Samenvatting
Loss and Psychotrauma summary Literature (Articles)
- Instelling
- Universiteit Utrecht (UU)
Summary of all the literature for the Loss and Psychotrauma exam in 2022. 12 articles, see the first page.
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Loss & Psychotrauma Articles SummaryPage Article
2 Stroebe et al. (2007). The health consequences of bereavement: A review.
4 Heide et al. (2016). Complex PTSD and phased treatment in refugees: A debate piece.
5 Bryant (2019). Post-traumatic stress disorder: A state-of-the-art review of evidence and challenges.
7 Stroebe et al. (2017). Models of coping with bereavement: An updated overview.
9 Chen et al. (2015). Eye Movement Desensitization and Reprocessing versus Cognitive-Behavioral Therapy for adult
posttraumatic stress disorder: Systematic review and meta-analysis.
10 Slobodin & De Jong (2015). Mental health interventions for traumatized asylum seekers and refugees: What do
we know about their efficacy?
12 Steel et al. (2009). Association of torture and other potentially traumatic events with mental health outcomes
among populations exposed to mass conflict and displacement: A systematic review and meta-analysis.
13 Wittouck et al. (2011). The prevention and treatment of complicated grief: A meta-analysis.
14 Boelen et al. (2013). Prolonged grief disorder: Cognitive-behavioral theory and therapy.
16 Spuij et al. (2013). Cognitive-Behavioral Therapy for prolonged grief in children: Feasibility and multiple baseline
study.
18 Fazel (2018). Psychological and psychosocial interventions for refugee children resettled in high-income
countries.
19 Van Ee et al. (2016). Parental PTSD, adverse parenting and child attachment in a refugee sample.
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,Stroebe, M.S., Schut, H.A.W. & Stroebe, W. (2007). The health consequences of
bereavement: A review.
Summary
In this Review, we look at the relation between bereavement and physical and mental health. Although grief is not a disease
and most people adjust without professional psychological intervention, bereavement is associated with excess risk of
mortality, particularly in the early weeks and months after loss. It is related to decrements in physical health, indicated by
presence of symptoms and illnesses, and use of medical services. Furthermore, bereaved individuals report diverse
psychological reactions. For a few people, mental disorders or complications in the grieving process ensue. Intervention should
be targeted at high-risk people and those with complicated grief or bereavement-related depression and stress disorders.
Introduction
Much research has been undertaken on bereavement, defined as the situation of having recently lost a significant person
through death. It is associated with a period of intense suffering for most individuals, with an increased risk of developing
mental and physical health problems. Adjustment can take months or even years and is subject to substantial variation
between individuals and across cultures. Grief is defined as the mainly emotional reaction to bereavement, incorporating
diverse psychological and physical reactions.
The mortality of bereavement
Overall patterns
For several decades, researchers have examined whether the death of a loved one increases the mortality risk of the
bereaved person—understood popularly as dying of a broken heart. Most of the findings indicate an early excess risk of
mortality, although some researchers have also noted risks persisting for longer than 6 months after bereavement.
Subgroup differences
Researchers have examined subgroup differences—e.g., sex and age patterns, education and ethnic origin, household size
and number of children. For example, a study reported a greater risk of bereavement-related mortality in white people than
in black people. Sex and age patterns have been recorded most frequently. Findings confirm that there are sex differences in
the mortality of spousal bereavement: widowers (men) are at relatively more excessive risk of mortality than widows
(women) (compared with married same-sex counterparts). That sex-difference patterns can vary across types of loss (e.g.,
spousal, child, parent) is noteworthy. Death of a child has been reported to have an even greater effect on mothers than
fathers. With respect to age, findings of studies have also indicated a greater mortality risk for younger than for older
bereaved people who have lost their spouse.
Causes of death
Bereaved people die excessively from various causes, which are differentially related to the duration of bereavement. Excess
mortality in widowed populations is highest in the early months, and decreases with increasing duration of bereavement.
Of bereaved parents, excess risk of mortality for mothers has been seen to extend for 18 years in one study, with deaths
attributable to natural and unnatural causes, whereas for fathers, greater risk was noted early on in bereavement from
unnatural causes.
Conclusion
Bereavement is associated with an increased risk of mortality from many causes, including suicide. For widowers, the
increased risk will probably be associated with alcohol consumption and the loss of their sole confidante, who would have
overseen her husband’s health status.
