Background: In China, mental health services do not currently meet the needs of bereaved people with symptoms of prolonged grief disorder (PGD). Internet-based grief interventions may help fill this gap, but such programmes have not yet been developed or evaluated in China. The proposed study aims to investigate the effectiveness, acceptability, and feasibility of an online self-help intervention programme named Healing Grief for bereaved Chinese with prolonged grief, and to explore the psychological mechanisms of potential improvements.Methods: We designed a two-arm randomised controlled trial. At least 128 participants will be randomly assigned to either an Internet-based intervention group or a waitlist-control group. The Internet-based intervention will be developed based on the dual process model, integrating techniques of psychoeducation, behavioural activation, cognitive reappraisal, and meaning reconstruction, and will be delivered via expressive writing. The intervention comprises six modules, with two sessions in each module, and requires participants to complete two sessions per week and complete the intervention in 6 weeks. The primary outcomes include effectiveness, acceptability, and feasibility. The effectiveness will be assessed by measures of prolonged grief, posttraumatic stress, anxiety, and depressive symptoms. Acceptability and feasibility will be evaluated using survey and interview on user experience characteristics. Secondary outcomes include moderators and mediators, such as dual process coping, grief rumination, mindfulness, and continuing bond, to explore the psychological mechanisms of potential improvement. Assessments will take place at pre-intervention, post-intervention, and 3-month follow-up.Conclusion: The proposed study will determine the effectiveness, acceptability, and feasibility of the newly developed online self-help intervention for bereaved Chinese with prolonged grief and clarify how the intervention helps with symptom improvements. Such an intervention may play an important role in easing the imbalance between the delivery and receipt of bereavement psychological services in China.
In China, mental health services are not widely available for bereaved people.The proposed study will be the first one to develop and evaluate an Internet-based self-help grief intervention for bereaved Chinese with prolonged grief.The proposed study will determine whether and how the intervention helps to improve the mental health of bereaved Chinese with prolonged grief.

OBJECTIVE: Existential isolation refers to an individual\'s awareness of the unbridgeable gulf between oneself, other people and the world. This kind of isolation has been found to be higher in individuals with nonnormative experiences, such as racial or sexual minorities. Bereaved individuals may experience a stronger sense of existential isolation and feel that no one shares their feelings or perceptions. However, research on bereaved people\'s experiences of existential isolation and its effects on post-loss adaptation is scarce. This study aims to validate the German and Chinese versions of the Existential Isolation Scale, investigate cultural and gender differences in existential isolation and explore the associations between existential isolation and prolonged grief symptoms in German-speaking and Chinese bereaved individuals.
METHODS: A cross-sectional study with 267 Chinese and 158 German-speaking bereaved participants was conducted. The participants completed self-report questionnaires assessing existential isolation, prolonged grief symptoms, social networks, loneliness and social acknowledgement.
RESULTS: The results indicated that the German and Chinese versions of the Existential Isolation Scale demonstrated adequate validity and reliability. No cultural or gender differences (or their interaction) were found for existential isolation. Higher existential isolation was associated with elevated prolonged grief symptoms, which was further moderated by the cultural group. The relationship between existential isolation and prolonged grief symptoms was significant for the German-speaking bereaved people but not significant for those from China.
CONCLUSIONS: The findings highlight the role of existential isolation in the adaptation to bereavement and how different cultural backgrounds moderate the effect of existential isolation on post-loss reactions. Theoretical and practical implications are discussed.

The outbreak of the COVID-19 pandemic brought new challenges to mourning and growth of bereaved. The purpose is to explore the relationship between the prolonged grief (PG) symptoms and the post-traumatic growth (PTG) of recently bereaved people during the COVID-19 period, and the mediating role of meaning making. 305 participants were recruited to complete the Posttraumatic Growth Inventory, Inventory of Complicated Grief, and Integration of Stressful Life Experiences Scale. Hierarchical multiple regression analyses and Medcurve in SPSS were adapted to test the hypotheses. The results revealed that there was a curvilinear relationship between PG and PTG and meaning making had a completely mediating effect on this relationship. Different intervention goals - whether alleviating distress or cultivating growth - should be set up according to the level of grief for recently bereaved individuals during COVID-19. More attention should be paid to the role of meaning making in the future clinical practice.

