Texas-Revised Inventory of Grief: Validierung der deutschen Version TRIG-D

The loss of a loved person has often yearlong consequences for the bereaved. The Texas-Revised Inventory of Grief was developed by Faschingbauer and coworkers to measure the grief-specific distress. Up to now, no German translation of this instrument existed. An adapted German version of the TRIG is presented and results of a validation study with parents who lost a child are reported. The TRIG-D shows good internal consistency (Cronbach’s a =.87) Correlations of grief-intensity of the TRIG-D with stress-related symptoms and depression were high. These predictors explained 55% of the total variance of grief intensity. The TRIG-D measures reliably the intensity of grief related distress; however, there exist no cut-off-values for complicated grief.     

Pet Loss and Grief: Identifying At-risk Pet Owners during the Euthanasia Process

Pet owners often experience complex and profound grief reactions when their animals are euthanized. Veterinary staff are increasingly being called upon to be aware of and to respond to the grief reactions of pet owners at this critical time. The objectives of this study were to identify pet owners who are most at risk of grief and to suggest veterinary interventions during the euthanasia process. A convenience sample of 409 pet owners whose animals had been euthanized in the past year took part in a survey. Variables of interest included pet and pet-owner demographics, pet-death characteristics, attachment to pet, and bereavement reactions. Stepwise multiple regression analyses were conducted to identify factors related to the three grief reaction subtypes: sorrow, anger, and guilt. Results indicated that attachment to pets was a strong predictor of feelings of grief/sorrow (p < 0.001) and anger (p < 0.001). Sudden death was also related to feelings of anger (p < 0.05). Cancer diagnosis was negatively related to feelings of anger (p < 0.05) and guilt (p < 0.01). The findings from this study provide additional insight into the complexity of grief following pet euthanasia. For veterinary staff, anticipating the needs of pet owners and supporting them through the grief process is an integral role. Understanding which pet owners are at greatest risk of grief is an important initial step, followed by empathic communications, sensitive interactions, and the provision of grief support.     

A randomized controlled effectiveness trial of cognitive behavior therapy for post-traumatic stress disorder in terrorist-affected people in Thailand

Although cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), there is no evidence of its success with PTSD patients still under direct threat of terrorist attacks. This study reports the first randomized controlled trial of CBT for PTSD terrorist-affected people. Twenty-eight survivors of terrorist attacks in southern Thailand were randomized to 8 sessions of either CBT or treatment as usual (TAU). CBT was modified to accommodate the realistic threats facing patients. There were independent assessments conducted before, immediately after, and 3 months following treatment. Main outcome measures included symptoms of PTSD (PTSD Symptom Scale Interview), depression (Beck Depression Inventory) and complicated grief (Inventory of Complicated Grief). CBT resulted in significantly greater reduction in symptoms, including PTSD, depression, and complicated grief, at follow-up than TAU. Relative to TAU, CBT had stronger effect sizes at follow-up for PTSD, depression, and complicated grief. More patients in the CBT condition (75%) achieved high end-state functioning than participants in the TAU (33%). This preliminary evidence suggests that PTSD, depression, and complicated grief can be effectively treated despite ongoing threats of terrorism. Further, it demonstrates that non-specialist mental health workers in a non-western setting can be efficiently trained in using CBT, and this training can translate into successful treatment gains in trauma-affected individuals.     

The Correlates of Grief after Death of Pet

ABSTRACT

The correlates of degree of grief after death of dogs and cats were determined. With both animals, retrospectively reported grief was associated with present death depression and positive attitude toward pets. Grief after the death of a dog was associated with living alone at the time of death, higher death depression, and female gender. Grief after the death of a cat was associated with higher death depression, female gender, and was inversely correlated with the person's age at the time of the pet's death. These psychological and psychosocial variables were more associated with pet grief than behavioral variables such as amount of time spent with the pet.     

Regret on Choice of Colorectal Cancer Screening Modality Was Associated with Poorer Screening Compliance: A 4-Year Prospective Cohort Study

Purpose

Very few studies examined the issue of regret on choosing colorectal cancer (CRC) screening tests. We evaluated the determinants of regret and tested the hypothesis that regret over screening choices was associated with poorer screening compliance.

