Bereavement in the Context of Serious Mental Illness

Abstract

Objective-This study examined whether the situational factors that contribute to severe grief in the general population predicted the severity of grief in a sample of persons who had diagnoses of serious mental illness.Method-Research participants who had a diagnosis of a serious mental illness and who reported the death of a close friend or family member during a five-year service evaluation project were asked to detail the circumstances that surrounded the death and to rate how the death affected their lives. Key research measures included the self-rated measurement of the impact of the death, the self-rated measurement of the duration of the reported grief, and scores on a psychiatric symptom assessment in the six months after the death. A regression analysis tested the cumulative count of four situational factors-residing with the close friend or family member at the time of the death, the suddenness of the death, having low social support, and having concurrent stressors-as a predictor of severe and prolonged grief.Results-In the sample of 148 individuals with serious mental illness, 33 (22 percent) reported the death of a close friend or family member as a significant life event that resulted in relatively acute and brief grief (15 individuals, or 10 percent) or severe and prolonged grief (18 individuals, or 12 percent). The regression analysis confirmed that the more situational factors that occurred at the time of the death, the more severe the grief reaction was, irrespective of psychiatric symptomatology.Conclusions-Mental health services for persons with serious mental illness should begin to incorporate preparation for parental death and bereavement counseling as essential services, and such interventions should approach bereavement as a normal rather than a pathological response to interpersonal loss.Severe grief in response to the death of a close friend or family member is associated with a variety of physical and mental disorders (1-3) as well as with persistent depressive symptoms (4,5). Although the estimated incidence of prolonged, intense grief in the general population is only 11 to 15 percent (6-8), a study found that nearly a third of the psychiatric outpatients who were surveyed were currently experiencing intense grief that had already lasted an average of ten years (9).A bereaved individual with a preexisting psychiatric disorder is especially vulnerable to depression and depression-related physical illnesses (10,11). However, the etiology of chronic, severe grief appears to be more circumstantial than psychiatric in nature. Maladaptive cognitions-for example, denial, self-blame, and ambivalence-do not appear to lengthen the grieving process (12-15), but situational factors do. Circumstances that predict prolonged grief include a strong dependence on the close friend or family member before the death, the suddenness of the death, a lack of social support, and co-occurring other stressors (16-27). Cooccurring factors that can intensify grief or lengthen the time of grief include...

Subjective Distress Associated with Sudden Loss in Clients with Severe Mental Illness

“…The effort to discriminate traumatic/ complicated grief from other psychiatric disorders (e.g., MMD, PTSD) is itself complicated by a range of interacting and possibly shared genetic and familial risk factors for mental illnesses, substance abuse, and other psychosocial disturbances (Brady and Sinha 2005), correlations among symptoms of PTSD, SMI and severe grief reactions (Seedat et al 2003;Kilcommons and Morrison 2005;Kendler et al 2008), and social context factors that affect the bereaved before and after the loss of a loved one (Macias et al 2004). The difference in reported distress from sudden death of a loved one between clients with MMD and SSD in the current study, for example, raises the question of the capacity of some people to successfully process emotions in a way that is necessary for expressing and resolving grief.…”

Grief reaction model of families who experienced acute bereavement in Japan

“…For example, studies have shown that women show stronger grief reactions than men (Shear et al ., 2006; Neria et al ., 2007). In addition, grief reactions appear to be stronger when the bereaved person does not receive adequate support (Macias et al ., 2004), or when coping mechanisms are not appropriate for the loss (Sakaguchi et al ., 2001). Furthermore, parents who have lost a child and individuals who have lost a spouse show strong grief reactions (Kreicbergs et al ., 2004; Siegel et al ., 2008).…”

Music Therapy as Grief Therapy for Adults With Mental Illness and Complicated Grief: A Pilot Study

“…A mixed-methods approach was used so that (a) effectiveness of music therapy could be quantitatively measured; and (b) the experience of music therapy as a treatment for CG, specifically for adults with mental illness, could be qualitatively analyzed in relation to Worden's (2009) model of grief therapy. Adults with mental illness and CG were studied due to the higher prevalence of CG in adults with mental illness (Piper et al, 2001), and the resulting need for treatment options (Macias et al, 2004). It was hypothesized that participants who received music therapy in addition to standard treatment would have a greater reduction in grief symptoms as compared to those who received standard treatment alone.…”