Complicated grief (CG) occurs when an individual experiences prolonged, unabated grief. The neural mechanisms distinguishing CG from noncomplicated grief (NCG) are unclear, but hypothesized mechanisms include both pain-related activity (related to the social pain of loss) and reward-related activity (related to attachment behavior). Bereaved women (11 CG, 12 NCG) participated in an eventrelated functional magnetic resonance imaging scan, during grief elicitation with idiographic stimuli. Analyses revealed that whereas both CG and NCG participants showed pain-related neural activity in response to reminders of the deceased, only those with CG showed reward-related activity in the nucleus accumbens (NA). This NA cluster was positively correlated with self-reported yearning, but not with time since death, participant age, or positive/negative affect. This study supports the hypothesis that attachment activates reward pathways. For those with CG, reminders of the deceased still activate neural reward activity, which may interfere with adapting to the loss in the present.

Our systematic investigation provided valuable evidence for identifying the subgroup of cancer survivors and their spouses who are vulnerable to poor quality of life due to their mutual psychological distress. These findings suggest that couples may benefit from interventions that enhance their ability to manage psychological distress, particularly the wife's, which may improve the mental and physical health of both partners when they are dealing with cancer.

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Guided by the role strain and the role enhancement theories, this study examined the effect of caregivers' multiple roles, such as being employed and taking care of minors in their household, on their psychological adjustment. Of the caregivers who completed the American Cancer Society's Quality of Life Survey for Caregivers, 457 caregivers who were middle-aged (18-64) and provided complete data for the study variables were included in the analyses. The indicators of the outcome variables, namely, the levels of the caregivers' psychological adjustment, were cancer caregiving stress, management of meaning out of providing care, and negative and positive affect. Multivariate general linear modeling analyses revealed that employed caregivers who were also taking care of children reported higher levels of caregiving stress and negative affect. In contrast, employed caregivers who were not taking care of children reported greater levels of managing meaning of caregiving experience. The findings provide partial support for the role strain theory, that the more social roles a caregiver carries out, the more likely the caregiver is to experience stress and negative affect. The findings also suggest that when providing care for cancer survivors, caregivers may benefit from being employed. These findings have significant implications for developing targeted programs to reduce the psychological distress of cancer caregivers with multiple roles and to assist them in recognizing their caregiving experience as meaningful.

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Very few studies have been performed utilizing DSM criteria to diagnose major depressive disorder (MDD) in adult brain tumor patients. This study aimed to diagnose MDD in this population using DSM-IV criteria.Eighty-nine adult brain tumor patients were examined in an ambulatory neuro-oncology clinic setting using a structured psychiatric interview which followed current DSM-IV diagnostic criteria for MDD. This sample was interviewed and evaluated on a one-time basis. The patients were referred for evaluation on a consecutive basis. Multiple regression was used to model critical independent variables to predict MDD.Twenty-eight percent of the sample (N=89) were found to have major depressive disorder using DSM-IV criteria. Key predictors of MDD included frontal region of tumor location (p=0.001), combined sadness and lack of motivation symptoms (p=0.0001), and family psychiatric history (p=0.006). The multiple regression models account for 37% of variance in predicting MDD (R(2)=0.37).A substantially higher incidence of MDD was found in this sample of adult brain tumor patients compared with other adult, ambulatory cancer patients previously evaluated with DSM criteria. The incidence of MDD was about triple that found in other published studies using DSM criteria.

Background-Pro-inflammatory cytokines are associated with sickness behaviors, a set of behaviors including low mood, which are orchestrated by the brain and described as shift in motivational state. The present study investigated the hypothesis that local inflammation is associated with greater subgenual anterior cingulate cortex (sACC) activation in persons undergoing chronic stress.