Methods

A bowel cancer screening centre invited all Hong Kong citizens aged 50-70 years who were asymptomatic of CRC to participate in free-of-charge screening programmes. Upon attendance they attended health seminars on CRC and its screening, and were offered an option to choose yearly faecal immunochemical test (FIT) for up to four years vs. one direct colonoscopy. They were not allowed to switch the screening option after decision. A self-administered, four-item validated survey was used to assess whether they regretted over their choice (> 2 = regretful from a scale of 0 [no regret]-5 [extreme regret]). A binary logistic regression model evaluated if initial regret over their choice was associated with poorer programme compliance.

Results

From 4,341 screening participants who have chosen FIT or colonoscopy, 120 (2.8%) regretted over their decision and 1,029 (23.7%) were non-compliant with the screening programme. Younger subjects and people who felt pressure when making their decision were associated with regret. People who regretted their decision were 2.189 (95% C.I. 1.361-3.521, p = 0.001) times more likely to be non-compliant with the programme.

Conclusions

This study is the first to show that regret over the initial CRC screening choice was associated with later non-compliance. Screening participants who expressed regret over their choice should receive additional reminders to improve their programmatic compliance.     

Severe deep white matter lesions and outcome in elderly patients with major depressive disorder: follow up study

Objective To determine the difference in outcome among elderly people with major depression who do and do not have severe white matter lesions on magnetic resonance imaging.Design Follow up study.Setting Two psychiatric and two general hospitals in Melbourne, Australia.Subjects 60 depressed subjects aged over 55 referred to hospital psychiatric services with major depressive disorder meeting American Psychiatric Association (DSM-IIIR) criteria.Main outcome measure Proportion with good outcome as determined by full recovery from initial illness and no evidence of depressive relapse or cognitive decline during follow up among those with and without lesions.Results Mean (SD) follow up was 31.9 (9.9) months. Survival analysis showed a significant effect of severe lesions on time to poor outcome (P=0.04), with median survival 136 days in those with severe lesions compared with 315 days in those without.Conclusion Severe white matter change on magnetic resonance imaging is associated with poor outcome in elderly depressed subjects.

Key messages

• Severe deep white matter lesions on magnetic resonance imaging are common in elderly patients with depression
• Patients with these lesions are at greater risk of poor long term outcome (chronicity and relapse) than those without lesions
• The neuropathogical and neurochemical correlates of these white matter changes need investigation

     

Human Grief Resulting from the Death of a Pet

Abstract

This study investigated antecedents of the human grief response which was associated with the death of a pet cat or dog. The sample included 207 voluntary subjects who experienced this type of loss within a one-year time period prior to participating in the study. Data for the predictor variables were obtained from two validated instruments and a questionnaire developed by the author. Data for grief outcome were obtained from another validated instrument on three clinical and three validity scales. The results indicated that level of attachment to the deceased pet, perceived understanding from others and other stressful events combined to have significant predictive ability in grief outcome. Other analyses indicated qualitative differences in grief outcome according to gender of owner and the presence of children and/or more than one other adult in the household. No significant difference was found between single and multiple pet ownership in grief outcome.     

Proceedings: Female sterilization: long-term follow-up with particular reference to regret

220 women who had been sterilized 20-46 months previously were questioned about any regrets they felt about the operation. 13 patients expressed regret (5.9%) and 15 expressed uncertainty (6.8%). The worsening of the sex life, the occurrence of menorrhagia, dysmenorrhea, or both, and nervous problems were each significantly associated with the regret/uncertain group (p less than .01). 7 patients also experienced weight gain and 3 reported a bad conscience. The percentage of sterilization patients expressing regret is felt likely to decline since smaller families are now favored. The results did not indicate that sterilization necessarily causes the problem.     

