This article celebrates the 50th anniversary of hospice care in America. It also offers a brief recounting of one person’s reflections on some aspects of the history, achievements, and current status of American hospice care.
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This article celebrates the 50th anniversary of hospice care in America. It also offers a brief recounting of one person’s reflections on some aspects of the history, achievements, and current status of American hospice care.
The study explores resilience and posttraumatic growth in adults in Kosovo who have experienced grief, using the Resilience Portfolio Model as a guiding framework. Twelve participants shared their experiences through semi-structured interviews, aiming to capture detailed personal narratives and insights into coping with loss. Thematic analysis of the data revealed three main themes: “Reaction to Loss,” “Navigating through Loss and Embracing Adaptations,” and “Resilience and Posttraumatic Growth.” The findings highlight the transformative experiences contributing to personal development and resilience, emphasizing the significant role of cultural dimensions in shaping resilience and posttraumatic growth. The study underscores the importance of considering cultural context in therapeutic approaches to better support individuals in their recovery and growth from experiences of loss.
The aim of the presented study was to gain a better understanding of relationships between the pre-loss quality of marriage, global attachment style, rumination, the severity of complicated grief and the level of posttraumatic growth among widowed individuals. After the researchers obtained the consent of the ethics board to conduct the study, they examined widowed individuals (
Research exploring fathers’ experiences of using bereavement photography after perinatal loss is lacking. Using continuing bonds theory, this study aims to investigate fathers’experiences of bereavement photography and predictors of posttraumatic growth (PTG). Mixed methodology was employed with participants (
Physicians-in-training feel uncomfortable coping with the grief they experience while delivering end-of-life care, and medical schools offer minimal formal curricular offerings on end of life care. Few studies have identified what experiences medical students have with death while training or what lessons they are being taught by more senior physicians at bedside. This qualitative study conducted semi-structured interviews prior to and six months into the medical school clinical year. Our goal was to identify when students were encountering seriously ill/dying patients and what informal education students received about caring for dying patients. Descriptive statistics showed the majority of the encounters the students had with seriously ill or dying patients were in the hospital-based medicine setting. A minority of students participated in debriefs about end-of-life care with their care teams after the events. Thematic analysis showed significant heterogeneity in students’ exposure and responses to patient deaths.
Children of incarcerated parents may grieve this loss, yet perceptions of their grief are understudied. Using vignettes varying by age (adult/child) and grief response (prolonged/resilient), we examined differences between perceptions of adults and children grieving parental incarceration. Participants rated grief response appropriateness, comfort providing support, and grief therapy recommendations for the grieving person in the vignette. Participants perceived resilience as more appropriate than prolonged grief [
This article explores some of the implications of the often-heard saying that, “There are no right or wrong ways to grieve.” In order to do so, this article offers some reflections on the key phrases that are involved implicitly or explicitly in this advice: loss, bereavement, grief, grieving, and mourning. On that basis, this article examines a series of claims: Are there actually no right ways to grieve?; Is there no single right way to grieve?; Are there no wrong ways to grieve? These analyses are enriched by incorporating some of the new understandings of loss, grief, and mourning that have emerged in the professional literature in recent years from research and scholarship. The conclusion offers lessons that should be learned and that should not be learned from the advice that, “There are no right or wrong ways to grieve”.
Every society adheres to grieving rules that govern how people experience loss and grief. These are rarely communicated explicitly, which can lead to insecurities in dealing with one’s own grief and the grief of others. This is particularly true for adolescents. Based on Doka’s concept of disenfranchised grief, this study explores the grieving rules of mid-adolescents. Cross-sectional data collection took place in November and December 2022 at six secondary schools in Germany. A total of 226 adolescents predominantly aged between 14 and 16 years completed the questionnaire. The analysis of the data shows that in some respects, mid-adolescents have similar grieving rules as adults. However, they are more inclusive when it comes to losses of ex-partners, pets and people with intellectual disabilities. Possible sources of (self-)disenfranchisement are parasocial relationships and the duration of grief. Open communication about grieving rules is suggested to prevent possible disenfranchisement.
