Resourcing Popular Music for Relevant Themes in Music Therapy with Perinatal Loss

Perinatal loss poses unique challenges to grief work because of the complexity of dynamics it carries. Historically shrouded in socially and culturally based belief systems often impeding normal grief responses, the barriers to healthy processing have been surmounted in recent decades. The emergence of music therapy in partnership with social work is one such approach to addressing both anticipatory grief and bereavement of parents enduring the death of their infant prenatally. This retrospective article highlights the resourcing of popular music within a clinical music therapy approach to the curation of a perinatal bereavement event within a large hospital system in a metropolitan area. Popular music as a ubiquitous art form lends tangibility and relevance to the complicated themes of perinatal loss in a manner that invites bereft parents into a forum of acceptance and acknowledgment of a loss that for too long has remained in the shadows.

Co-designing an online COmmunity suPporting familiEs after Sudden Cardiac Death (COPE-SCD) in the young

Objective: To co-design an online support intervention for families after sudden cardiac death (SCD) in the young (<35 years). Design: Co-design of a SCD family intervention by stakeholder focus groups. Setting: Families and healthcare professionals with experience in SCD in the young. Participants: Semi-structured online focus groups were held with key stakeholders, i.e. family members who had experienced young SCD, healthcare professionals and researchers. Guided discussions were used to develop an online support intervention. Thematic analysis of discussions and iterative feedback on draft materials guided content development. Results: Four focus groups were held (10-12 participants per group). Stakeholder involvement facilitated development of high-level ideas and priority issues. Creative content and materials were developed based on user preference for stories, narratives and information reflecting everyday experience of families navigating the legal and medical processes surrounding SCD, normalising and supporting grief responses in the context of family relationships, and fostering hope. Emphasis on accessibility led to the overarching need for digital information and online engagement. These insights allowed development of an online intervention - COPE-SCD: A COmmunity suPporting familiEs after Sudden Cardiac Death - which includes a website and online support program. Conclusion: Using co-design with stakeholders we have developed a support intervention that directly addresses the needs of SCD families and fills a large gap in existing health care. We will evaluate COPE-SCD to determine whether this is an effective intervention for support of families following a young SCD.

Supporting bereavement and complicated grief in primary care: a realist review

BackgroundBereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients.AimTo identify what works, how, and for whom, in the management of complicated grief (CG) in primary care.Design & settingA review of evidence on the management of CG and bereavement in UK primary care settings.MethodA realist approach was taken that aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes.ResultsForty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time, and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients’ needs can encourage a proactive response and help identify appropriate support.ConclusionBereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients.

Case Report: Parental Loss and Childhood Grief During COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedent public health crisis, transforming many aspects of our daily life. Protection measures, such as social distancing, nationwide lockdowns, and restrictions on hospital visits and funerals have a serious impact on how people mourn their loved ones. The grieving process during childhood and adolescence evolves along the developmental stages and is a dynamic, non-linear process that needs time. Parental death increases the risk for psychopathology in the short and long term. We present a case of an 11-year-old girl referred to child psychiatry-liaison service by her neurologist due to peer relationship problems and sadness. Fifteen days before her first psychiatric consultation, her father suffered a myocardial infarction complicated with hypoxic ischemic encephalopathy, and he was hospitalized in the intensive care unit. Positive coping mechanisms and adaptive emotional expression strategies were explored during her consultations. Her father died 2 weeks after emergency state and nationwide lockdown was declared in Portugal, during the first COVID-19 outbreak. The family did not have the opportunity for a proper farewell, the funeral obeyed strict rules, and the patient and her family were at home, due to social distancing and school closure policies. Consultations were maintained by telephone calls and, less frequently, by face-to-face appointments. Adaptive and helpful strategies to grieve were shared with the patient and her mother. Intervention with the mother alone was also helpful. Death circumstances related to COVID-19, confinement policies, and social–economical stressors can intensify the grief experience, increasing the risk for complicated grief. Although psychiatric teleconsultation is essential during COVID-19 pandemic, it poses various limitations. Non-verbal communication clues may not be totally apprehended; it may represent a problem in the therapeutic relationship, and access to technology can be difficult for psychiatric patients and clinicians. COVID-19 pandemic policies should include mental health protection measures, which should facilitate adjusted grief responses for those who lose a loved one during this pandemic.

What Are the Obstacles to Compassion?

In this chapter, the author examines the obstacles that impede the flow of compassion in three directions: for others, from others, and from self. Obstacles to compassion for others include insecure attachment style, personal identity, self-interests, social dominance orientation, moral judgment, confusing compassion with submissiveness or weakness, empathy fatigue, time pressure, and scale of suffering (including psychophysical numbing, pseudo-inefficacy, and prominence effect). Obstacles to receiving compassion from others include activation of grief responses, perceived weakness, and vulnerability. The author also looks at what inner compassion is and how self-criticism hinders it. Finally, the author also discusses the barriers to compassion that are unique to the healthcare environment, including self-recrimination and self-neglect, empathic distress and empathy fatigue, moral suffering, bullying, burnout, medical culture, and cognitive scarcity.

