Advertisement

The nature of death, coping response and intensity of bereavement following death in the critical care environment

Published:March 22, 2015DOI:https://doi.org/10.1016/j.aucc.2015.02.003

      Abstract

      Introduction

      Bereavement, defined as the situation of having recently lost a significant other, is recognised as one of life's greatest stressors and may lead to decrements in health status, psychological morbidity and excess risk of mortality.

      Aim

      The aim of this study was firstly to describe the relationships between the nature of death and bereavement intensity following death in the adult critical care environment and secondly to examine the modifying effects of coping responses on intensity of bereavement reaction.

      Method

      Prospective evaluation of the impact of the nature of death and coping responses on bereavement intensity. 78 participants completed a nature of death questionnaire within 2 weeks of bereavement and at 3 and 6 months completed the Core Bereavement Items Questionnaire (CBI-17) and Brief COPE Inventory.

      Results

      At 6 months, univariate variables significantly associated with bereavement intensity were: being unprepared for the death (p < 0.001), a drawn out death (p < 0.001), a violent death (p = 0.007) and if the deceased appeared to suffer more than expected (p = 0.03). Multivariate analysis revealed being unprepared for the death appears to account for these relationships. Regarding coping, there were significant increases from 3 to 6 months in both acceptance scales (p = 0.01) and planning (p = 0.02) on The Brief COPE Inventory. Greater use of emotional support (p = 0.02), self-blame (0.003) and denial (p < 0.001) were multivariate variables associated with higher bereavement intensity at 6 months.

