Background: Research on bereavement after terrorism is limited and primarily aiming on short-term consequences.Objective: To better understand the long-term health consequences of terrorism, we studied bereaved parents and siblings eight years after the Utøya terrorist attack in Norway. We examined the participants\' symptom levels of prolonged grief (PG) and post-traumatic stress (PTS), as well as their psychosocial functioning and employment status.Method: Bereaved parents (n = 88) and siblings (n = 34) aged 19 and above (mean age  = 49.7 years, SD = 13.8 years, 59.8% female) completed the Inventory of Complicated Grief (ICG), the Impact of Event Scale-Revised (IES-R), and the Work and Social Adjustment Scale (WSAS) to assess PG, PTS, and functional impairment, respectively. In addition, information about employment status was obtained. The proportion of participants scoring above recommended thresholds on the ICG, IES-R, and WSAS was calculated. Differences between parents and siblings and gender differences on these measures were examined.Results: In total, 62.3% of the participants had scores on the ICG indicating a risk for prolonged grief, while 45.9% scored over cutoff on the IES. There was a high overlap between symptoms of PG and PTS. Females had significantly higher scores on both the ICG and the IES compared to males. There were no differences between parents and siblings regarding PG and PTS symptoms. One out of three showed severe functional impairment on the WSAS. Approximately 30% of all the bereaved were outside the labour force, and one third of the parents had become unable to work after the terrorist attack.Conclusion: Many bereaved parents and siblings, following the Utøya terror attack, report long-lasting health consequences with symptoms of PG and PTS and functional impairment. The results suggest a need for follow up of bereaved after a terror attack and identify family members in need of health services.
Eight years after the Utøya terrorist attack bereaved parents and siblings still report high levels of prolonged grief and post-traumatic stress symptoms.There were no differences between parents and siblings regarding prolonged grief and post-traumatic stress symptoms.Many bereaved are still suffering functional impairments. Post-traumatic stress symptoms are found to be an important predictor for functional impairments.

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.

Background: The death of a child is a highly traumatic event for parents and often leads to posttraumatic stress disorder (PTSD). Attentional bias has been demonstrated in the onset and maintenance of PTSD symptoms.Objective: This study aimed to investigate the time course of attentional bias among bereaved Chinese parents who have lost their only child (Shidu parents), and to examine its relationship with PTSD symptoms and symptom clusters.Methods: Shidu parents (n = 38; 50-72 years of age) completed a dot-probe task with negative (trauma-related), positive, and neutral images at four stimulus presentation times (250, 500, 750, and 1250 ms). PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5).Results: We observed difficulty in disengaging from both negative and positive stimuli at 750 ms and attentional bias away from negative stimuli at 1250 ms. At 1250 ms, attentional avoidance of trauma-related stimuli was positively correlated with PCL-5 total and intrusion scores. Difficulty in disengaging from positive stimuli was negatively correlated with PCL-5 total and intrusion scores as well as negative alterations in cogniti and mood scores.Conclusions: These findings enhance our understanding of attentional bias and cognitive-affective processing in PTSD. This study provides evidence that attentional bias (difficulty in disengaging from positive stimuli and bias away from negative stimuli) are correlated with PTSD symptoms and certain symptom clusters.
The current study examined the time course of attentional bias among bereaved Chinese parents who have lost their only child through a dot-probe task and investigated its relationship with PTSD symptoms and symptom clusters.Participants exhibited difficulty in disengaging from both trauma-related and positive stimuli at 750 ms and exhibited attentional avoidance of trauma-related stimuli at 1250 ms.Attentional avoidance of trauma-related stimuli was positively correlated with PCL-5 total and intrusion scores. Difficulty in disengaging from positive stimuli was negatively correlated with PCL-5 total and intrusion scores as well as negative alterations in cognition and mood scores.

Background: Social acknowledgment is a protective factor for survivors of trauma. However, the role of social acknowledgment in association with prolonged grief symptoms has not yet been established.Objectives: The current study aims to explore the relationship between social acknowledgment and prolonged grief via two beliefs foundational to how people think about grief-related emotions (1) goodness (i.e. whether emotions are desirable, useful, or unwanted and harmful), and (2) controllability (i.e. whether emotions are regulated according to our will or involuntary, arising of their own accord). These effects were explored in two different cultural samples of bereaved people.Methods: One hundred and fifty-four German-speaking and two hundred and sixty-two Chinese bereaved people who lost their loved ones completed questionnaires assessing social acknowledgment, beliefs about the goodness and controllability of grief-related emotions, and prolonged grief symptoms.Results: Correlation analyses showed that social acknowledgment was positively linked with stronger beliefs about the goodness and controllability of grief-related emotions and negatively related to prolonged grief symptoms. Beliefs about the goodness and controllability of grief-related emotions correlated negatively with prolonged grief symptoms. Multiple mediation analyses suggested that beliefs about the controllability and goodness of grief-related emotions mediated the link between social acknowledgment and prolonged grief symptoms. Cultural groups did not moderate the above model.Conclusion: Social acknowledgment may be related to bereavement adjustment consequences via the roles of beliefs about the goodness and controllability of grief-related emotions. These effects seem to be consistent cross-culturally.
Social acknowledgment correlated positively with stronger beliefs about the goodness and controllability of grief-related emotions and negatively with prolonged grief symptoms.Beliefs about the goodness and controllability of grief-related emotions were negatively linked with prolonged grief symptoms.Beliefs about the controllability and goodness of grief-related emotions mediated the relationship between social acknowledgment and prolonged grief symptoms. The model presented cross-cultural consistency.

