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A framework of meaning attribution following loss.
Source publication
The loss of a loved one causes the world and the place of the bereaved survivor in it to change irreversibly. A key aspect of the grieving process is the integration of the loss in the bereaved survivor’s life story, identity change, and a new future orientation through meaning attribution. Meaning attribution can have favourable or unfavourable ef...
Context in source publication
Context 1
... a group of suicide survivors followed up 6 months to 2 years after the loss (Kõlves & de Leo, 2018), both feelings of responsibility for the suicide and severity of grief were high, compared to survivors after other sudden losses. Figure 1 depicts the framework of meaning attribution. ...
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Background:
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Objective:
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Objectives
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Citations
... In light of this, one of the key processes in adapting to loss is the gradual reconstruction of a new meaning to life without the loved one. Therefore, the framework of values and beliefs of the "survivor" may have a promoting or inhibiting effect in the process of processing the loss [63]. Although belonging to a religious framework and belief have often been documented as being associated with improved mental and physical health [13], it does not necessarily guarantee an adaptive response to loss, so it may affect person's values and religious views [19]. ...
The chapter will focus on findings from research aimed at studying the impact of caregiving for spouses living with cognitive impairment through the prism of the Two-Track Model of Dementia Grief. This model provides a bifocal approach addressing the nature of the emotional attachment to a loved one living with cognitive impairment, along with a medico-psychiatric perspective related to stress, trauma, and life transitions. In order to examine the research hypotheses, the study was designed to be cross-sectional and included 122 participants recruited among four groups: spouses of individuals currently living with mild to moderate cognitive impairment, spouses of individuals living with advanced-stage dementia, widows and widowers of deceased dementia sufferers, and a control group. Participants completed a battery of self-report questionnaires. Following a presentation of the results on the bio-psycho-social consequences of the informal caregivers' role and the ongoing emotional connection to the spouse living with dementia, the chapter will highlight various risk factors for maladaptive outcomes concerning the different stages of the disease. In addition, the chapter will discuss the research findings and their theoretical and empirical significance, as well as how these findings can be translated and contribute to clinical practice today.
... The indeterminacy or ambiguity of loss and 'as if presence' of the deceased are at the basis of cultural explanations of grief experiences. The indeterminacy of grief is filled in, as it were, with ideas and experiences from culture, faith, spirituality, or worldview, causing individuals, families, and communities to create or maintain explanatory models and cultural norms (Smid, 2020;Smid et al., 2018). Whether grief processing consists of continuing bonds with the deceased or relinquishing these depends on the bereaved person and their cultural context (Stroebe & Schut, 2005). ...
In contrast to normative views on grief, phenomenological descriptions of grief aim to provide a comprehensive picture of the lived experience, providing space for both uniqueness and universality. However, it is unclear how application of phenomenological descriptions contributes to bereavement care. The aim of the current study was to evaluate the clinical applicability of phenomenological descriptions of grief through autoethnographic exploration. The lived experience of the first author's grief following the death of his husband illustrates two strands of time that increasingly desynchronize: the alienated reality of everyday life and the lingering presence-in-absence of the deceased. Processing grief involved a fundamental reorganization of his identity through representation of and identification with the deceased. Clinical applications of phenomenological descriptions include diagnosing existential manifestations of Prolonged Grief Disorder, cultural aspects, and psychoeducation for the bereaved and for those close to them.
... It is important to further explore the implications of economic and sociocultural population context, that apparently matters, for clinical practice and public health. Meaning attribution after loss is determined by sociocultural factors, in addition to event-related, individual and relational factors that may either facilitate or complicate the grieving process (Smid, 2020). Whether the loss of a loved one leads to loss of meaning characteristic of PGD may in part depend on an individual's assumptive world (Parkes, 2006). ...
Background
Prolonged grief disorder (PGD) is now included as a diagnosis in international classification systems. Most research on PGD is based on Western populations, but first data from non-Western countries have recently become available. Little is still known about country-related effects on PGD's prevalence.
Objective
Determining possible causes of variations in the prevalence of PGD as defined by DSM-5-TR and ICD-11 within and between countries.
Methods
We retrieved data from 24 prevalence studies, the World Bank and the 2022 World Risk Report. Negative binomial regressions were used to explore methodological, loss-related and country context characteristics as predictors of PGD. The average rate of PGD was calculated using random effects models.