      Conclusion

      The results from this evaluation provide insight into the impact of bereavement after death in the critical care environment and inform potential preventative approaches at the time of death to reduce bereavement intensity.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Australian Critical Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Maciejewski P.K.
        • Zhang B.
        • Block S.D.
        • Prigerson H.G.
        An empirical examination of the stage theory of grief.
        JAMA. 2007; 297: 716-723
        • Stroebe M.S.
        Handbook of bereavement research: consequences, coping, and care.
        American Psychological Association, Washington, DC2001
        • Stroebe M.
        • Schut H.
        • Stroebe W.
        Health outcomes of bereavement.
        Lancet. 2007; 370: 1960-1973
        • Buckley T.
        • McKinley S.
        • Tofler G.
        • Bartrop R.
        Cardiovascular risk in early bereavement: a literature review and proposed mechanisms.
        Int J Nurs Stud. 2010; 47: 229-238
        • Prigerson H.G.
        Better bereavement: coping with the death of a spouse.
        Health News. 2002; 8: 5
        • Prigerson H.G.
        • Bierhals A.J.
        • Kasl S.V.
        • Reynolds 3rd, C.F.
        • Shear M.K.
        • Newsom J.T.
        • et al.
        Complicated grief as a disorder distinct from bereavement-related depression and anxiety: a replication study.
        Am J Psychiatry. 1996; 153: 1484-1486
        • Li J.
        • Laursen T.M.
        • Precht D.H.
        • Olsen J.
        • Mortensen P.B.
        Hospitalization for mental illness among parents after the death of a child.
        N Engl J Med. 2005; 352: 1190-1196
        • Anderson M.J.
        • Marwit S.J.
        • Vandenberg B.
        • Chibnall J.T.
        Psychological and religious coping strategies of mothers bereaved by the sudden death of a child.
        Death Stud. 2005; 29: 811-826
        • Anderson W.G.
        • Arnold R.M.
        • Angus D.C.
        • Bryce C.L.
        Posttraumatic stress and complicated grief in family members of patients in the intensive care unit.
        J Gen Intern Med. 2008; 23: 1871-1876
        • Omerov P.
        • Steineck G.
        • Dyregrov K.
        • Runeson B.
        • Nyberg U.
        The ethics of doing nothing. Suicide-bereavement and research: ethical and methodological considerations.
        Psychol Med. 2013; : 1-12
        • Prigerson H.G.
        • Frank E.
        • Kasl S.V.
        • Reynolds 3rd, C.F.
        • Anderson B.
        • Zubenko G.S.
        • et al.
        Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses.
        Am J Psychiatry. 1995; 152: 22-30
        • Currier J.M.
        • Holland J.M.
        • Neimeyer R.A.
        Sense-making, grief, and the experience of violent loss: toward a mediational model.
        Death Stud. 2006; 30: 403-428
        • Meert K.L.
        • Thurston C.S.
        • Thomas R.
        Parental coping and bereavement outcome after the death of a child in the pediatric intensive care unit.
        Pediatr Crit Care Med. 2001; 2: 324-328
        • Buckley T.
        • Stannard A.
        • Bartrop R.
        • McKinley S.
        • Ward C.
        • Mihailidou A.S.
        • Morel-Kopp M.-C.
        • Spinaze M.
        • Tofler G.
        Effect of early bereavement on heart rate and heart rate variability.
        Am J Cardiol. 2012; 110: 1378-1383
        • Buckley T.
        • Morel-Kopp M.-C.
        • Ward C.
        • Bartrop R.
        • McKinley S.
        • Mihailidou A.S.
        • Spinaze M.
        • Chen W.
        • Tofler G.
        Inflammatory and thrombotic changes in early bereavement: a prospective evaluation.
        Eur J Prev Cardiol. 2012; 19: 1145-1152
        • Buckley T.
        • Mihailidou A.S.
        • Bartrop R.
        • McKinley S.
        • Ward C.
        • Morel-Kopp M.C.
        • et al.
        Haemodynamic changes during early bereavement: potential contribution to increased cardiovascular risk.
        Heart Lung Circ. 2011; 20: 91-98
        • Barry L.C.
        • Kasl S.V.
        • Prigerson H.G.
        Psychiatric disorders among bereaved persons: the role of perceived circumstances of death and preparedness for death.
        Am J Geriatr Psychiatry. 2002; 10: 447-457
        • Burnett P.
        • Middleton W.
        • Raphael B.
        • Martinek N.
        Measuring core bereavement phenomena.
        Psychol Med. 1997; 27: 49-57
        • Tomita T.
        • Kitamura T.
        Clinical and research measures of grief: a reconsideration.
        Compr Psychiatry. 2002; 43: 95-102
        • Carver C.S.
        • Scheier M.F.
        • Weintraub J.K.
        Assessing coping strategies: a theoretically based approach.
        J Pers Soc Psychol. 1989; 56: 267-283
        • Carver C.S.
        You want to measure coping but your protocol's too long: consider the brief cope.
        Int J Behav Med. 1997; 4: 92-100
        • Carver C.S.
        Brief cope.
        2007 (Available from: http://www.psy.miami.edu/faculty/ccarver/sclBrCOPE.html [accessed 15.01.15])
        • Field A.
        Discovering statistics using spss.
        Sage, Thousand Oaks, CA2013
        • Byrne G.J.
        • Raphael B.
        The psychological symptoms of conjugal bereavement in elderly men over the first 13 months.
        Int J Geriatr Psychiatry. 1997; 12: 241-251
        • Zisook S.
        • Chentsova-Dutton Y.
        • Shuchter S.R.
        PTSD following bereavement.
        Ann Clin Psychiatry. 1998; 10: 157-163
        • Murphy S.A.
        • Chung I.J.
        • Johnson L.C.
        Patterns of mental distress following the violent death of a child and predictors of change over time.
        Res Nurs Health. 2002; 25: 425-437
        • Mor V.
        • McHorney C.
        • Sherwood S.
        Secondary morbidity among the recently bereaved.
        Am J Psychiatry. 1986; 143: 158-163
        • Kaprio J.
        • Koskenvuo M.
        • Rita H.
        Mortality after bereavement: a prospective study of 95,647 widowed persons.
        Am J Public Health. 1987; 77: 283-287
        • Kubler-Ross E.
        On death and dying.
        McMillian, New York1969
        • Stroebe M.
        • Stroebe W.
        • van de Schoot R.
        • Schut H.
        • Abakoumkin G.
        • Li J.
        Guilt in bereavement: the role of self-blame and regret in coping with loss.
        PLOS ONE. 2014; 9: e96606
        • Weinberg N.
        Does apologizing help? The role of self-blame and making amends in recovery from bereavement.
        Health Soc Work. 1995; 20: 294-299
        • Parkes C.M.
        The first year of bereavement. A longitudinal study of the reaction of London widows to the death of their husbands.
        Psychiatry. 1970; 33: 444-467
        • Buckley T.
        • Bartrop R.
        • McKinley S.
        • Ward C.
        • Bramwell M.
        • Roche D.
        • et al.
        Prospective study of early bereavement on psychological and behavioural cardiac risk factors.
        Intern Med J. 2009; 39: 370-378