Attachment styles, grief responses, and the moderating role of coping strategies in parents bereaved by the Sewol ferry accident

Background: The death of a neonatal baby has the potential for parents to experience many negative outcomes. Post traumatic growth describes positive personal change from the struggle with a traumatic event. This has not been explored in this context.Objective: This study sought to understand the experiences of mothers whose neonatal baby had died; in particular, whether mothers were able to experience any positive changes in their lives since the death of their baby. The study also sought to explore what factors may have facilitated or prevented these changes.Method: Ten mothers were recruited, whose baby had died in the neonatal period between two and 10 years previously. Mothers completed semi-structured, one-to-one interviews. Interview transcripts were analysed using Template Analysis.Results: Despite ongoing sadness, mothers recognized positive personal changes in their self-perception, relationships and life philosophy which were consistent with the post-traumatic growth model. Mothers also identified facilitators and barriers to these changes which were categorized into five themes: ‘Person-centred care’, ‘making sense’, ‘personal coping strategies’, ‘learning to live with it’ and ‘identity’.Conclusions: This study identified that the mothers made a conscious personal decision to cope with their experience. This is a unique finding which requires further exploration. Facilitators and barriers of growth both occurred as elements within the same five themes, indicating that all identified domains before and after the death have the potential to facilitate or to prevent personal growth. Importantly, these findings indicate that person-centred services, which are responsive to individual needs at all stages, are vital when providing maternity care in the context of loss.

Section: Discussionsupporting

confidence: 87%

Understanding mothers’ experiences of positive changes after neonatal death

Waugh

Kiemle

Slade

2018

“…Three articles examine moderators and mediators of disordered grief following different forms of traumatic loss. Huh, Kim, Lee, and Chae ( 2017 ) examined coping strategies moderating the relationship between attachment representations and patterns of disaster-related grief using data from 81 bereaved parents following the loss of their child in the 2014 Sewol ferry accident. Parents with highly avoidant attachment were found to be overwhelmed by shame and guilt when applying problem-focused coping strategies, suggesting that mental health service providers should take individual differences in attachment representations among bereaved parents into account.…”

Section: Overview Of This Special Issuementioning

confidence: 99%

Traumatic loss: Mental health consequences and implications for treatment and prevention

Boelen

Olff

Smid

2019

Traumatic loss involves the loss of loved ones in the context of potentially traumatizing circumstances and is a commonly reported traumatic event. It may give rise to disturbed grief, called prolonged grief disorder (PGD) in ICD-11 and persistent complex bereavement disorder (PCBD) in DSM-5, combined with posttraumatic stress disorder (PTSD) and depression. The recent inclusion of grief disorders in both DSM-5 and ICD-11 have spurred research on griefrelated psychopathology. This special issue on traumatic loss includes 10 articles and two letters. Topics addressed include diagnostic criteria for PGD, children's perspectives on life after parental intimate partner homicide, and the impact of visiting the site of deaths caused by terror. Early indicators of problematic grief trajectories are addressed, as well as moderators and mediators of disordered grief, including coping strategies, rumination, and meaning-making. Further, a meta-analysis synthesizing research findings on correlates of disturbed grief following traumatic loss is presented. Finally, specialized treatments as Eye Movement Desensitisation and Reprocessing (EMDR) and Cognitive Behavioural Therapy (CBT) for grief are addressed, and predictors of treatment response for CBT for PGD including levels of self-blame and avoidance are scrutinized. As such, the articles included in this special issue increase our understanding of the needs of people confronted with traumatic loss and bring promising findings with regard to diagnosis, prevention, and specialized treatment in children, young people and adults. This article also introduces a hypothetical staging, profiling, and stepped care model which may offer a template to integrate existing and emerging research findings on possible courses and correlates of grief, in order to inform treatment decisions.

“…Complicated grief (CG) occurs in approximately 10% of bereaved adults (Lundorff, Holmgren, Zachariae, Farver-Vestergaard, & O'Connor, 2017) and is characterized by symptoms of both separation distress such as yearning for the deceased and proximity seeking, and traumatic distress such as intrusive thoughts and avoidance of reminders of the loss (Killikelly & Maercker, 2017;Shear et al, 2011). Theoretical conceptualizations of CG have highlighted a central role of the attachment system in its pathophysiology (Maccallum & Bryant, 2013;Shear et al, 2007), with some supporting evidence (Huh, Kim, Lee, & Chae, 2017;Mancini & Bonanno, 2012). Individuals with CG have difficulty fully processing the loss, with a mismatch between an explicit understanding that the death occurred and implicit internal representations of the deceased and their relationship with them in memory that drive persistent activation of the attachment system and failed, painful attempts at reunion (Maccallum & Bryant, 2013;Shear & Shair, 2005).…”

Section: Introductionmentioning

confidence: 99%

Circulating levels of oxytocin may be elevated in complicated grief: a pilot study

Bui

Hellberg

Hoeppner

et al. 2019

Complicated grief (CG) is a debilitating syndrome characterized by persisting and intense distress and impairment after the death of a loved one. The biological mechanisms associated with this syndrome remain unclear but may involve neurobiological pathways implicated in the stress response and attachment systems. The neuropeptide oxytocin has been implicated in attachment and social behaviour, and loss of social bonds has been associated with disruptions in oxytocin signalling. Furthermore, prior research has reported associations between circulating oxytocin and other mental illnesses, including depression. The present pilot study aimed to examine plasma levels of oxytocin in bereaved adults with primary CG (n = 47) compared to age-and sex-matched bereaved individuals with primary Major Depressive Disorder (MDD) (n = 46), and bereaved individuals without any mental disorder (n = 46). In unadjusted analyses comparing groups according to primary diagnosis, oxytocin levels were significantly higher for primary CG compared to primary MDD (p = 0.013), but not compared to bereaved controls (p = 0.069). In adjusted regression models, having a primary or probable (Inventory of Complicated Grief ≥ 30) diagnosis of CG was associated with significantly higher oxytocin levels (p = 0.001). While additional research is needed, findings from our pilot study provide preliminary support for recent conceptualizations of CG implicating a role for oxytocin and the attachment system. Importantly, these findings contribute to the limited current knowledge about possible biological correlates of CG.