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Slide 1 - BEREAVEMENT Kara Z. McDaniel, M.A., NCC Behavioral Medicine Intern Emory Family Medicine at Dunwoody 404-778-6924
Slide 2 - Life is a series of experiences, each one of which makes us bigger, even though it is hard to realize this. For the world was built to develop character, and we must learn that the setbacks and griefs which we endure help us in our marching onward. -Henry Ford
Slide 3 - OBJECTIVES Participants will learn the definition of bereavement and grief in addition to the basic tasks/phases of grieving Participants will learn the psychological, social, and physiological effects of bereavement and factors that influence the process of grief Participants will learn the importance of their role in identifying and treating bereaved patients
Slide 4 - WHAT IS BEREAVEMENT? “To be deprived by death” (NMHA, p.1) “The state of having suffered a loss” (Rando, p. 16). Feelings of grief experienced following the death of loved one
Slide 5 - TYPES OF LOSSES Physical (tangible) Symbolic (psychosocial)
Slide 6 - BASIC TASKS OF GRIEF Emancipation Readjustment Formation
Slide 7 - PROCESS OF GRIEF Numbness Yearning and searching Disorganization and despair Reorganization
Slide 8 - EXPRESSION OF LOSS Psychological Avoidance Phase Confrontation Phase Reestablishment Phase Social Physiological
Slide 9 - FACTORS INFLUENCING REACTIONS TO GRIEF Psychological Social Physiological
Slide 10 - IS IT BEREAVEMENT OR DEPRESSION? Differentiating between normal grief reaction and depression Morbidity and Mortality
Slide 11 - BEREAVEMENT CARE Physicians’ perception of bereavement care Role of physician in bereavement care contact with bereaved patients facilitating healing treatment when to intervene and/or make referral psychiatric complications related to bereavement
Slide 12 - “Physicians who aid grief-stricken patients are afforded the rewarding, quintessentially human opportunity of transforming a personal sorrow they inevitably will experience into sympathetic and supportive aftercare” -George Eliot
Slide 13 - RESOURCES American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, DC.: American Psychiatric Association. Bedell, S.E., Cadenhead, K. Graboys, T.B. (2001). The doctor’s letter of condolence. National vital statistics reports final data. New England Journal of Medicine, 344, 1161- 1162. Birtchnell, J. (1970).The relationship between attempted suicide, depression, and parent death. British Journal of Psychiatry, 116, 307-313. Bowlby, J. (1980). Attachment and loss: Loss, sadness and depression (Vol. III). New York: Basic Books. Brown, L.F, Reynolds, C.F., Monk, T.H., et al. (1996). Social rhythm stability following late-life spousal bereavement: Associations with depression and sleep impairment. Psychiatry Res., 62, 161-169.
Slide 14 - Bruce, M. L., Kim, K., Leaf, P. J., & Jacobs, S. (1990).Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample. American Journal of Psychiatry, 147, 608-611. Chen, J. H., Bierhals, A. J., Prigerson, H. G., Kasl, S. V., Mazure, C. M., & Jacobs, S. (1999). Gender differences in the effects of bereavement-related psychological distress in health outcomes. Psychol Med., 29, 367-380. Clayton, P.J., Halikas, J.A., Maurice, W.L. (1972). The depression of widowhood. British Journal of Psychiatry, 120, 71-77. DeVries, B., Davis, C. G., Wortman, C. B., & Lehman, D. R. (1997). Long-term psychological and somatic consequences of later life parental bereavement, OMEGA Journal of Death and Dying, 35, 97-117. Esterling, B.A., Antoni, M.H., Fletcher, M.A., Margulies, S., Schneiderman, N. (1994). Emotional disclosure through writing or speaking modulates latent Epstein-Barr virus antibody titers. Journal of Consulting and Clinical Psychology, 62, 130-140.