BACKGROUND: COVID-19 deaths elevate the prevalence of prolonged grief and post-traumatic stress symptoms among the bereaved, yet few studies have examined potential positive outcomes. Moreover, how COVID-19 bereavement affects individual-level mental health outcomes is under-researched.
OBJECTIVE: This is the first study to use latent profile analysis (LPA) to identify heterogeneous profiles of prolonged grief, post-traumatic stress and post-traumatic growth among people bereaved due to COVID-19 and to identify predictors of latent class membership.
METHODS: Four hundred and twenty-two Chinese participants who were bereaved due to COVID-19 completed an online survey between September and October 2020. The survey included the International (ICD-11) Prolonged Grief Disorder Scale (IPGDS), the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Post-traumatic Growth Inventory (PTGI). LPA was run in Mplus, and the 3-step auxiliary approach was used to test the predicting effects of potential predictors of latent class membership identified with chi-square tests and ANOVAs.
RESULTS: Four latent profiles were identified: resilience (10.7%), growth (20.1%), moderate-combined (42.2%) and high-combined (27.0%). The bereaved who shared a close relationship with the deceased and identified COVID-19 as the fundamental cause of death were more likely to be in the high-combined group. A conflictful bereaved-deceased relationship reduces the chance of being in the growth group. Moreover, the death of a younger person and loss of a partner attributed to maladaptive outcomes.
CONCLUSIONS: Serious attention needs to be paid to the mental health issues of people bereaved due to COVID-19 because nearly 70% of this group would have a moderate-combined or high-combined symptom profile. Special care should be given to those who lost someone younger, lost a partner or shared a close relationship with the deceased. Grief therapies that work on the conflicts between the deceased and the bereaved and unfinished business can be applied to facilitate growth.
Antecedentes: Las muertes por COVID-19 elevan la prevalencia de síntomas de duelo prolongado y estrés postraumático entre las personas en duelo, sin embargo, pocos estudios han examinado los posibles resultados positivos. Además, la forma en que el duelo por COVID-19 afecta los resultados de salud mental a nivel individual está poco investigada.Objetivo: Este es el primer estudio que utiliza el análisis de perfil latente (LPA) para identificar perfiles heterogéneos de duelo prolongado, estrés postraumático y crecimiento postraumático entre personas en duelo debido al COVID-19 y para identificar predictores de pertenencia a una clase latente.Métodos: Cuatrocientos veintidós participantes chinos que estaban en duelo debido a COVID-19 completaron una encuesta en línea entre septiembre y octubre de 2020. La encuesta incluyó la Escala Internacional de Trastorno por Duelo Prolongado (ICD-11) (IPGDS), la Lista de verificación de trastornos por estrés para el DSM-5 (PCL-5) y el Inventario de crecimiento postraumático (PTGI). Se ejecutó LPA en Mplus y se usó el enfoque auxiliar de 3 pasos para probar los efectos de concordancia de posibles predictores de pertenencia a una clase latente identificados con pruebas de chi-cuadrado y ANOVA.Resultados: Se identificaron cuatro perfiles latentes: resiliencia (10,7%), crecimiento (20,1%), combinado moderado (42,2%) y combinado alto (27,0%). Los deudos que compartían una relación cercana con el fallecido e identificaron al COVID-19 como la causa fundamental de muerte tenían más probabilidades de estar en el grupo de alta combinación. Una relación conflictiva con el fallecido reduce la posibilidad de estar en el grupo de crecimiento. Además, la muerte de una persona más joven y la pérdida de una pareja se asocian a resultados desadaptativos.Conclusiones: Se debe prestar mucha atención a los problemas de salud mental de las personas en duelo debido a COVID-19 porque casi el 70% de este grupo tendría un perfil de síntomas combinados moderados o combinados altos. Se debe prestar especial atención a quienes perdieron a alguien más joven, perdieron a una pareja o tuvieron una relación cercana con el fallecido. Las terapias de duelo que trabajan en los conflictos entre el fallecido y los deudos y en temáticas no resueltas, se pueden aplicar para facilitar el crecimiento.
背景: COVID-19 死亡增加了丧亲者的延长哀伤和创伤后应激症状的流行率, 但很少有研究考查潜在的积极结果。此外, 对 COVID-19 丧亲如何影响个体层面心理健康结果的研究不足。目的: 这是第一项使用潜在剖面分析 (LPA) 来确定因 COVID-19 丧亲者的延长哀伤, 创伤后应激和创伤后成长的异质剖面并确定潜在类别成员的预测因素的研究。方法: 422 名因 COVID-19 丧亲的中国参与者在 2020 年 9 月至 10 月期间完成了一项在线调查。该调查包括国际 (ICD-11) 延长哀伤障碍量表 (IPGDS), DSM-5创伤后应激障碍检查表 (PCL-5) 和创伤后成长量表 (PTGI) 。在 Mplus 中运行LPA, 并使用 3 步辅助方法来检验通过卡方检验和方差分析确定的潜在类别成员的潜在预测因子的预测效果。结果: 确定了四种潜在剖面:复原力(10.7%), 成长 (20.1%), 混合中等症状 (42.2%) 和混合高症状 (27.0%)。与死者关系亲密并确定 COVID-19 为根本死因的丧亲者更有可能属于混合高症状组。与死者有冲突会降低成为成长群体的几率。此外, 年轻人的死亡和丧失伴侣会增加适应不良的结果。结论: 需要认真关注因 COVID-19 丧亲者的心理健康问题, 因为该群体中有近 70% 的人具有混合中等或混合高症状剖面。应该给那些丧失更年轻人, 伴侣或与死者关系亲密的人提供特别护理。处理死者与丧亲者之间的冲突和未完成事件的哀伤疗法可用于促进成长。.

