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Ludwikowska-Świeboda, K. (2022). A sudden and unexpected death of a spouse and the severity of symptoms of complicated grief and Post-Traumatic Stress Disorder . Kwartalnik Naukowy Fides Et Ratio, 49(1), 191-203. https://doi.org/10.34766/fetr.v49i1.1049
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Introduction: The death of a spouse is one of the most stressful events in life. A better understanding of the factors leading to difficulties in adaptation to the situation of loss in widowed people seems to be important. The main goal of the presented study is to verify the role of the circumstances of the loss of a spouse (a sudden and unexpected death) with respect to severity of the symptoms of complicated grief and post-traumatic stress disorders.
Method: Fifty five widowed people participated in the study (27 of them indicated that their spouse's death occurred suddenly and unexpectedly, in the case of 28 people the loss had been anticipated). The time elapsed since death ranged from six months to 2.5 years. To measure the severity of complicated grief, the Complicated Grief Inventory by Prigerson et al. (in the Polish adaptation by Ludwikowska-Świeboda and Lachowska) was used. In order to assess the severity of symptoms of post-traumatic stress disorder (intrusion, avoidance and hyperarousal), the Impact of Event Scale — Revised by Weiss and Marmar (in the Polish adaptation by Juczyński and Ogińska-Bulik) was used. To determine the circumstances of the spouse's death, a self-authored demographic data questionnaire was used.
Results: As expected, the experience of a sudden and unexpected death is a significant predictor of the severity of complicated grief. Detailed analyses revealed that widowed people who experienced a sudden and unexpected death of their spouse are significantly more likely to be preoccupied with thinking about the deceased, experience shock and disbelief, and feel distanced from those who are important to them (compared to people who experienced an anticipated loss). They may also have a greater tendency to avoid stimuli reminding them of the deceased, experience more discomfort when recalling the deceased, and have difficulty trusting other people since their loss. A sudden and unexpected death is also a significant predictor of the severity of hyperarousal symptoms.
Conclusions: Widowed people who view their spouse's death as sudden and unexpected are at a greater risk of a disruption of the grief process.
Bibliografia
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn). Washington, DC: APA.
Barlé, N., Wortman, C. B., & Latack, J. A. (2017). Traumatic bereavement: Basic research and clinical implications. Journal of Psychotherapy Integration, 27(2), 127–139. https://doi.org/10.1037/int0000013
Djelantik, A. M. J., Smid, G. E., Mroz, A., Kleber, R. J., & Boelen, P. A. (2020). The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis. Journal of Affective Disorders, 265, 146-156.
https://doi.org/10.1016/j.jad.2020.01.034.
Domino, J. L., Whiteman, S. E., Davis, M. T., Witte, T. K., & Weathers, F. W. (2021). Sudden unexpected death as a traumatic stressor: The impact of the DSM–5 revision of Criterion A for posttraumatic stress disorder. Traumatology, 27(2), 168–176.
https://doi.org/10.1037/trm0000272
Eisma, M. C., Boelen, P. A., & Lenferink, L. (2020). Prolonged grief disorder following the Coronavirus (COVID-19) pandemic. Psychiatry Research, 288, 113031.
DOI: https://doi.org/10.1016/j.psychres.2020.113031
Ennis, J., Majid, U. (2021) “Death from a broken heart”: A systematic review of the relationship between spousal bereavement and physical and physiological health outcomes, Death Studies, 45(7), 538-551.
https://doi.org/10.1080/07481187.2019.1661884
Główny Urząd Statystyczny (2019). Sytuacja demograficzna Polski do 2018r. Tworzenie i rozpad rodzin. Warszawa: Zakład Wydawnictw Statystycznych.
Goldstein, R. D., Lederman, R. I., Lichtenthal, W. G., Morris, S. E., Human, M., Elliott, A. J., Tobacco, D., Angal, J., Odendaal, H., Kinney, H. C., Prigerson, H. G., & PASS Network (2018). The Grief of Mothers After the Sudden Unexpected Death of Their Infants. Pediatrics, 141(5), e20173651.
https://doi.org/10.1542/peds.2017-3651
Hardt, M. M., Williams, J. L., & Jobe-Shields, L. (2021). The role of experiential avoidance in the relationship between traumatic distress and yearning in sudden and unexpected bereavement. Journal of Clinical Psychology, 1– 11.
https://doi.org/10.1002/jclp.23233
Holland, J. M., Klingspon, K. L., Lichtenthal, W. G., & Neimeyer, R. A. (2020). The Unfinished Business in Bereavement Scale (UBBS): Development and psychometric evaluation. Death Studies, 44(2), 65–77.