Memories of Lost Loved Ones

The death of a loved one is a challenging but also normative occurrence in later life (e.g., Thomson et al, 2018). Experiencing the death of others typically increases with age, so personal reaction to loss becomes an ongoing process (Harrop et al., 2016). When adults lose someone, the deceased person is often ‘gone but not forgotten.’ That is, they are remembered over time (Klass & Steffen, 2017). The way one remembers their lost loved one’s life and their death (e.g., Mroz et al., 2019) may influence post-loss emotional adjustment and personal views. This symposium brings together Psychology and Sociology researchers with data from Germany, the US, and China whose work elucidates the complex relation between loss and memory: we identify how remembering lost loved ones relates to both adaptive and difficult outcomes. In this symposium, Wolf et al. examine beneficial and harmful ways of using autobiographical memories after a personal loss. Mroz and Bluck identify how grief responses in older adult widows lead to functional use of memories from the very end of the spouse’s life. Fu and Idler focus on the directive function of autobiographical memory, examining how memory for end-of-life experience with loved ones influences current choices for aggressive end-of-life care. Bolkan and Weaver examine how early life experiences with loss influence later personal views and advance care planning. Our Discussant, Debby Carr, integrates these talks to elucidate how remembering loss experiences relate to not only current grief, but also to people’s preparations for the future.

A relational turbulence theory perspective on women’s grief following miscarriage

This study used relational turbulence theory to examine (a) how the relational impact of miscarriage corresponded with bereaved mothers’ grief responses and (b) the association between a partner’s supportive conversational behaviors and relationship qualities. The sample included 193 women who had experienced a miscarriage within the previous year. As predicted, relational uncertainty was positively associated with women’s negative appraisals of miscarriage; facilitation from a partner was positively associated with women’s negative emotions; bereaved mothers’ negative appraisals and negative emotional responses covaried; and a partner’s supportive conversational behaviors were positively associated with facilitation from a partner. Contrary to our predictions, interference from a partner was not associated with more intense negative emotions, and a partner’s supportive conversational behaviors were positively associated with relational uncertainty and interference from a partner. The discussion highlights the relational impact of miscarriage on bereaved mothers’ experiences of grief.

Factors During a Child’s Illness Are Associated With Levels of Prolonged Grief Symptoms in Bereaved Mothers and Fathers

PURPOSE Previous research shows that bereaved parents are at an increased risk for intense and prolonged grief responses. To offer effective support to parents during a child’s cancer treatment and after their child’s death, more knowledge is needed about factors related to the child’s illness trajectory that may contribute to prolonged grief in bereaved parents and about possible sex differences related to such factors. Therefore, we examined possible contributing factors associated with prolonged grief in cancer-bereaved mothers and fathers 1 to 5 years after their child died of cancer. METHODS We studied data from a population-based nationwide survey, including 133 mothers and 92 fathers who had lost a child to cancer 1 to 5 years earlier, using univariable and multiple regression analyses to assess the associations between prolonged grief and possible contributing variables. RESULTS The variables associated with lower levels of prolonged grief symptoms for mothers were being able to talk about feelings within the family ( P = .00) and trusting that health care professionals made every possible effort to cure the child ( P = .01). The statistically significantly associated variables for fathers were having said farewell to the deceased child in the way they wanted ( P = .00) and feeling that they had received practical support from health care professionals during the child’s illness trajectory ( P = .01). CONCLUSION We found factors during the illness of children with cancer that contributed to prolonged grief for parents; these were different for mothers and fathers. The results may have implications for design of family bereavement support within pediatric oncology care, including addressing the differing needs of mothers and fathers more effectively.

MIDDLE-AGED ADULTS’ BEREAVEMENT RESPONSE TO PARENT DEATH: THE ROLE OF PRE-LOSS RELATIONSHIP QUALITY

The bereavement literature in adulthood has largely focused on spousal loss. Yet the death of a parent is an influential – and expected – loss experience in middle and later life. This study analyzed prospective data from two waves of the Family Exchanges Study (2008 and 2013) to explore adults’ (N = 192; Mage = 56.76) experience of a recent parent death in the past 5 years, including grief responses and positive memories of the deceased parent. We examined how pre-loss relationships with the deceased parent (e.g., positive and negative relationship quality, relationship importance) are associated with different bereavement responses among the bereaved children. Findings showed that the levels of grief were higher for children who placed more importance on the parent prior to that parent’s death. Positive relationship quality was associated with positive memories after a parent’s death. However, negative relationship quality was not associated with any bereavement responses.