Depression in elderly medical inpatients: a meta-analysis of outcomes

OBJECTIVE: To determine the prognosis of elderly medical inpatients with depression. DATA SOURCES: A MEDLINE search for relevant articles published from January 1980 to September 1996 and a search of the PSYCH INFO database for articles published from January 1984 to September 1996. The bibliographies of identified articles were searched for additional references. STUDY SELECTION: Eight reports (involving 265 patients with depression) met the following 5 inclusion criteria: original research, published in English or French, population of general medical inpatients, mean age of depressed patients 60 years and over, and affective state reported as an outcome. The validity of the studies was assessed according to the criteria for prognostic studies described by the Evidence-Based Medicine Working Group. DATA EXTRACTION: Information about the patient population, the proportion of cases detected and treated by attending physicians, the length of follow-up, the affective outcome and the prognostic factors was abstracted from each report. DATA SYNTHESIS: All of the studies had some methodologic limitations. A meta-analysis of outcomes at 3 months or less indicated that 18% of patients were well, 43% were depressed and 22% were dead. At 12 months or more, 19% were well, 29% were depressed and 53% were dead. Factors associated with worse outcomes included more severe depression, more serious physical illness and symptoms of depression before admission. CONCLUSIONS: Elderly medical inpatients who are depressed appear to have a very poor prognosis: the recovery rate among these patients is low and the mortality rate high.     

Effects of depression on physical health and mortality in the elderly. Longitudinal results of the LASA research

This longitudinal study examines the physical health consequences of depression among 3107 older persons (55-85 years). Major depression was defined according to DSM-III criteria in a psychiatric interview. Minor depression was defined by a Center for Epidemiologic Studies Depression score > or = 16. Health consequences were assessed by 3-year change in self-reported functional status, 3-year change in performance on objective tests, and risk of death over 4.5 years. At baseline, 12.8% of the older persons had minor depression and 2.0% major depression. Minor depression was associated with a significantly greater decline in functional status and performance and, only in men but not in women, with an increased risk of death. Major depression also increases decline in functional status and the risk of death (irrespective of sex), but was not associated with decline in physical performance. These results show that late-life depression has strong unfavorable physical health consequences. The consequences of minor depression are comparable with those of major depression.     

Poststerilization regret among women: methodological considerations for the next decade

The literature concerning regret among women following voluntary sterilization shows a lack of methodological rigor. This paper reviews the 7 prospective studies of voluntary sterilization conducted since 1973 that are judged to have adequate design and measurement standards, and suggests methodological considerations for future research. 3 of the studies were conducted in the US, 2 in the UK, 1 in Thailand, and 1 in Pakistan. Only 3 of the 7 studies used control groups and only 3 used standardized pre- and posttest psychological measures. Subjects in all the studies requested sterilization on a voluntary basis. 4 of the 7 studies evaluated contraceptive and menstrual histories before and after sterilization. All the studies varied in their poststerilization follow-up intervals ranging from 2 months and 1 year to 18 months and 2 years. Attrition rates also varied widely across the studies. Although none of these studies presented percentages for precise measures of regret, the overall effect of the sterilization procedure was found to be positive. The relationship between regret and purported indicators of regret, such as depression, anxiety, menstrual difficulties, and desire for reversal, should be documented in prospective, controlled studies. Longer poststerilization follow-up periods are recommended. Responses of childless women and male partners to sterilization should also be considered in future studies. Finally, since repeated references are made to menstrual problems following voluntary sterilization, it is important that studies assessing poststerilization responses control for oral contraceptive (OC) use because OCs reduce menstrual flow and their discontinuation results in a return to normal, although heavier, menstrual flow.     

Development of the Pet Bereavement Questionnaire

Abstract

The death of a pet can be a significant stressor for some people and is a known risk factor for depression. The Pet Bereavement Questionnaire (PBQ) was developed to fill the need for a brief, acceptable, well-validated instrument for use in studies of the psychological impact of losing a pet. Initial results suggest that the PBQ has good internal reliability (Cronbach's α = 0.87), as well as good construct validity, with three distinct factors reflecting grief, anger and guilt. Grief was found to correlate strongly with pet attachment. The anger and guilt scales, however, correlated with depressive symptoms. The PBQ discriminated between individuals seeking support after pet loss (who would be expected to show higher levels of bereavement) and those who simply acknowledge the recent loss of a pet. We suggest that future research into pet bereavement use this new questionnaire so that the results of different studies can be compared, normative scores can be developed and researchers in this area can use a single instrument with established construct validity. In particular, we hope the PBQ will be used in treatment outcome research to identify high-risk individuals and test the effectiveness of both existing and novel interventions. Moreover, the PBQ could also be used in clinical settings, such as tertiary care veterinary hospitals, to identify pet owners in need of clinical support services.     