DOI: https://doi.org/10.1080/07481187.2018.1521101
Holmes, T. H., Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic Research, 11, 213-218.
Ingles, J., Spinks, C., Yeates, L., McGeechan, K., Kasparian, N., & Semsarian, C. (2016). Posttraumatic stress and prolonged grief after the sudden cardiac death of a young relative. JAMA Internal Medicine, 176(3), 402-405.
https://doi.org/10.1001/jamainternmed.2015.7808
Juczyński, Z., Ogińska-Bulik, N. (2009). Pomiar zaburzeń po stresie traumatycznym-polska wersja Zrewidowanej Skali Wpływu Zdarzeń. Psychiatria, 6(1), 15-25.
Kaltman, S., & Bonanno, G. A. (2003). Trauma and bereavement: Examining the impact of sudden and violent deaths. Journal of Anxiety Disorders, 17(2), 131–147. https://doi.org/10.1016/S0887-6185(02)00184-6
Kersting, A., Brähler, E., Glaesmer, H., Wagner, B. (2011). Prevalence of complicated grief in
a representative population-based sample. Journal of Affective Disorders, 131(1-3), 339-343.
https://doi.org/10.1016/j.jad.2010.11.032
Killikelly, C., & Maercker, A. (2017). Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability. European Journal of Psychotraumatology, 8(sup6), 1476441.
https://doi.org/10.1080/20008198.2018.1476441
Kostrubiec-Wojtachnio, B. (2020). Koncepcja zadań w rozwoju religijnym małżonków w biegu ich życia: próba określenia stadiów rozwojowych i osiągnięć rozwojowych. W: M. Borowska, J. Kraśniewska (red.). Konteksty religijności i rodziny (s. 265-299). Kraków: Wydawnictwo Naukowe Uniwersytetu Papieskiego Jana Pawła II.
HTTP://DX.DOI.ORG./10.15633/9788374389327.07
Layne, C. M., Kaplow, J. B., Oosterhoff, B., Hill, R. M., & S Pynoos, R. (2017). The interplay between posttraumatic stress and grief reactions in traumatically bereaved adolescents: When trauma, bereavement, and adolescence converge. Adolescent Psychiatry, 7(4), 266-285.
https://doi.org/10.2174/2210676608666180306162544
Ludwikowska-Świeboda, K. (2020). Attachment style and experiencing the symptoms of complicated grief after the death of a spouse – preliminary research among widowed women. Psychiatria i Psychologia Kliniczna, 20(2), 112-121.
https://doi.org/10.15557/PiPK.2020.0015
Ludwikowska-Świeboda, K., Lachowska, B. (2019). Polska wersja Inwentarza Żałoby Powikłanej– wstępna walidacja. Psychiatria Polska, 53(5), 1069-1086.
https://doi.org/10.12740/PP/91729.
Lundorff, M., Johannsen, M., & O'Connor, M. (2021). Time elapsed since loss or grief persistency? Prevalence and predictors of ICD-11 prolonged grief disorder using different applications of the duration criterion. Journal of Affective Disorders, 279, 89-97.
https://doi.org/10.1016/j.jad.2020.09.116
Moon, J.R., Kondo, N., Glymour, M.M., Subramanian, S.V. (2011). Widowhood and Mortality: A Meta-Analysis. PLOS ONE, 6(8): e23465.
https://doi.org/10.1371/journal.pone.0023465
Morris, S., Fletcher, K., & Goldstein, R. (2019). The grief of parents after the death of a young child. Journal of Clinical Psychology in Medical Settings, 26(3), 321-338.
https://doi.org/10.1007/s10880-018-9590-7
Neria, Y., Gross, R., Litz, B., Maguen, S., Insel, B., Seirmarco, G., Rosenfeld, H., Suh, E.J., Kishon, R., Cook, J. and Marshall, R.D. (2007). Prevalence and psychological correlates of complicated grief among bereaved adults 2.5–3.5 years after September 11th attacks. J. Traum. Stress, 20, 251-262.
https://doi.org/10.1002/jts.20223
Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., ... Miller, M. (1995). Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Research, 59(1), 65-79.
https://doi.org/10.1016/0165-1781(95)02757-2
Pużyński, S., Wciórka, J. (2000). Klasyfikacja zaburzeń psychicznych i zaburzeń zachowania w ICD-10. Kraków-Warszawa: Uniwersyteckie Wydawnictwo Medyczne „Vesalius.