The death of a family member affects not only individual family members but also their relationships and interactions. Grief has been studied mostly as an intrapersonal experience. Adopting the family perspective, this systematic scoping review focused on parent-child relationships in widowed families so as to identify what is already known on this topic and the research gaps for future study. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Four databases (Web of Science, Psycinfo, PubMed, and CINAHL Plus) were searched. Search terms were combinations of two concepts: (1) loss of a parent (20 terms) and (2) parent-child (eight terms). 5,419 studies were identified during the search, of which 36 studies were included in the review following two rounds of screening. Four research themes emerged, and the aggregated findings were identified: (a) The surviving parent and children are likely to become closer following the loss of a parent, while other relevant factors need to be taken into account; (b) Better parent-child relationships play a protective role in children\'s adjustment to loss; (c) The surviving parent and children\'s adjustment to loss are interdependent; (d) Through parenting, communication style, coping strategy, and other attributes, the surviving parent can influence their children\'s adjustment. Gender and age differences were identified in parent-child relationships. The findings further justify the importance of a family perspective when conducting research and practice on bereavement. Several research gaps were identified. Existing studies paid insufficient attention to children\'s agency and bidirectional relationships, and the interaction process and its role underlying parent-child bidirectional causality. A conceptual framework of parent-child relationships in widowed families is proposed based on these findings.
La muerte de un miembro de la familia afecta no solo a los miembros individuales de la familia, sino también sus relaciones e interacciones. El duelo se ha estudiado habitualmente como experiencia intrapersonal. Adoptando la perspectiva familiar, esta revisión sistemática exploratoria se centró en las relaciones entre progenitor e hijos en familias donde había fallecido uno de los progenitores con el objetivo de identificar lo que ya se sabe sobre este tema y las deficiencias en las investigaciones para futuros estudios. La revisión sigue las pautas de la extensión para revisiones sistemáticas exploratorias de los Ítems de Referencia para Publicar Revisiones Sistemáticas Exploratorias y Metaanálisis (PRISMA-ScR). Se realizaron búsquedas en cuatro bases de datos (Web of Science, Psycinfo, PubMed y CINAHL Plus). Los términos buscados fueron combinaciones de dos conceptos: (1) pérdida de un progenitor (20 términos) y (2) progenitor-hijo (ocho términos). Se identificaron 5419 estudios durante la búsqueda, de los cuales 36 se incluyeron en la revisión después de dos rondas de selección. Surgieron cuatro temas de investigación y se indicaron los resultados colectivos: a. El progenitor superviviente y los hijos tienden a desarrollar un vínculo más estrecho después de la muerte del otro progenitor, si bien es necesario tener en cuenta otros factores relevantes; b. Una mejor relación entre progenitores e hijos desempeña un papel protector en la adaptación de los hijos a la pérdida; c. La adaptación a la pérdida del progenitor superviviente y de los hijos es independiente; d. Mediante la crianza, el estilo de comunicación, la estrategia de afrontamiento y otros atributos, el progenitor superviviente puede influir en la adaptación de sus hijos. Se identificaron las diferencias de género y de edad en las relaciones entre progenitores e hijos. Los resultados justifican además la importancia de una perspectiva familiar a la hora de llevar a cabo investigaciones y prácticas sobre la pérdida de un ser querido. Se detectaron varias deficiencias en las investigaciones. Los estudios existentes prestaron poca atención a la voluntad de los hijos y a las relaciones bidireccionales, así como al proceso de interacción y su papel detrás de la causalidad bidireccional entre progenitores e hijos. Sobre la base de estos resultados, se propone un marco conceptual de relaciones entre padres e hijos en familias donde falleció uno de los progenitores.
家庭成员的死亡不仅影响到单个的家庭成员，而且影响他们的关系和人际间的互动。悲伤主要是作为一种内在的体验来研究的。本研究采用家庭视角，以丧偶家庭的亲子关系为研究对象，进行系统的范围考察，以确定对该课题已有的认识以及未来研究的研究空白。本文献综述遵循系统研究和扩大范围审查元分析(PRISMA-ScR)指南的首选报告项目。搜索了四个数据库(Web of Science, Psycinfo, PubMed和CINAHL Plus)。搜索词是两个概念的组合:(1)失去一位家长(20个词)和(2)亲子关系(8个词)。在检索过程中确定了5419项研究，其中36项研究在经过两轮筛选后被纳入综述。分析得出四个研究主题，并确定了综合结果:a.在失去父母一方后，尚存的父母与子女之间的关系可能会更加密切，不过还是要考虑其他相关因素; b.更好的亲子关系对孩子适应家人失去具有保护作用; c.在世父母和子女对失去亲人的适应是相互依赖的;d.幸存的父母可以通过养育方式、沟通方式、应对策略等属性影响子女的适应。性别和年龄差异在亲子关系中被确认。研究结果进一步证明了家庭视角在研究和实践丧亲之痛时的重要性。发现了几个研究空白。现有研究对儿童的主体性作用和双向关系以及亲子双向因果关系背后的互动过程及其作用关注仍不够。本文在此基础上提出了丧偶家庭亲子关系的概念框架。.