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.

Around 10% of bereaved youths experience symptoms of prolonged grief disorder (PGD). Recently, PGD was included in the two main classification systems for mental disorders: the ICD-11 and DSM-5-TR. Assessing PGD symptoms in youth is currently hindered by the lack of instruments for ICD-11 and DSM-5-TR criteria. To fill this gap, we developed an instrument to assess PGD symptoms in children and adolescents, the Traumatic Grief Inventory - Kids - Clinician-Administered (TGI-K-CA), based on input of grief experts and bereaved children.
Five experts rated the items on alignment with DSM-TR and ICD-11 PGD symptoms and comprehensibility. The adjusted items were then presented to seventeen bereaved youths (Mdnage = 13.0 years, range = 8-17 years). Using the Three-Step Test Interview (TSTI), children were asked to verbalize their thoughts while answering the items.
Issues raised by experts were mostly related to alignment with the DSM-5-TR/ICD-11 symptom, ambiguous formulation of the items, or low comprehensibility for children and adolescents. Items raising fundamental issues according to experts were adjusted. The TSTI showed that children encountered relatively few problems with the items. Frequently reported problems with some of the items (e.g. regarding comprehensibility) led to final adjustments.
With input from grief experts and bereaved youths, an instrument to assess PGD symptoms as defined in DSM-5-TR and ICD-11 in bereaved youths was finalized. Further quantitative research is currently undertaken to evaluate the instrument\'s psychometric qualities.
Children with symptoms of Prolonged Grief Disorder (PGD) experience a debilitating longing for and/or preoccupation with a deceased loved one.Assessment of PGD in youth is hindered by the lack of an instrument.With the involvement of grief experts and bereaved youth, the current study developed an instrument that can be used in bereaved children and adolescents.

Background: Prolonged grief disorder (PGD) has been included in the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR). Loss-related avoidance behavior perpetuates grief and effective interventions for prolonged grief symptoms target such avoidance behavior. Yet, behaviors characterized by approach of loss-related cues (i.e. rumination, yearning, proximity seeking) are also implicated in prolonged grief reactions.Objective: To solve this paradox, we will test the Approach Avoidance Processing Hypothesis, which holds that loss-related approach and avoidance behaviors co-occur in PGD, using latent class analyses (LCA).Methods: Two-hundred eighty-eight bereaved adults (92% female) completed questionnaires assessing loss-related approach behaviors (rumination, yearning, proximity seeking), loss-related avoidance behaviors (anxious avoidance, experiential avoidance) and ICD-11 and DSM-5-TR prolonged grief symptoms.Results: LCA demonstrated the best fit for a three-class solution comprising a low approach/low avoidance class (n = 98, 34%), a high approach/low avoidance class (n = 79, 27%), and a high approach/high avoidance class (n = 111, 39%). The latter class showed significantly higher prolonged grief symptom levels and higher odds of probable PGD compared to the other classes.Conclusions: Co-occurrence of loss-related approach and avoidance appears characteristic to prolonged grief reactions. Distinguishing bereaved people with these behavioral patterns from those solely experiencing loss-related approach behaviors may improve the efficacy of PGD therapies.
A latent class analysis of bereaved adults showed high approach/high avoidance, high approach/low avoidance and low approach/low avoidance classes.The high approach/high avoidance class showed highest prolonged grief symptoms and higher odds of probable prolonged grief disorder.Co-occurrence of loss-related approach and avoidance appears to characterize prolonged grief.

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。.