Remondet, J. H., & Hansson, R. O. (1987). Assessing a widow's grief - A short index. Journal of Gerontological Nursing, 13(4), 30-34.
https://doi.org/10.3928/0098-9134-19870401-07
Rubin, S. S., Malkinson, R., & Witztum, E. (2020). Traumatic Bereavements: Rebalancing the Relationship to the Deceased and the Death Story Using the Two-Track Model of Bereavement. Frontiers in Psychiatry, 11, 537596.
https://doi.org/10.3389/fpsyt.2020.537596
Schaal, S., Richter, A., & Elbert, T. (2014). Prolonged grief disorder and depression in a German community sample. Death Studies, 38(7), 476-481.
https://dx.doi.org/10.1080/07481187.2013.809032
Sekowski, M., & Prigerson, H. G. (2021). Associations between interpersonal dependency and severity of prolonged grief disorder symptoms in bereaved surviving family members. Comprehensive Psychiatry, 108, 152242.
https://doi.org/10.1016/j.comppsych.2021.152242.
Shear, M. K. (2015). Complicated grief. New England Journal of Medicine, 372(2), 153-160.
https://doi.org/10.1056/NEJMcp1315618
Simon, N. M., Wall, M. M., Keshaviah, A., Dryman, M. T., LeBlanc, N. J., & Shear, M. K. (2011). Informing the symptom profile of complicated grief. Depression and Anxiety, 28(2), 118-126.
https://doi.org/10.1002/da.20775
Stroebe, M., Schut, H., Finkenauer, C. (2001). The traumatization of grief? A conceptual framework for understanding the trauma-bereavement interface. Israel Journal of
Psychiatry and Related Sciences, 38(3/4), 185-201.
Szuhany, K. L., Young, A., Mauro, C., Garcia de la Garza, A., Spandorfer, J., Lubin, R., Skritskaya, N. A., Hoeppner, S. S., Li, M., Pace-Schott, E., Zisook, S., Reynolds, C. F., Shear, M. K., & Simon, N. M. (2020). Impact of sleep on complicated grief severity and outcomes. Depression and Anxiety, 37(1), 73–80.
https://doi.org/10.1002/da.22929
Thomas, K., Hudson, P., Trauer, T., Remedios, C., & Clarke, D. (2014). Risk factors for developing prolonged grief during bereavement in family carers of cancer patients in palliative care: a longitudinal study. Journal of Pain and Symptom Management, 47(3), 531-541.
https://doi.org/10.1016/j.jpainsymman.2013.05.022
Tsai, W. I., Prigerson, H. G., Li, C. Y., Chou, W. C., Kuo, S. C., & Tang, S. T. (2016). Longitudinal changes and predictors of prolonged grief for bereaved family caregivers over the first 2 years after the terminally ill cancer patient’s death. Palliative Medicine, 30(5), 495-503.
DOI: https://doi.org/10.1177/0269216315603261
Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event Scale Revised in Assessing Psychological Trauma and PTSD–A Practitioners Handbook, New York: Edited by Wilson JP & Keane TM.
World Health Organisation. ICD-11 Reference Guide. Pobrano z: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1183832314 (data dostępu: 05.01.2021).
Barlé, N., Wortman, C. B., & Latack, J. A. (2017). Traumatic bereavement: Basic research and clinical implications. Journal of Psychotherapy Integration, 27(2), 127–139. https://doi.org/10.1037/int0000013
Djelantik, A. M. J., Smid, G. E., Mroz, A., Kleber, R. J., & Boelen, P. A. (2020). The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis. Journal of Affective Disorders, 265, 146-156.
https://doi.org/10.1016/j.jad.2020.01.034.
Domino, J. L., Whiteman, S. E., Davis, M. T., Witte, T. K., & Weathers, F. W. (2021). Sudden unexpected death as a traumatic stressor: The impact of the DSM–5 revision of Criterion A for posttraumatic stress disorder. Traumatology, 27(2), 168–176.
https://doi.org/10.1037/trm0000272
Eisma, M. C., Boelen, P. A., & Lenferink, L. (2020). Prolonged grief disorder following the Coronavirus (COVID-19) pandemic. Psychiatry Research, 288, 113031.