Results
The included studies comprised 34 samples from 16 countries (20,347 participants). Non-probability sampling and older mean age of the sample as well as lower country vulnerability were associated with higher PGD rates. The average PGD prevalence was 13 % (95 % CI [11, 22]), varying from 5 % (95 % CI [3, 11]) in probability to 16 % (95 % CI [13, 25]) in non-probability samples.
Limitations
Samples from Europe and North America were overrepresented. For about half of the countries, data were available from only one sample.
Conclusions
While confirming the importance of studies' methodological quality, the results show that PGD is of public health relevance around the world, but especially common in less vulnerabled countries with better access to daily necessities and healthcare services, highlighting sociocultural impacts on grief processing. Further investigations of cross-national differences are needed.
... War, disasters, genocide, or other massive traumatic events that involve multiple losses require authentic mourning and bereavement. Attribution of meaning in cases of bereavement takes on special importance as it can have favorable or unfavorable effects on the grieving process, determining the extent to which the bereaved are affected (Smid, 2020;Milman et al, 2017). Commemoration practices, which are widespread following wars and disasters across different countries and cultures, might also have both positive and negative consequences, depending on a number of factors (Mitima-Verloop, Boelen & Mooren, 2020;Volkan, 2006). ...
This article introduces a new concept, that of “substitutive trauma,” which refers to the utilization of unprocessed collective traumatic experiences by political leadership to create shared feelings of victimhood and vengeful attitudes within a population. The analysis explores how a substitutive trauma-based psycho-political dynamic culminated in February 2022 in Russia’s war against Ukraine. The article argues that the community of traumatic stress professionals, studying and understanding macro-societal processes can contribute to reducing and ameliorating such destructive psycho-political developments.
Link to the article: https://tidsskrift.dk/torture-journal/article/view/141714/186780
... Several theoretical frameworks of risk factors for grief outcomes exists, providing an overview of potential risk factors (e.g., Prigerson & Parkes, 2013;Smid, 2020;Stroebe, Folkman, Hansson, & Schut, 2006). The theoretical framework by Stroebe et al. (2006) identifies multiple risk factors and their inter-connections for bereavement-related outcomes. ...
... Before migration, people may experience violence, loss of family or community members, and disruption of family and community life; difficult and strenuous conditions may occur during the journey to move and, finally, reached host countries people can experience social isolation, joblessness and unemployment, language difficulties, different forms of persecution and acculturative stress (5,6). These experiences are associated with psychological distress and an increased risk of psychiatric disorders; women are also more likely to develop internalizing symptoms (7). In addition, these people are at high risk of developing anxiety and depressive disorders, post-traumatic stress disorder (PTSD), and suicidal ideation/behavior (8)(9)(10)(11). ...
... Het risico op traumatische rouw hangt samen met de omstandigheden rond het overlijden, de relatie met de dierbare, en sociale, culturele en individuele aspecten (Smid, 2020). Traumatische rouw treedt vaker op na een traumatisch verlies of problematische omstandigheden rond het overlijden, zoals een niet-natuurlijke, gewelddadige doodsoorzaak. ...
Tijdschrift Klinische Psychologie, 2023, 53 (2), 151-160 Volgens het Nederlandse Centraal Bureau voor de Statistiek (2022) is 5,4% van alle overlijdens in Nederland in 2020 (9030 van 168.678) het uiteindelijke gevolg van uitwendige (niet-natuurlijke) doodsoorzaken. Het gaat hierbij om ongevallen (71,2%, 6433), zelfdoding (20,2%, 1823), moord en doodslag (1,2%, 107), overig geweld (7,1%, 639) en gebeurtenissen opzet onbekend (0,3%, 28). Bij nabestaanden is het risico op traumatische rouw na een dergelijk 'traumatisch' verlies sterk verhoogd vergeleken met een verlies door ziekte van een dierbare. Van traumatische rouw is sprake bij ernstige psychische klachten na een als traumatisch ervaren verlies van (een) dierbare(n).
... Meaning attribution depends upon the circumstances and expectedness of the death, the relationship with the deceased, individual factors, and the sociocultural context (Smid, 2020). Processes of meaning-making include the following. ...
