Following the topic of the last post “Psychological treatment to cope with the “mourning”, in this occasion we want to analyse in-depth which would be the protection and risk factors that permit to predict the emergence of possible familiar or caretakers complications.
14 september 2016
As we explained, grief is a psychological process due to the loss of a beloved one, it is a universal, unique and painful experience. The fact is that we need to face the loss and adjust to a new life situation at the same time. According to Diagnostic and Statistical Manual of Mental Disorders, grief can be defined as “an entity subject to receive medical care that could cause similar symptoms to major depression, post-traumatic stress, sorrow, insomnia and anorexia.It has a chronic course and involves great amounts of suffering and substantial healthcare expenditures.”
The fact is that we need to face the loss and adjust to a new life situation at the same time.
Pilar Barreto (Universitat de València), Patricia Yi (Universitat de València) and Carmen Soler (Hospital Pare Jofre, Valencia) explain in their essay “Predictores de duelo complicado” (“Signs of complicated grief”), published in the magazine Piscooncología in 2008, how the study of the grief process has brought into focus some of its physiological, affective, cognitive and behavioural manifestations.
The academicians quote Bowlby, Parkes and Kübler-Ross in order to explain the theory that grievers go through different stages: denial, anger, bargaining, depression and acceptance. Nevertheless, although it can be found in the normal development of the grief, it has been discovered that acceptance, for example, appears from the very moment the death of the beloved one is notified.Despite that, it is possible that it does not present itself until two years after the incident.
As we said, the grief can suffer complications during the process. This could cause an alteration in the person’s overall functioning, endangering his or her health. This situation can last for years and even become chronic, as the authors point. According to the study, around 300.000 people could be in this situation. On the other hand, the line that separates the normal grief from the complicated one is not completely well defined: “having clear and useful criteria for the diagnosis is necessary in order to provide with psychological treatment”.
In the past the classification was established depending on the complication: anticipatory, chronic, delayed or avoidance grief. Anyway, nowadays the criteria used are the contained in “Diagnostic and Statistical Manual of Mental Disorders” (includes the possible psychopathology of the duel) and “Inventory of complicated grief” (collects the normal responses of the grief and those related to stress).
For that matter, it is important to say that there are disagreements about when is the right time to establish if a grief is having or not trouble in its development. Some experts defend that the right moment comes six months after the death, while others consider those factors can be determined after two months. According to Barreto, Yi and Soler, they can come from some aspects of the lifestyle or a personal behaviour, an inherited characteristic or the environmental situation. The factors can affect not just the grieving’s health, but also the recovering time he or she will need.
The most common are the ones related to personality or social context, which are divided in “factors that modulate the effects of the grief and factors with specific effects on the grief”, point the authors. First of all, they use as example the fact that social support impacts in the general state of health, but it also affects the grief process. After that, they explain that the specific factors are related to the situation of the death; the less expected the death is or the more traumatic, the worse the consequences are for the grieving.
Social support impacts in the general state of health, but it also affects the grief process
At the same time, the academicians point that protection factors, such as religious beliefs and social support, are as important as risk ones. The investigations in this field aim to the terms of resilience, post-traumatic growth or hardiness. The academicians develop a study where both factors are analysed together, which according to them “offers a greater margin in planning assistance programmes for families”. They conclude that from the 2 months after the death, we can observe if there are complications, is a revealing fact to determinate the temporal indication of the interventions.
