptance) predicted by the stage theory of grief.
CONCLUSIONS: Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member.
Given that the negative grief indicators all peak within approximately 6 months postloss, those who score high on these indicators beyond 6 months postloss might benefit from further evaluation.
Publication Types:
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
PMID: 17312291 [PubMed - indexed for MEDLINE]
Dying woman seeks backing for dose of morphine to hasten death.
Dyer C.
Publication Types:
PMID: 17303849 [PubMed - indexed for MEDLINE]
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Role of non-governmental organisations in physician assisted suicide.
Ziegler SJ, Bosshard G.
School of Public and Environmental Affairs, Indiana University-Purdue University, Fort Wayne, IN 46805-1499, USA
.
zieglers@ipfw.edu
Publication Types:
PMID: 17289733 [PubMed - indexed for MEDLINE]
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Care of dying patients and safety dominate report on NHS complaints.
Mayor S.
Publication Types:
PMID: 17289704 [PubMed - indexed for MEDLINE]
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Defining limits in care of terminally ill patients.
Braun UK, Beyth RJ,
Ford ME, McCullough LB.
Houston Center for Quality of Care and Utilization Studies, Sections of Geriatrics and Health Services Research, Michael E DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA.
ubraun@bcm.tmc.edu
Publication Types:
- Research Support, U.S. Gov't, Non-P.H.S.
- Review
PMID: 17272566 [PubMed - indexed for MEDLINE]
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Dutch court acquits suicide counsellor of breaking the law.
Sheldon T.
Publication Types:
PMID: 17272547 [PubMed - indexed for MEDLINE]
Comment on:
The healing power of listening in the ICU.
Lilly CM, Daly BJ.
Publication Types:
PMID: 17267913 [PubMed - indexed for MEDLINE]
-
Comment in:
A communication strategy and brochure for relatives of patients dying in the ICU.
Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R, Garrouste-Orgeas M, Georges H, Goldgran-Toledano D, J
ourdain M, Loubert G, Reignier J, Saidi F, Souweine B, Vincent F, Barnes NK, Pochard F, Schlemmer B, Azoulay E.
Saint-Louis Hospital and Paris 7 University, Assistance Publique-Hopitaux de Paris, France.
BACKGROUND: There is a need for close communication with relatives of patients dying in the intensive care unit (ICU).
We evaluated a format that included a proactive end-of-life conference and a brochure to see whether it could lessen the effects of bereavement.
METHODS: Family members of 126 patients dying in 22 ICUs in France were randomly assigned to the intervention format or to the customary end-of-life conference.
Participants were interviewed by telephone 90 days after the death with the use of the Impact of Event Scale (IES; scores range from 0, indicating no symptoms, to 75, indicating severe symptoms related to post-traumatic stress disorder [PTSD]) and the Hospital Anxiety and Depression Scale (HADS; subscale scores range from 0, indicating no distress, to 21, indicating maximum distress).
RESULTS: Participants in the intervention group had longer conferences than those in the control group (median, 30 minutes [interquartile range, 19 to 45] vs.
20 minutes [interquartile range, 15 to 30]; P<0.001) and spent more of the time talking (median, 14 minutes [interquartile range, 8 to 20] vs.
5 minutes [interquartile range, 5 to 10]).
On day 90, the 56 participants in the intervention group who responded to the telephone interview had a significantly lower median IES score than the 52 participants in the control group (27 vs.
39, P=0.02) and a lower prevalence of PTSD-related symptoms (45% vs.
69%, P=0.01).
The median HADS score was also lower in the intervention group (11, vs.
17 in the control group; P=0.004), and symptoms of both anxiety and depression were less prevalent (anxiety, 45% vs.
67%; P=0.02; depression, 29% vs.
56%; P=0.003).
CONCLUSIONS: Providing relatives of patients who are dying in the ICU with a brochure on bereavement and using a proactive communication strategy that includes longer conferences and more time for family members to talk may lessen the burden of bereavement.
(ClinicalTrials.gov number, NCT00331877.) 2007 Massachusetts Medical Society
Publication Types:
- Multicenter Study
- Randomized Controlled Trial
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
PMID: 17267907 [PubMed - indexed for MEDLINE]