History of Pregnancy Loss Increases the Risk of Mental Health Problems in Subsequent Pregnancies but Not in the Postpartum

While grief, emotional distress and other mental health conditions have been associated with pregnancy loss, less is known about the mental health impact of these events during subsequent pregnancies and births. This paper examined the impact of any type of pregnancy loss on mental health in a subsequent pregnancy and postpartum. Data were obtained from a sub-sample (N = 584) of the 1973-78 cohort of the Australian Longitudinal Study on Women''s Health, a prospective cohort study that has been collecting data since 1996. Pregnancy loss was defined as miscarriage, termination due to medical reasons, ectopic pregnancy and stillbirth. Mental health outcomes included depression, anxiety, stress or distress, sadness or low mood, excessive worry, lack of enjoyment, and feelings of guilt. Demographic factors and mental health history were controlled for in the analysis. Women with a previous pregnancy loss were more likely to experience sadness or low mood (AOR = 1.75, 95% CI: 1.11 to 2.76, p = 0.0162), and excessive worry (AOR = 2.01, 95% CI: 1.24 to 3.24, p = 0.0043) during a subsequent pregnancy, but not during the postpartum phase following a subsequent birth. These results indicate that while women who have experienced a pregnancy loss are a more vulnerable population during a subsequent pregnancy, these deficits are not evident in the postpartum.     

Psychobiological and evolutionary perspectives on coping and health characteristics following loss: a twin study.

An analysis of coping, grief and health characteristics is reported for a bereaved monozygotic (MZ) and dizygotic (DZ) same-sex twin sample. The data were examined with reference to psychobiological and evolutionary perspectives on behavior. A Coping Scale, included as part of a comprehensive Twin Loss Survey (TLS), assessed coping with daily responsibilities and activities 1-2 months before the co-twin's death, 1-2 months following the co-twin's death and currently. A Grief Intensity Scale obtained judgments of grief 1-2 months following the loss, and currently. Information on physical symptoms was available from the Somatization Scale of the Grief Experience Inventory. Psychobiological and evolutionary perspectives specified hypotheses for two twin groups: one model was specified to reflect bereavement experiences immediately following loss of the co-twin (retrospective twin group); a second model represented present bereavement response (current twin group). Consistent with psychobiological theory, twins' social closeness showed a positive association with grief intensity which, in turn, affected somatic symptoms and coping efficacy in predicted directions. With respect to evolutionary psychological theory, the effect of zygosity on current grief implicated correlates of genetic relatedness as factors in the bereavement process.     

The Relationship between Frontal Lobe Lesions,Course of Post-Stroke Depression,and 1-year Prognosis in Patients with First-Ever Ischemic Stroke

Background and Purpose

Most studies on post-stroke depression (PSD) have focused on a certain time point after stroke instead of the time course of PSD. The aim of this study was to determine the relationship between frontal lobe lesions, course of PSD over a year following the stroke onset, and the 1-year prognosis in patients with first-ever ischemic stroke.

Methods

A total of 1067 patients from the prospective cohort study on the incidence and outcome of patients with post stroke depression in China who were diagnosed with first-ever ischemic stroke and attended 4 follow-up visits at 14±2 days, 3 months, 6 months, and 1 year after stroke onset, were enrolled in the study. PSD was diagnosed according to DSM-IV. The course of PSD was divided into the following two categories: persistent/recurrent depression and no/transient depression. Patients with any ischemic lesion responsible for the indexed stroke event located in the frontal lobe were defined as patients with frontal lobe lesions. Modified Rankin Scale (mRS) ≥2 at 1-year was considered to be poor prognosis.

Results

There were 109 patients with and 958 patients without frontal lobe lesions that formed the frontal lobe (FL) and no-frontal lobe (NFL) groups, respectively. After adjusting for confounding variables, frontal lobe lesion was significantly associated with persistent/recurrent PSD (OR 2.025, 95%CI 1.039–3.949). Overall, 32.7% of patients in the FL group had poor prognosis at 1- year compared with 22.7% in the NFL group (P = 0.021). Compared with no/transient depression, persistent/recurrent depression was found to be an independent predictor of poor prognosis at 1-year both in FL and NFL groups.