In recent years, suspicious deaths, often portrayed as “falls from a height,” have been increasingly associated with femicides in Turkey. This phenomenon coincided with the official withdrawal process from the “Council of Europe Convention on Preventing and Combating Violence against Women and Domestic Violence” (Istanbul Convention). Our study aims to reveal the impact of Turkey’s withdrawal from the Istanbul Convention on femicides and the yet officially unrecognized “suspicious female deaths.” This research, conducted in a descriptive, cross-sectional epidemiological style, draws its population from records of suspicious female deaths and femicides that occurred in Turkey between January 1, 2020, and June 1, 2023. There has been a notable increase in the rate of suspicious female deaths. Additionally, a significant rise has been observed in the proportion of women who were employed, had children, and sought legal protection in these deaths. The study suggests a return to the Istanbul Convention.
This systematic review explores factors influencing resilience and post-traumatic growth in parents who have lost a child under 25 to cancer. While such parents are vulnerable to complicated grief, not all experience it. Eight qualitative and mixed studies from ProQuest, Science Direct, PubMed, and Cochrane databases were included. They highlight the importance of support and communication with palliative care teams and other grieving families. Understanding the ambivalence experienced during the process is crucial. The review underscores the limited research in this area and offers direction for future studies. Psychological interventions could aid these parents in adapting to their new reality.
Suicide and self-harm events are elevated in psychiatric inpatient populations. In this study, health data were retrospectively collected from the medical records of 183 patients (97 civil and 86 forensic) who had resided in, or been admitted to, a public psychiatric hospital in Saskatchewan, Canada from April 1 to December 31, 2021. Descriptive and inferential analyses were conducted to estimate prevalence and correlates of (non-fatal) suicide and self-harm events, including recent and lifetime occurrences, according to patients’ health information. Nearly two-thirds (62%) of patients had any record of non-fatal suicide or self-harm events, including a lifetime history of self-harm (42%) and suicidal behavior (37%) as well as recent self-harm (24%) and suicidal (31%) thoughts or behaviors. Forensic patients were significantly more likely to have a record of suicide and self-harm events. This study emphasizes the need for further research into the course of suicidality and self-harm in psychiatric inpatients.
Death anxiety has been linked to several psychopathological conditions. However, the causes, comorbidity, and differential diagnosis of death anxiety is unexplored. This paper stands out by identifying common predictors of death anxiety and exploring the potential of death anxiety as a predictor for other psychological conditions. The paper reports the findings of four consecutive studies that involved a total of 2291 conveniently selected participants including 861 men and 1430 women. We focused on clarifying both the predictors of death anxiety and the psychopathological consequences emerging from it. Our findings established depression, anxiety, stress, fear of aging, and reduced life satisfaction as predictors of death anxiety. Psychosocial illness, sleep disturbances, aggression, and daily hassles were established as the adverse outcomes of death anxiety. Fear of aging was the most significant predictor of death anxiety and daily hassles emerged as the most significant adverse consequence of death anxiety.
Comorbidities due to aging and the COVID-19 pandemic together are expected to cause death anxiety among older adults. This study aimed to assess the prevalence of death anxiety and its impact on psychological well-being and successful aging of older adults with chronic illness. A cross-sectional correlational survey was conducted on 79 older adults with chronic illness, drawn with a stratified random sampling method. Self-report measures were used to assess death anxiety, psychological well-being, and successful aging. A high prevalence of death anxiety was reported among older adults. Psychological well-being and successful aging in these older adults were significantly and negatively associated with death anxiety. Further, death anxiety showed substantial predictive valence for psychological well-being and successful aging of older adults with chronic illness. Findings strongly advocate and call for timely intervention programs for chronically ill older adults to reduce their death anxiety for enhanced psychological well-being and promote successful aging.
Prolonged grief disorder has recently been officially introduced as a new mental disorder. This study aimed to validate the Persian version of the revised Prolonged Grief Scale (PG-13-R). This study was conducted among the general population in Shahroud, Iran, during 2023. Employing face and content validity, along with exploratory and confirmatory factor analyses (EFA), the study validates the PG-13-R. Average variance extracted value showed an acceptable convergent validity. The EFA reveals a singular factor structure explaining 60.541% of the variance in prolonged grief disorder, and the confirmatory factor analysis demonstrates an excellent model fit. Internal consistency, evaluated through Cronbach’s alpha and MacDonald’s omega, highlights the scale’s reliability. The Persian version of PG-13-R had acceptable composite reliability. Stability is confirmed by an intra-class correlation coefficient. In conclusion, the Persian PG-13-R displays satisfactory validity and reliability to assessing prolonged grief symptoms in the Iranian population.
