To define the prevalence and correlates of grief-related symptoms among long-term care staff who care for patients near the end of life, a cross-sectional survey was conducted at six Program of All-inclusive Care for the Elderly (PACE) organizations that provide long-term care in the home and in institutions. All clinical and non-clinical program staff were surveyed to examine the prevalence of 20 grief-related symptoms and assess current sources of bereavement support, as well as willingness to use additional sources of support. Surveys were completed by 203/236 staff (86%), who described a wide variety of symptoms they attributed to the death of one of their patients in the past month. Most staff (147/203; 72%) reported at least one symptom. Staff with more symptoms had experienced more patient deaths in the past month (Spearman rho = 0.20, P = 0.007), had worked for a longer time at a PACE organization (Spearman rho = 0.16, P = 0.031), and reported a closer and longer relationship with the last patient who died (Spearman rho = 0.32, P < 0.001; rho = 0.24, P = 0.001). Although staff identified several informal sources of bereavement support (mean 2.3 sources, range 0-6), almost all (n = 194; 96%) said they would use additional support services if they were offered. These community-based long-term care staff experience a variety of symptoms attributable to the deaths of their patients, and would welcome additional sources of bereavement support.

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Men tend to view their own aggression as an instrumental act aimed at imposing control, whereas women tend to view theirs as an expressive act resulting from a loss of self-control. These interpretations have been called social representations based on their presumed social origins and mode of transmission. However, if women's self-control is generally higher than men's, they would be expected to behave aggressively only infrequently and at higher levels of provocation. Aggression would be experienced phenomenologically as a loss of self-control. In Study 1, a student sample, men scored higher than women on instrumental beliefs, impulsivity, and risk seeking. As predicted, instrumental beliefs were associated with higher impulsive risk seeking and an expressive representation was positively associated with temper. In Study 2, an offender sample, there were no gender differences in instrumental beliefs, physical aggression, temper, carelessness, and present orientation. Instrumental beliefs were again associated with impulsive risk seeking and, to a lesser extent, temper. Expressive beliefs were again associated with temper and, to a lesser extent, present orientation. Physical aggression was associated with holding instrumental beliefs, impulsive risk seeking, and temper. The model is broadly supported and directions for future work are suggested.

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