This chapter focuses on the mental vulnerability of traumatic grief and recovery with this vulnerability, which implies a reduction in the number or intensity of symptoms or distress. Grief is characterized by an ambiguous presence-in-absence of the deceased, involving existential concerns such as isolation and meaninglessness. Existential isolation and loneliness can be simultaneously relieved and enhanced by an "as-if presence" of the deceased. Grief affects the identity of the bereaved and may involve the feeling of having lost a part of oneself with the loved one, due to the disruption of the shared physical existence. The loss of a shared world with shared habits and customs creates an unwanted freedom that complicates reintegrating into one's relationships and activities. The feeling that life is meaningless is enhanced as grief separates time into two strands: an alienated present and an ongoing past-with-the-loved one. Reintegration and acceptance of the reality of the loss involves incorporation or identification and representation of the loved one. "Traumatic grief " denotes mental health problems following the loss of a loved one. Spiritual interventions for traumatic grief consist of providing information about grief, involving significant others, listening to the story of the loss and the lost person, providing space for emotions, finding meaning, and symbolic interaction.
... If the spiritual world of the individual is damaged, constructing and reconstructing the religious and spiritual domain can be helpful. In much the same way that adapting to bereavement and loss brings with it the need to construct new meanings to self and a life without the loved one, a similar challenge may be experienced with regard to the religious and the spiritual (Neimeyer et al., 2006;Smid, 2020). In contrast to Hebert et al. (2007), in our study, greater religious adherence was associated with greater risk. ...
Pre-death grief in the context of dementia caregiving is a significant risk factor for depression, burden, anxiety, and adjustment difficulties. The Two-Track Model of Dementia Grief (TTM-DG) provides a bifocal perspective addressing the nature of the emotional attachment to a loved one living with cognitive impairment, along with a medico-psychiatric perspective associated with stress, trauma, and change in life. The aims of the present study were to empirically validate the components of the model as to identify salutary and risk factors for maladaptive grief responses. Participants were 62 spouses of people living with cognitive impairment, and a control group of 32 spouses. All completed a battery of self-report questionnaires. Structural Equation Modeling yielded six variables consistent with the TTM-DG: partner’s behavioral disorders; caregiver’s burden; social support; physical health; attachment anxiety; and dementia grief as an outcome measure. Additional findings addressed participants at risk for grief difficulties. The findings provide empirical support for the utility of the TTM-DG in the identification of risk factors associated with maladaptive responses and pre-death grief following a spousal cognitive decline. The TTM-DG can assist in the formulation of evidence-based evaluations and interventions to assist spouses caring for their loved ones living with dementia.
... Such cognitive, emotional, and behavioral reactions may be considered normal ways of coping with a situation of prolonged uncertainty. However, uncertainty complicates meaning attribution to the ambiguous loss of a loved one, which may be further complicated by social, economic, juridical, and other factors [18]. Furthermore, catastrophizing of one's own reactions, depressive avoidance [19], counterfactual thinking [20], intolerance of uncertainty [21], maladaptive affect regulation strategies [22], and moderate levels of hope [10] have been identified as correlates of PGD symptoms in relatives of missing persons. ...
... Moreover, previous studies used established measures not specifically designed to assess symptoms after an ambiguous loss. Studies on PGD symptoms, for example, used validated grief measures referenced for the study purpose of a disappeared instead of a deceased person while answering the questions [9,18]. The situation after an ambiguous loss may not enable one to grieve as there is no possibility for closure [2]. ...
Background:
The disappearance of a significant person is an ambiguous loss due to the persistent uncertainty about the whereabouts of the person. Measures specifically capturing the psychological consequences of ambiguous loss are lacking. Therefore, this study aimed to develop the Ambiguous Loss Inventory Plus (ALI+) and evaluated its suitability for use with relatives of missing persons.
Methods:
ALI+ items were generated based on established measures for prolonged grief symptoms and literature on psychological responses to ambiguous loss. Eight relatives of missing persons (three refugees, five non-refugees) and seven international experts on ambiguous loss rated all items in terms of understandability and relevance on a scale from 1 (not at all) to 5 (very well).
Results:
On average, the comprehensibility of the items was rated as high (all items ≥ 3.7). Likewise, all items were rated as relevant for the assessment of common responses to the disappearance of a loved one. Only minor changes were made to the wording of the items based on the experts' feedback.
Conclusions:
These descriptive results indicate that the ALI+ seems to cover the intended concept, thus showing promising face and content validity. However, further psychometric evaluations of the ALI+ are needed.