Across the United States, some regions demonstrate greater readiness to adopt palliative care than others. This geographic variation in access and utilization may be due to cultural variation in “tightness” and “looseness,” which can be understood as the relative strength and enforcement of social norms and behavioral constraint within a culture. The present study examined the influence of cultural tightness-looseness on access to palliative care (i.e., statewide percentage of hospitals with palliative care programs) across the 50 U.S. states while controlling for demographic covariates. Results of regression analyses demonstrated that states with looser cultures (i.e., less adherence to norms) had better palliative care access (β = .501,
The purpose of this study was to investigate the relationship between mortality salience, death anxiety, and two moderating variables: self-esteem and religiosity. A total of 174 undergraduate students from the Mindanao State University-Main Campus in the Philippines were selected via convenience sampling. Specifically, the study was carried out to determine if both self-esteem and religiosity moderate the relationship between mortality salience and death anxiety. The results revealed that mortality salience was positively correlated with death anxiety among undergraduate students. Moreover, self-esteem significantly moderated the relationship between mortality salience and death anxiety, with low self-esteem enhancing this relationship. However, religiosity was found to be a non-significant moderator of the link between mortality salience and death anxiety. Overall, the findings of this study have implications for understanding these relationships and offer recommendations for further research.
With the aging of the population and the substantial surge of individuals above the age of 60, psychological concerns particular to this population have come to hold more weight on the healthcare and social levels. One of the concerns of older adults, which can significantly influence their psychological well-being, is the fear of inevitable mortality or death anxiety. This integrative review tackles the subject of death anxiety among older adults by providing a comprehensive synthesis of the factors associated with death anxiety and the effective interventions to mitigate it. A systematic screening of relevant articles was conducted using the PRISMA guidelines. Content and thematic analysis of 46 selected articles were performed, from which five key themes emerged: demographic factors, psychological and psychosocial factors, spiritual and religious factors, death reminders, and effective interventions. The review contributes to the field of thanatology and offers clinical insights into the care of older adults.
Prolonged Grief Disorder (PGD) is characterized by extensive yearning, which includes a strong desire, for the deceased that occurs for at least 12 months. The aim of this study was to identify risk factors that contribute to PGD including the type of loss, relationship to the deceased, and coping. The sample included 190 bereaved adults (71 unexpected or violent loss and 119 natural loss) that experienced the loss of a loved one at least 12 months prior to completing the survey used in this study. There were non-significant results for type of loss, the presence of PGD, and coping. Findings showed that dysfunctional coping including self-blame explained the presence of PGD. Closeness to the deceased prior to the loss contributed to the presence of PGD. The findings highlight the risk factors for adults that experience a presence of PGD.
This study aimed to provide a systematic overview of existing quantitative research on the effects of psychotherapy interventions given to women with stillbirth on the grief process and depression in the postpartum period and to analyze the results. Four databases (PubMed (MEDLINE), Cochrane, Google Scholar, Web of Science) were searched between January-March 2024. Risk of bias and precision of evidence were assessed with the Cochrane risk of bias tool ROB-2 and ROBIN-1. Ten studies were included. Meta-analysis results showed that psychotherapeutic interventions significantly reduced the grief adaptations of mothers in the mourning process and there was a significant difference in the assessment of grief adaptation. Sub-group analyzes revealed mothers’ depression values and stress levels compared to the control groups and there was a significant difference between the groups. Psychotherapeutic interventions given to women positively affect their grief adaptation and reduce stress, anxiety, and depression.