Slide 15 - Glass, T.A., Prigerson, H.G., Kasl, S.V., Mendes de Leon, C.F. (1995). The effects of negative life events on alcohol consumption among older men and women. J Gerontol B Psychol Sci Soc Sci, 50, S205-S216. Gregory, R.J. (1994). Grief and loss among Eskimos attempting suicide in western Alaska. American Journal of Psychiatry, 151, 1815-1816. Kaprio, J., Koskenvuo, M., Rita, H. (1987). Mortality after bereavement: A prospective study of 95,647 widowed persons. American Journal of Public Health, 77, 283-287. Kubler-Ross, E. (1969). On death and dying. New York: Simon and Schuster. Lehman, D. R., Wortman, C. B., & Williams, A. F. (1987). Long-term effects of losing a spouse or child in a motor vehicle crash. Journal of Pers. Soc. Psychology, 52, 218-231. Lemkau, J.P., Mann, B., Little, D., Whitecar, P., Hershberger, P. & Schumm, J.A. (2000). Questionnaire survey of family practice physicians’ perceptions of bereavement care. Arch. Family Medicine, 9, 822-829. Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, 141-148.
Slide 16 - Maddison, D.C. & Viola, A. (1968). The health of widows in the year following bereavement. J Psychosom Res., 12, 297-330. Main, J. (2000). Improving management of bereavement in general practice based on a survey of recently bereaved subjects in a single general practice. British Journal of General Practice, 50, 863-866. Martikainen, P. & Valkonen, T. (1996). Mortality after the death of a spouse: Rates and causes of death in a large Finnish cohort. American Journal of Public Health, 86, 1087-1093). McDermott, O.D., Prigerson, H.G., Reynolds, C.F.III, et al. (1997). Sleep in the wake of complicated grief symptoms: An exploratory study. Biol Psychiatry, 41, 710-716. National Mental Health Association (2004). General mental health issues: Coping with loss-bereavement and grief. Retrieved from world wide web, Parkes, C. M. (1972). Bereavement: Studies of grief in adult life. New York: International Universities Press. Parkes, C. M., & Weiss, R. S. (1983). Recovery from bereavement. New York: Basic Books.
Slide 17 - Pennebaker, J.W., Zech, E., & Rime, B. (2001). Disclosing and sharing emotion: Psychological, social and health consequences. In M.S. Stroebe, R.O. Hansson, W. Stroebe, & H. Schut, eds. Handbook of Bereavement Research: Consequences, coping, and care. Washington, DC: American Psychological Association. Prigerson, H.G. & Jacobs, S.C. (2001). Caring for bereaved patients: “All the doctors just suddenly go.” Journal of American Medical Association, 286, 1369-1376. Prigerson, H. G., Bierhals, A. J., Kasl, S. V., et al. (1997). Traumatic grief as a risk factor for mental and physical morbidity. American Journal of Psychiatry, 154, 616-623. Prigerson, H.G., Reynolds, C.F. III, Frank, E., Kupfer, D.J., George, C.J., & Houck, P.R. (1994). Stressful life events, social rhythms, and depressive symptoms among the elderly: An examination of hypothesized causal linkages. Psychol Res., 51, 33-49. Rando, T. A. (1984). Grief, dying, and death: Clinical interventions for caregivers. Illinois: Research Press. Reynolds, C.F. III, Hoch, C.C., Buysse, D.J., et al. (1993). Sleep after spousal bereavement: A study of recovery from stress. Biol Psychiatry, 34, 791-797.
Slide 18 - Reynolds, C.F. III, Miller, M.D., Pasternak, R.E., et al. (1999). Treatment of bereavement-related major depressive episodes in later life: A controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. American Journal of Psychiatry, 156, 202-208. Rogers, M. P. & Reich, P. (1988). On the health consequences of bereavement. New England Journal of Medicine, 319, 510-511. Rynearson, E. K. & McCreery, J. M. (1993). Bereavement after homicide: A synergism of trauma and loss. American Journal of Psychiatry, 150, 258-261. Schaefer, C., Quesenberry, C.P. Jr., & Wi, S. (1995). Mortality following conjugal bereavement and the effects of a shared environment. Am J Epidemiol, 141, 1142-1152. Umberson, D. Wortman, C.B., & Kessler, R.C. (1992). Widowhood and depression: Explaining long-term gender differences in vulnerability. J Health Soc Behav., 33, 10-24.