PDF The Anatomy of Bereavement: A Handbook for the Caring Professions (The Caring Professions)

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The right of minority groups to define their culture and identity in their own terms is the central theme of this book. Kieran O'Hagan, Offers service agency staff responsible for practice teaching and assessment an agenda for the development of practice learning programs. Dave Evans, Knowledge-in-Practice in the Caring Professions explores the nature and role of knowledge in the practical work of the caring professions.

Denise Lyons, This book combines recent developments in the study of the understanding of dreams in the fields of social anthropology and psychology to present a novel cultural approach to dreamwork for those in the caring professions. Iain R. Edgar, This innovative text offers comprehensive coverage of the discipline of social policy and its central relevance to social work, social care and related practice in Scotland.

The Anatomy Of Bereavement A Handbook For The Caring Professions The Caring Professions

Richard Hugman, Bereavement is a painful and inevitable experience. This book shares the experience of many bereavements, how they are dealt with, understood, and eventually adapted to in the ongoing framework of human life. Beverley Raphael, At a recent reunion of past participants, it was interesting to note many former students had entered caring professions , like nursing and elder Of course, there are low-paid men in caring professions and high-paid women in banking.

However if anyone should doubt the general rule, a quick visit to a Staff taking part have expressed a wish that it will show the caring professions and the hospital in a positive light and according to psychologist Studies have found that suicide rates for the caring professions who bear witness to so much human trauma and misery are significantly above The horizontal error bar associated with each ICC represents the standard error in the estimate of the location of the ICC with respect to the PG attribute.

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Of 16 informative symptoms examined, four symptoms displayed DIF and were excluded from further analysis as indicated in Table 1. As a potential criterion standard for PGD, the rater determination of caseness of PGD had the advantage of reflecting experienced clinical judgment. However, rater assessments of PGD were subjective, were made without explicit reference to any established criteria, and were not always consistent with more objective, reliable assessments of PG as measured with IRM scores for the underlying PG attribute i.

It was decided that a criterion standard for caseness should be informed by clinical judgment, but should also be a function of PG symptom severity. This figure illustrates how rater diagnoses were used to establish a minimum-threshold cutoff PG attribute score for diagnosis of PGD i. Based on consensus opinion of the previously mentioned expert panel [23] , and confirmed by results showing yearning was the most common The analyses then sought to determine the number and combination of the remaining 11 nonmandatory symptoms in addition to yearning that would yield the most efficient i.

Combinatorics [68] , the branch of mathematics that studies the number of different ways of arranging sets, was used to enumerate alternative sets of nonmandatory symptoms to construct alternative, candidate diagnostic algorithms for meeting the symptom criterion for PGD. Each of these diagnostic algorithms was specified in terms one common, mandatory symptom, yearning, a specific set of n other, nonmandatory symptoms, and some minimum number of nonmandatory symptoms within this set, k , which one must have to satisfy the symptom criterion for PGD.

A total of 4, of these algorithms for meeting the symptom criterion for PGD were enumerated [i. Algorithms requiring yearning and as few as three of five, and as many as eight of nine, additional symptoms were considered. Figure 4 displays results for a subset of the diagnostic algorithms considered. Each data point in Figure 4 represents the sensitivity and specificity of a unique diagnostic algorithm. Each algorithm is specified in terms of one common, mandatory symptom, yearning, a specific set of n other, nonmandatory symptoms, and some minimum number of nonmandatory symptoms within this set, k , which one must have to satisfy the symptom criterion for PGD.

Based on the current data, the optimal, most efficient algorithm requires having yearning and at least five of the following nine symptoms: avoidance of reminders of the deceased; trouble accepting the death; a perception that life is empty or meaningless without the deceased; bitterness or anger related to the loss; emotional numbness; feeling stunned, dazed or shocked; feeling that part of oneself died along with the deceased; difficulty in trusting others; and difficulty moving on with life. In Table 2 , we see that the acute temporal specification was not significantly associated with any of the examined outcomes evaluated 12—24 mo post-loss.

Grief: A cognitive-behavioral analysis

These results indicate that diagnoses of PGD before 6 mo post-loss do not effectively identify bereaved individuals at risk of long-term dysfunction, whereas delayed and persistent temporal subtypes do. To reduce further the likelihood of a false-positive diagnosis, a timing criterion Criterion D was added to specify that a diagnosis not be made until at least 6 mo have elapsed since the death. This would exclude the acute cases described above in which a person with initially high levels of grief in the first few months experiences declines in grief intensity at and beyond 6 mo post-loss.

To be conservative in our diagnosis of PGD, we also added a requirement that the symptomatic distress be associated with functional impairment Criterion E. Diagnoses of PDG based on these criteria demonstrated convergent validity with respect to the diagnostic algorithm proposed by Horowitz et al. Our results indicate that PGD meets DSM criteria for inclusion as a distinct mental disorder on the grounds that it is a clinically significant form of psychological distress associated with substantial disability.

Findings from this field trial of consensus criteria for PGD confirm prior work demonstrating the distinctiveness of the symptoms of PGD e. Because standard treatments for depression have not always proven effective for the reduction of PGD [49] — [52] , whereas psychotherapies designed specifically to ameliorate symptoms of PGD have demonstrated efficacy [53] , [54] , there exists a need for the accurate detection and specialized treatment of PGD.