The number of Shidu parents (parents over the age of 45 years who have lost their only child) has been increasing in China, which is important because Shidu parents experience depressive symptoms. This study investigated the potential mediating roles of mindfulness and resilience in the relation between social support and depressive symptoms among Shidu parents. From June to December 2021, 111 Shidu parents in Baoji city, China, completed a web-based survey on social support, depressive symptoms, mindfulness, and resilience. The results indicated that Shidu parents suffer from a high risk of depressive symptoms, and significant correlations were found between the study variables. Path analysis models showed that the relation between social support and depressive symptoms in Shidu parents was fully mediated by a combination of mindfulness and resilience. These findings further highlighted the significance of social support, mindfulness, and resilience in potentially alleviating depressive symptoms among Shidu parents.
Hope is a critically important concept in palliative care that enables coping and increases quality of life. This qualitative study was conducted to determine how palliative care patients describe hope and the factors that increase or decrease hope after a hope intervention. Data were collected through semi-structural interviews with 10 palliative care patients. The analysis followed a thematic analysis approach. The participants defined hope as the joy of living in general, and the strength to cope with difficulties and stated that spending time with loved ones increased their hopes, the worsening of their diseases reduced their hopes, hope made them feel good psychologically, and health workers had an important role in increasing hope. It is recommended that hope interventions be person-centric in palliative care settings and that care should be structured by considering the factors that maintain and prevent hope.
‘Existential’ can be seen as a broad term for issues surrounding people’s experiences and way of thinking about life. This study examined availability of existential care and found that many different staff categories performed existential care. Existential care is associated with conversations and experienced as both easy and difficult; several factors were cited, e.g. insufficient time, stress and the difficulty of addressing existential questions for oneself. Respondents reported need for education, guidance and reflection around existential issues and care. Existential care is described as a natural part of patient care that all professional categories have a responsibility to offer.
Although perceived and internalized suicide stigma are considered risk factors for suicidal thoughts and behaviors (STBs), their specific roles in STBs are not well understood. This study examined the relationships among perceived and internalized suicide stigma, hopelessness, unbearable pain, suicidal desire, and suicide attempts in college students. A total of 1,387 Chinese college students (mean age: 22.22 years) completed the relevant scales. Structural equation modeling was used to determine the relationships of interest. The results showed that perceived stigma primarily had indirect impacts on suicidal desire through internalized stigma, which subsequently affected unbearable pain and hopelessness. The findings of this study suggest that the internalization of suicide stigma is an important predictor of STBs. These findings advocate for stigma interventions aimed at reducing internalized stigma as a potentially effective strategy for suicide prevention, as it may alleviate unbearable pain and hopelessness, which are significant contributors to suicidal desire and attempts.
Guided by the conceptual framework of widowed parenting, the current study takes a relational approach to understand more about how the characteristics of parents of young and adult children relate to coping following the unexpected death of a partner due to COVID-19, and how these variables predict complicated grief and posttraumatic growth. A sample of 81 widowed parents completed self-report measures examining parenting self-efficacy, relationship uncertainty, coping, complicated grief, and posttraumatic growth. Results of hierarchical regression analyses suggest that, when controlling for time since death (1) relationship uncertainty and avoidant coping significantly predict complicated grief for parents in the sample with adult children, and (2) widowed parenting self-efficacy and both problem-focused and emotion-focused coping significantly predict posttraumatic growth for parents in the sample with young children. Results of the current study may inform future practices (e.g., use of Emotionally Focused Family Therapy) to aid families grieving an unexpected loss.
The importance of ritual/ceremony following bereavement is well documented, however restrictions during the COVID-19 pandemic impacted the freedom to bury loved ones according to beliefs/traditions. This study explores the experiences of staff providing funeral services during COVID-19 and considers the implications for supporting bereaved families. Fifty-eight staff (male, 72.4%;
Death Cafes (DCs) explicitly encourage conversation and constitute space to explore the dialogue around death and dying. This study draws on scholarship from communication and dialogue theory to explore the design features and facilitation practices used within DC meetings. Through qualitative analysis of the DC webpage and interviews with facilitators, the study uncovers how DC facilitators structure and manage conversations to help attendees normalize death conversations and manage the death anxiety of others in their lives. The analysis highlights three main tensions within the DC structure and facilitation guidelines: structure versus openness, authority versus equality, and conversation versus information. These fundamental contradictions are inherent in DCs, and facilitators need to manage them in order to promote meaningful dialogue among DC participants. This study deepens the theorizing around DC facilitation practices and has implications for death and dying practitioners hoping to foster dialogue about end-of-life topics.