Background: Attentional bias refers to a preference for (e.g., vigilance) or a shifting away (e.g., avoidance) of one\'s focus with respect to specific stimuli. Accumulating evidence suggests that an attentional bias toward death/threat-related stimuli exists in bereaved individuals experiencing prolonged grief (PG). Measuring for different processing may reflect different cognitive characteristics. Therefore, this study sought to compare information-processing biases in Chinese individuals with high versus low levels of PG symptomatology at supraliminal and subliminal levels, respectively. Method: A 2 (grief level) × 2 (consciousness level) × 2 (word type) three-factor mixed design with supraliminal and subliminal tasks was utilized in the current study. Based on their Prolonged Grief Questionnaire-13 (PG-13) scores, 38 participants were included in the low-PG group, and 34 individuals were included in the high-PG group. All the participants completed a dot-probe task in which they were primed with death-related and life-related words paired with neutral stimuli. Results: High-PG individuals were slower in reacting to the death-related information in both supraliminal and subliminal tasks. After controlling for other symptoms in the backward deletion regression, PG-13 scores significantly predicted the avoidance tendency to death-related words in the supraliminal task, while anxiety was the best predictor of turning one\'s vision away from death-related stimuli in the subliminal trials. Conclusion: The results suggested that high PG is associated with a tendency to avoid death-related words. Future research is needed to explore interventions that address the avoidance of death-related stimuli among individuals with elevated, or diagnosable, levels of PG.

Spousal bereavement is closely linked to prolonged grief, that is, significant adjustment symptoms that last for more than six months after the loss. This article focused on potential risk and protective factors that may influence bereavement outcomes. Participants in this study were surviving spouses of individuals who died of acquired immune deficiency syndrome (AIDS). These participants were themselves living with human immunodeficiency syndrome. In this cross-sectional study, 120 bereaved participants completed measures of grief, quality of dying and death of the deceased, negative conceptions of death resulting from AIDS, death attitudes, and personal resilience. The results showed that one-third (35.0%) of the bereaved participants reported grief levels above the prolonged grief cut-off scores, and can be categorized as the \"prolonged grief\" group. Although quality of dying and death was not associated with the intensity of grief, negative conceptions of death from AIDS, fear of death and resilience independently predicted grief symptoms in the regression models. Our findings provide insight into the grief process for the surviving spouse of AIDS victims in rural China. Since resilience is malleable, developing resilience interventions to enhance adjustment to bereavement may be a promising direction in grief counselling and therapies.

Stigma towards people with HIV (PHIV) can affect their family members. In this study of 68 HIV seronegative participants in China whose spouse died of AIDS, 35.3% reported prolonged grief. Stigma beliefs towards PHIV (i.e., belief that PHIV\'s death leaves the deceased, the family and society better off) predicted grief symptoms. Social campaigns to combat stigma and grief therapy to reconstruct the meaning of HIV-related death may be helpful to reduce suffering in HIV bereaved.