prolonged grief -> artikel bonanno: resilience to loss and chronic grief

Question 1

introductie artikel

Answer 1

Individuals differ in how and long they grieve. Different patterns of grief have been identified, namely: common grief, chronic grief, chronic depression, improvement during bereavement and resilience. What is problematic in most grief studies is that do not investigate preloss data.

! common grief was relatively infrequent and resilient pattern most frequent.

Question 2

chronic grief

Answer 2

Chronic grief: is found in about 10-20%. It is important to distinguish it from chronic depression. That is also why pre-bereavement data is important, since otherwise there are unanswered questions about whether there might be a relationship with chronic grief to a previous psychopathology. Adding to this, chronic grief is mostly assessed through retrospective accounts, which are susceptible to depression related memory biases.

Question 3

absence of grief

Answer 3

Absence of grief (resilience) was initially thought to be maladaptive because it might come from denial or inhibition. Recently studies have challenged this view and said it might also be because the individual is able to adjust quickly, or it might be due to personality factors.

Question 4

delayed grief

Answer 4

Delayed grief: a reaction where individuals show an improved functioning during bereavement and develop depression/ grief symptoms later. The evidence for this is low. Improved functioning after the bereavement might be due to people feeling relieved, for example after caring for a loved one with a serious illness for a long time.

Question 5

belangrijke begrippen: veerkracht, algemene rouw, chronische rouw, chronische depressie en depressie-verbeterning

Answer 5

• Veerkracht: De meest voorkomende reactie, waarbij mensen weinig last hebben van verdriet door sterke persoonlijke en sociale middelen.
• Algemene rouw: Voldoet aan traditionele rouwmodellen, met een tijdelijke toename van verdriet.
• Chronische rouw: Verlies blijft intens voelbaar; interventies kunnen gericht zijn op het verbeteren van copingmechanismen.
• Chronische depressie: Vereist psychologische ondersteuning vanwege voortdurende depressieve symptomen.
• Depressie-verbetering: Het verlies kan verlichting bieden bij een slechte huwelijksrelatie.

Question 6

huidige studie

Answer 6

Current study
This study looked at different patterns in depression at preloss, 6 and 18 months after the loss of the partner. Participants were categorized in low and high preloss depression and analyzed separately.

Through including preloss data it was possible:
- To distinguish chronic grief from chronic depression.
- To differentiate between stable low depression, which is also called resilient pattern, and improved functioning.

Question 7

Hypothese 1: kwaliteit relatie partner bepaald hoeveelheid rouw & resultaat

Answer 7

1. Chronic grief is partly due to conflict and ambivalence with the partner, whereas resilient grievers are adjusted well. A competing hypothesis would be that not grieving (resilient individuals) is because they had a bad marriage
   a. They failed to prove these hypotheses. There were no significant differences in the quality of the relationship with the partner between the resilient, common grief and chronic grief groups.

Question 8

Hypothese 2: chronische grief komt van hoge afhankelijkheid & resultaat

Answer 8

2. Chronic grief might result from a high level of dependency
   a. This was supported. Chronic grievers showed significantly higher dependency on their partner.

Question 9

hypothese 3: veerkrachtige individuen zijn cold en distant & resultaat

Answer 9

3. Resilient individuals are cold and distant
   a. Not supported

Question 10

hypothese 4: chronic grief komt door mindere coping mechanisme & resultaat

Answer 10

4. Chronic grief is due to less coping resources, whereas resilient individuals have more coping mechanisms
   a. The pairwise comparison did not find a significant difference. Therefore, they failed to support this hypothesis. Only the chronically depressed group scores significantly lower in coping mechanisms than every other group.

Question 11

Hypothese 5: veerkrachtige mensen hebben wereldeeld dat helpt bij rouw & resultaat

Answer 11

5. Resilient individuals have a worldview that helps them to accept the loss and believe in a fair world.
   a. Supported

Question 12

hypothese 6: chronische grief hebben minder support

Answer 12

6. Chronic grievers have less social and instrumental support.
   a. Partly supported -> It showed significant groups differences only for instrumental support, not social support.

Question 13

Belangrijkste bevindingen

Answer 13

Belangrijkste bevindingen:
* Chronische rouw was gekoppeld aan een hoge afhankelijkheid van de partner en minder copingvaardigheden.
* Veerkracht werd geassocieerd met acceptatie van de dood en een geloof in een rechtvaardige wereld.
* Verbeterde depressie hing samen met slechte huwelijkstevredenheid en conflicten vóór het verlies.

The study led to important findings:
- Chronis grief could be differentiated from chronic depression and other grief groups.
- The resilient group showing a stable and low depression was the biggest group, not the common grief group
- There was one group that showed high preloss depression and then improvement after the loss occurred. This is the first prospective study proving the existence of a depression improved impact.
- There was no evidence for a delayed grief pattern.

Question 14

discussie

Answer 14

The most important predictors of chronic grief were high dependency, low instrumental support and having a spouse that was not sick before.

A lot of variables that were assumed to be predictors of chronic grief, were instead related to chronic depression like for example not having anything positive to say about the relationship, being highly emotionally unstable, showing little of no confidence in one’s ability to deal with stressful events and believing that they cannot control negative events.

The resilient group proved to not be maladaptive as assumed before. They were well-adjusted and showed sufficient coping resources to deal with the loss.

The depressed improved group was maladjusted and self-absorbed. They showed deficient coping resources dealing with stress and had rather negative and ambivalent feelings about their marriage. Besides that, for them it was more likely that their partner was seriously ill and they had little instrumental support. They seemed to be very introspective, emotionally unstable and had the feeling that the world was unfair especially for them.