DOI: https://doi.org/10.1016/j.psychres.2020.113031
Ennis, J., Majid, U. (2021) “Death from a broken heart”: A systematic review of the relationship between spousal bereavement and physical and physiological health outcomes, Death Studies, 45(7), 538-551.
https://doi.org/10.1080/07481187.2019.1661884
Główny Urząd Statystyczny (2019). Sytuacja demograficzna Polski do 2018r. Tworzenie i rozpad rodzin. Warszawa: Zakład Wydawnictw Statystycznych.
Goldstein, R. D., Lederman, R. I., Lichtenthal, W. G., Morris, S. E., Human, M., Elliott, A. J., Tobacco, D., Angal, J., Odendaal, H., Kinney, H. C., Prigerson, H. G., & PASS Network (2018). The Grief of Mothers After the Sudden Unexpected Death of Their Infants. Pediatrics, 141(5), e20173651.
https://doi.org/10.1542/peds.2017-3651
Hardt, M. M., Williams, J. L., & Jobe-Shields, L. (2021). The role of experiential avoidance in the relationship between traumatic distress and yearning in sudden and unexpected bereavement. Journal of Clinical Psychology, 1– 11.
https://doi.org/10.1002/jclp.23233
Holland, J. M., Klingspon, K. L., Lichtenthal, W. G., & Neimeyer, R. A. (2020). The Unfinished Business in Bereavement Scale (UBBS): Development and psychometric evaluation. Death Studies, 44(2), 65–77.
DOI: https://doi.org/10.1080/07481187.2018.1521101
Holmes, T. H., Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic Research, 11, 213-218.
Ingles, J., Spinks, C., Yeates, L., McGeechan, K., Kasparian, N., & Semsarian, C. (2016). Posttraumatic stress and prolonged grief after the sudden cardiac death of a young relative. JAMA Internal Medicine, 176(3), 402-405.
https://doi.org/10.1001/jamainternmed.2015.7808
Juczyński, Z., Ogińska-Bulik, N. (2009). Pomiar zaburzeń po stresie traumatycznym-polska wersja Zrewidowanej Skali Wpływu Zdarzeń. Psychiatria, 6(1), 15-25.
Kaltman, S., & Bonanno, G. A. (2003). Trauma and bereavement: Examining the impact of sudden and violent deaths. Journal of Anxiety Disorders, 17(2), 131–147. https://doi.org/10.1016/S0887-6185(02)00184-6
Kersting, A., Brähler, E., Glaesmer, H., Wagner, B. (2011). Prevalence of complicated grief in
a representative population-based sample. Journal of Affective Disorders, 131(1-3), 339-343.
https://doi.org/10.1016/j.jad.2010.11.032
Killikelly, C., & Maercker, A. (2017). Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability. European Journal of Psychotraumatology, 8(sup6), 1476441.
https://doi.org/10.1080/20008198.2018.1476441
Kostrubiec-Wojtachnio, B. (2020). Koncepcja zadań w rozwoju religijnym małżonków w biegu ich życia: próba określenia stadiów rozwojowych i osiągnięć rozwojowych. W: M. Borowska, J. Kraśniewska (red.). Konteksty religijności i rodziny (s. 265-299). Kraków: Wydawnictwo Naukowe Uniwersytetu Papieskiego Jana Pawła II.
HTTP://DX.DOI.ORG./10.15633/9788374389327.07
Layne, C. M., Kaplow, J. B., Oosterhoff, B., Hill, R. M., & S Pynoos, R. (2017). The interplay between posttraumatic stress and grief reactions in traumatically bereaved adolescents: When trauma, bereavement, and adolescence converge. Adolescent Psychiatry, 7(4), 266-285.
https://doi.org/10.2174/2210676608666180306162544
Ludwikowska-Świeboda, K. (2020). Attachment style and experiencing the symptoms of complicated grief after the death of a spouse – preliminary research among widowed women. Psychiatria i Psychologia Kliniczna, 20(2), 112-121.
https://doi.org/10.15557/PiPK.2020.0015
Ludwikowska-Świeboda, K., Lachowska, B. (2019). Polska wersja Inwentarza Żałoby Powikłanej– wstępna walidacja. Psychiatria Polska, 53(5), 1069-1086.
https://doi.org/10.12740/PP/91729.