Physical ill health
Overall patterns
Some investigators have reported a greater occurrence of physical health complaints in bereaved people (compared with
matched controls), ranging from physical symptoms (e.g., headaches, dizziness, indigestion, and chest pain) to high rates of
disability and illness, greater use of medical services (in some studies), and drug use. The results suggest that bereaved
individuals who are most in need of health care might not be obtaining such help.
Specific debilitating aspects
Those bereaved for short durations had substantially increased activity-limiting pain and moderate-to-severe current pain. In
general, compared with non-bereaved controls, widowed people were three times more likely to report having current
strong pain. The current level of mood disturbance mediated the relation between widowhood and pain. Bereavement has
also been associated with weight loss.
2
, Psychological symptoms and ill health
Psychological symptoms
Bereavement is also associated with various psychological symptoms and illnesses. See Panel 1 (p. 5) for an overview of
common reactions. Psychological reactions to bereavement are diverse, varying between individuals as well as between
cultures and ethnic groups. For example, Egyptian Muslims express intense overt grief, but the Muslim community in Bali
does not; they avoid any display of grief such as crying.
Reactions vary in nature and intensity according to the type of lost relationship. Scientific investigation has recorded specific
reaction patterns to various different types of bereavements.
Changes during bereavement
Changes in symptoms of bereavement over time were originally described in terms of stages or phases of shock, yearning
and protest, despair, and recovery, and lately in terms of tasks. This so-called task model is used in guiding counselling and
therapy. The four tasks of grieving are: accepting reality of loss; experiencing the pain of grief; adjusting to the environment
without the deceased; and relocating the deceased emotionally and moving on. We should note, however, that not all
grieving individuals undertake these tasks, nor do they undertake them in a fixed order. Both individual and cultural
differences may play a role. In addition, bereaved individuals are far from uniform in their emotional reactions over time,
leading some investigators to suggest that there are different trajectories of adaptation.
Resilience versus vulnerability
Researchers have reported that over the long-term, most bereaved people are resilient, recovering from their loss,
emotionally and physically, with time. Researchers have focused on positive growth or, more specifically (albeit with limited
empirical evidence so far), on creativity that might come about as a result of (early-life) bereavement. Thus some people gain
from their bereavement experience.
Complications in the grieving process
Complicated grief has been defined as a deviation from the normal (in cultural and societal terms) grief experience in either
time course, intensity, or both, entailing a chronic and more intense emotional experience or an inhibited response, which
either lacks the usual symptoms or in which onset of symptoms is delayed. Prigerson and Jacobs have suggested criteria for
complicated grief in terms of separation distress (e.g., preoccupation with thoughts of the deceased) and traumatic distress
(e.g., feelings of disbelief about the death). Estimates of the occurrence of complicated forms of grief vary across
investigations and diagnostic criteria.
Additional medical implications
Bereavement can have an even broader range of consequences than those already discussed. Bereavement has been shown
to be associated with impaired memory performance nutritional problems, work and relationship difficulties, difficulties
concentrating, and decreases in social participation. Research has been done looking at how bereavement affects the
immune system.
Risk factors
Bereavement researchers use the term risk factor to signify the situational and intrapersonal and interpersonal
characteristics associated with increased vulnerability to the range of bereavement outcomes.
Table 2 (p. 7) categorises risk factors into four categories:
- Situation and circumstances of death: cause of death, circumstances surrounding death or place of death, pre-
bereavement caregiver strain, type of lost relationship, quality of relationship, ongoing conflicts/work and legal
difficulties/poverty or economic decline.
- Intrapersonal risk or protective factors: personality or attachment style, predisposing factors or previous
bereavements, religious beliefs and other meaning systems, sociodemographic variables.
- Interpersonal or non-personal resources and protective factors: social support, cultural setting, economic resources,
professional intervention.
- Coping styles, strategies, processes: grief work, appraisal processes, emotion regulation.
Situational, intrapersonal, interpersonal, and coping factors affect bereavement outcome. They do so in complex ways and
there could be interactions between factors (e.g., between personality and circumstances of death) that operate to affect
outcome.
Intervention efficacy
Grief interventions can be divided into primary, secondary, and tertiary preventive interventions. Primary preventive
interventions are those in which professional help is available to all bereaved individuals irrespective of whether intervention
is indicated. Secondary preventive interventions are designed for bereaved individuals who, through screening or
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