Although the YBS data may appear unrepresentative of the general US population, a comparison with US Census [48] , [69] , [70] data reveals similarities with the US widowed population.

For example, the YBS sample was Like the population of US widowed individuals, the YBS sample is disproportionately female, white, and elderly. Compared with the US widowed population, however, the study participants were somewhat younger, more likely to be male, and a higher proportion was white and better educated. Future research should replicate the analyses in older, nonwhite, less-educated widowed samples. Although there is a need to confirm the results in nonwidowed bereaved persons, we consider widowhood following an older spouse's death from natural causes to be the prototypical case of bereavement.

In addition, the symptoms retained were only those proven to be invariant across gender, time from loss, and kinship groups e. Thus, the results are expected to be generalizable to most bereaved individuals. The generalizability of the results reported here is not intended to deny the value in further confirmation of the findings in nonwidowed, more traumatically bereaved, younger, less-educated, more male, and ethnically and geographically diverse samples, and the need to examine longer-term bereavement outcomes e.

Although the sample size may appear modest, the study was designed and appropriately powered to evaluate a wide range of potential diagnostic criteria i.


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The YBS PGD prevalence rate was obtained in a resilient community sample in which rates of mental illness were lower than those that have been reported in other bereavement studies e. The only analyses limited by statistical power would have been the predictive validity analyses.

Here, we found large, statistically significant effects suggesting the conservative nature of our estimates of functional impairment associated with PGD. Study participants may have been less distressed than study nonparticipants. In addition, our statistical power to detect significant effects of PGD on mental health and functional impairment outcomes would be lower than would have been the case if more distressed nonparticipants with PGD had been included in the study sample.

This report provides psychometric validation of a diagnostic algorithm for PGD. In light of the recent concerns about financial conflicts of interest in psychiatric research, especially that which involves pharmaceutical manufacturers, it is noteworthy that this study was federally funded by the US NIMH, and no part of this research was sponsored by producers of a potential therapeutic remedy for PGD.

Sudden bereavement in acute care settings

Although most bereaved individuals will eventually adapt to the loss of a significant other more or less successfully, a significant, identifiable minority will experience chronic and disabling grief. A PGD diagnosis has the potential to enhance the detection and effective treatment of a substantial cause of morbidity among persons who have experienced the loss of a significant other. The diagnosis and treatment of PGD offers the promise of reducing the personal and societal toll taken by prolonged grief.

Enrolled patients: HGP. Contributed to the conceptualisation: BR. Assisted with interpretation of the results and contributed to the writing of the final manuscript, and reviewed and approved the contributions of others: RAN. Abstract Background Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Methods and Findings A total of bereaved respondents were interviewed three times, grouped as 0—6, 6—12, and 12—24 mo post-loss. Conclusions The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction.

Please see later in the article for Editors' Summary. Editors' Summary Background Virtually everyone loses someone they love during their lifetime. Why Was This Study Done? What Did the Researchers Do and Find? What Do These Findings Mean? Introduction Bereavement is a universal experience to which most individuals adequately adjust. Assessment of Symptoms of PGD Symptoms of PGD were assessed with the rater version of the Inventory of Complicated Grief—Revised ICG-R [34] — [36] , [40] , [41] , [45] , [59] , a structured interview designed to assess a wide variety of potential PGD symptoms, using five-point scales to represent increasing levels of symptom severity.

Assessment of Additional Outcomes Positive responses to one or more of the four Yale Evaluation of Suicidality [25] screening questions were categorized as having suicidal ideation. Analyses and Results The psychometric validation of diagnostic criteria for PGD proceeded through a cumulative series of analyses, with each phase in the overall analysis having a distinct aim.

Phase 1: deriving a set of informative, unbiased symptoms of PGD. Download: PPT. Figure 1. Relative item information as a function of the prolonged grief attribute for 22 candidate symptoms for PGD. Figure 2. Differential item functioning for two biased symptoms.

The journey through loss and grief - Jason B. Rosenthal

Table 1. Phase 2: deriving a criterion standard for assessing diagnostic algorithms for symptoms of PGD. Figure 3. Agreement between rater diagnoses and dichotomized prolonged grief attribute score diagnoses of PGD as a function of cutoff PG attribute score for diagnosis. Phase 3: identifying an optimal diagnostic algorithm for symptoms of PGD.

Figure 4. Alternative diagnostic algorithms for meeting symptom criteria for PGD. Phase 4: evaluating the predictive validity for temporal subtypes of PGD. Table 2. Mental health and functional consequences of meeting symptom criteria for PGD by temporal subtype.

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Phase 5: proposing criteria for PGD. Table 3. Phase 6: evaluating the predictive validity of the proposed criteria for PGD. Table 4. Discussion Our results indicate that PGD meets DSM criteria for inclusion as a distinct mental disorder on the grounds that it is a clinically significant form of psychological distress associated with substantial disability. Conclusion This report provides psychometric validation of a diagnostic algorithm for PGD.

References 1. Lancet — View Article Google Scholar 2. Parkes CM Bereavement: studies of grief in adult life. New York: Routledge.

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