Lundorff, M., Johannsen, M., & O'Connor, M. (2021). Time elapsed since loss or grief persistency? Prevalence and predictors of ICD-11 prolonged grief disorder using different applications of the duration criterion. Journal of Affective Disorders, 279, 89-97.
https://doi.org/10.1016/j.jad.2020.09.116
Moon, J.R., Kondo, N., Glymour, M.M., Subramanian, S.V. (2011). Widowhood and Mortality: A Meta-Analysis. PLOS ONE, 6(8): e23465.
https://doi.org/10.1371/journal.pone.0023465
Morris, S., Fletcher, K., & Goldstein, R. (2019). The grief of parents after the death of a young child. Journal of Clinical Psychology in Medical Settings, 26(3), 321-338.
https://doi.org/10.1007/s10880-018-9590-7
Neria, Y., Gross, R., Litz, B., Maguen, S., Insel, B., Seirmarco, G., Rosenfeld, H., Suh, E.J., Kishon, R., Cook, J. and Marshall, R.D. (2007). Prevalence and psychological correlates of complicated grief among bereaved adults 2.5–3.5 years after September 11th attacks. J. Traum. Stress, 20, 251-262.
https://doi.org/10.1002/jts.20223
Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., ... Miller, M. (1995). Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Research, 59(1), 65-79.
https://doi.org/10.1016/0165-1781(95)02757-2
Pużyński, S., Wciórka, J. (2000). Klasyfikacja zaburzeń psychicznych i zaburzeń zachowania w ICD-10. Kraków-Warszawa: Uniwersyteckie Wydawnictwo Medyczne „Vesalius.
Remondet, J. H., & Hansson, R. O. (1987). Assessing a widow's grief - A short index. Journal of Gerontological Nursing, 13(4), 30-34.
https://doi.org/10.3928/0098-9134-19870401-07
Rubin, S. S., Malkinson, R., & Witztum, E. (2020). Traumatic Bereavements: Rebalancing the Relationship to the Deceased and the Death Story Using the Two-Track Model of Bereavement. Frontiers in Psychiatry, 11, 537596.
https://doi.org/10.3389/fpsyt.2020.537596
Schaal, S., Richter, A., & Elbert, T. (2014). Prolonged grief disorder and depression in a German community sample. Death Studies, 38(7), 476-481.
https://dx.doi.org/10.1080/07481187.2013.809032
Sekowski, M., & Prigerson, H. G. (2021). Associations between interpersonal dependency and severity of prolonged grief disorder symptoms in bereaved surviving family members. Comprehensive Psychiatry, 108, 152242.
https://doi.org/10.1016/j.comppsych.2021.152242.
Shear, M. K. (2015). Complicated grief. New England Journal of Medicine, 372(2), 153-160.
https://doi.org/10.1056/NEJMcp1315618
Simon, N. M., Wall, M. M., Keshaviah, A., Dryman, M. T., LeBlanc, N. J., & Shear, M. K. (2011). Informing the symptom profile of complicated grief. Depression and Anxiety, 28(2), 118-126.
https://doi.org/10.1002/da.20775
Stroebe, M., Schut, H., Finkenauer, C. (2001). The traumatization of grief? A conceptual framework for understanding the trauma-bereavement interface. Israel Journal of
Psychiatry and Related Sciences, 38(3/4), 185-201.
Szuhany, K. L., Young, A., Mauro, C., Garcia de la Garza, A., Spandorfer, J., Lubin, R., Skritskaya, N. A., Hoeppner, S. S., Li, M., Pace-Schott, E., Zisook, S., Reynolds, C. F., Shear, M. K., & Simon, N. M. (2020). Impact of sleep on complicated grief severity and outcomes. Depression and Anxiety, 37(1), 73–80.
https://doi.org/10.1002/da.22929
Thomas, K., Hudson, P., Trauer, T., Remedios, C., & Clarke, D. (2014). Risk factors for developing prolonged grief during bereavement in family carers of cancer patients in palliative care: a longitudinal study. Journal of Pain and Symptom Management, 47(3), 531-541.
https://doi.org/10.1016/j.jpainsymman.2013.05.022
Tsai, W. I., Prigerson, H. G., Li, C. Y., Chou, W. C., Kuo, S. C., & Tang, S. T. (2016). Longitudinal changes and predictors of prolonged grief for bereaved family caregivers over the first 2 years after the terminally ill cancer patient’s death. Palliative Medicine, 30(5), 495-503.
DOI: https://doi.org/10.1177/0269216315603261
Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event Scale Revised in Assessing Psychological Trauma and PTSD–A Practitioners Handbook, New York: Edited by Wilson JP & Keane TM.
World Health Organisation. ICD-11 Reference Guide. Pobrano z: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1183832314 (data dostępu: 05.01.2021).
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