Conclusions

Long-term and periodical screening, evaluation and treatment are needed for PSD after the onset of ischemic stroke, particularly for patients with frontal lobe infarction.     

Initial versus longer‐term effects of tadpole declines on algae in a Neotropical stream

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Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study

Objective To estimate the one year prognosis and identify prognostic factors in cases of recent onset low back pain managed in primary care.Design Cohort study with one year follow-up.Setting Primary care clinics in Sydney, Australia.Participants An inception cohort of 973 consecutive primary care patients (mean age 43.3, 54.8% men) with non-specific low back pain of less than two weeks’ duration recruited from the clinics of 170 general practitioners, physiotherapists, and chiropractors.Main outcome measures Participants completed a baseline questionnaire and were contacted six weeks, three months, and 12 months after the initial consultation. Recovery was assessed in terms of return to work, return to function, and resolution of pain. The association between potential prognostic factors and time to recovery was modelled with Cox regression.Results The follow-up rate over the 12 months was more than 97%. Half of those who reduced their work status at baseline had returned to previous work status within 14 days (95% confidence interval 11 to 17 days) and 83% had returned to previous work status by three months. Disability (median recovery time 31 days, 25 to 37 days) and pain (median 58 days, 52 to 63 days) took much longer to resolve. Only 72% of participants had completely recovered 12 months after the baseline consultation. Older age, compensation cases, higher pain intensity, longer duration of low back pain before consultation, more days of reduced activity because of lower back pain before consultation, feelings of depression, and a perceived risk of persistence were each associated with a longer time to recovery.Conclusions In this cohort of patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year.     

Muscular force production after concentric contraction

The steady-state force following active shortening does not reach the maximum isometric force associated with the final length. Isolated extensor digitorum longus and soleus muscles from mice (NMRI strain) were used to investigate the force produced by a muscle, and some parameters hypothetically influencing this shortening-induced force depression. The muscles were pre-stimulated at fixed length, shortened and then held isometrically to give maximum post-shortening forces, before de-stimulation. The shortening magnitude was 0.18, 0.36 or 0.72mm (about 2-7% of optimal length), time of shortening was chosen as 0.03, 0.06 and 0.12s, and final length as +0.72, 0 and -0.72mm, related to optimal length. The mechanical work during active shortening was evaluated by integrating the product of force and shortening velocity over the shortening period. The results show a positive correlation between the force depression and the mechanical work, whereas the force depression was not correlated to the velocity of shortening. Depression of the passive force component was also observed following all stimulations. Experiments show that the fully stimulated redevelopment of isometric force following concentric contraction follows a time function similar to the creation of force when isometric muscle is initially stimulated. The conclusion is that the isometric force development after active shortening can be well described by an asymptotic force which is decided by the produced work, and the initial isometric time constant.     

Maintaining diversity through intermediate disturbances: evidence from rodents colonizing rehabilitating coastal dunes

Rodents inhabit the coastal dune forests of KwaZulu‐Natal, South Africa. Here habitat rehabilitation following mining of dunes has resulted in coastal dune forest succession similar to that recorded in nonmined forests. We investigated the colonization of rehabilitating stands and evaluate the role of disturbance in maintaining rodent diversity. A trapping programme was established between July 1993 and February 1995 during which rodent colonization, local extinction and species richness were recorded for rehabilitating stands of different ages. Trends in these variables were closely associated with one of three possible outcomes for a disturbed patch over time, with no intervening disturbances following the initial disturbance. Colonization was initially high which led to an increase in species richness. Extinction was lower than colonization, but became higher when the habitat was 3 years old, which led to a decline in richness. We extrapolate this result assuming negligibly small disturbances after the initiation of rehabilitation and suggest that intermediate levels of disturbance maintain rodent species richness in coastal dune forests. Furthermore, our results illustrated species turnover, a prediction of the recorded outcome, with young stands dominated by Mastomys natalensis and older stands by Saccostomus campestris or Aethomys chrysophilus.