Hope is a complex and ever-evolving personal phenomenon that plays a vital role in individuals’ abilities to cope with stressful events. This is particularly true for parents who are coping with the traumatic loss of a child. However, the topic of hope in this context is often inadequately addressed. The primary objective of this paper is to gain insight into the hope held by Finnish parents following the traumatic loss of a child. This qualitative study unfolded in two phases. A total of 117 participants took part in the study, including 108 females, 5 males, and 4 individuals who chose not to disclose their sex. Subsequently, 17 parents participated in in-depth phone interviews. Thematic analysis was conducted to identify key themes. Several themes emerged from the analysis, including the endurance of hope amidst uncertainty, the hope for a reunion based on faith, hope directed towards family members, and moments of hopelessness regarding the future. The findings of this research are pivotal in enhancing our comprehension of the challenges faced by grieving parents in the aftermath of a child’s traumatic death. Moreover, this study holds significant relevance for professionals who work with bereaved parents following the traumatic loss of a child.
This study aimed to describe the experiences of parents of children with cancer in the diagnosis process. A descriptive qualitative research design and content analysis method were used. Eleven parents participated in the study. Three main themes emerged, each with related sub-themes: encountering a cancer diagnosis, changes in the lives of those affected by the diagnosis, and coping strategies. Upon their children’s diagnosis, parents reported feelings of guilt, regret, helplessness, devastation, constant thoughts of death, and changes in their lives, with some siblings displaying negative reactions. Some children felt their freedom was restricted, and some refused treatment. Parents coped by distracting their attention, praying, receiving support from their family, relatives or health professionals, and maintaining hope for their children’s recovery. The study concludes that parents of children diagnosed with cancer require support to manage and adapt to the diagnosis process and meet their needs effectively throughout this difficult journey.
Obituaries serve important social functions; they announce death, but more importantly, allow the living to shape how the dead are remembered. Originally reserved for the elite, a democratization of the format has led to obituaries becoming more common and more detailed over the past century. Changes in this genre interact with the rise of nonreligion. As declining affiliation complicates the relationship between death and religious structures, obituaries reveal a shift from transcendent to immanent life stances, reflected in patterns of death commemorations. Based on analysis of obituaries across six Canadian newspapers over the past 120 years, this paper explores the relationships, activities, and values people express through obituaries. We argue that the growing appearance of family members left behind, favourite hobbies, and community associations indicate changes in how death is understood. Death is increasingly commemorated by reflecting on the relationships that people form in life.
This study provides a decadal analysis of national suicide data over 90 years, offering a comprehensive view of long-term trends and current levels in the United States. We analyzed mean decadal suicide numbers, rates, and confidence intervals from the 1930s to the early 2020s across demographic categories including sex, race, and age. Our findings reveal that suicide rates in the 2020s are the highest since the 1930s. The data indicate significant variations across groups; the 2020s show the highest suicide rates for both Whites and Nonwhites, and individuals under 44 years of age. Conversely, men’s suicide rates were slightly lower than those in the 1930s, whereas rates for women and older adults peaked during the 1930s. The results underscore the need for ongoing surveillance of suicide trends and proactive suicide prevention measures by governmental and other relevant organizations.
The medicalization of death has left gaps in the spiritual and psychosocial well-being of the dying. Factors like professional and caregiver burnout, lack of training, overburdened caseloads and rigid schedules, and other organizational constraints lead to holistic, humane care falling through the cracks. Consequently, the dying and their families are opting to rely on individuals who can bridge these gaps—end-of-life (EOL) doulas. EOL doulas employ a variety of non-medical practices from touch therapies to legacy projects to religious rites that provide support covering the emotional, spiritual, and practical aspects of dying. Utilizing qualitative interviews with 23 EOL doulas located and working in the United States, this research offers insights into doulas’ provisions of spiritual care, how death doulas’ understanding of the death transition inform spiritual care provisions, as well as how death doulas navigate differences in spiritual and religious belief systems between themselves and their clients. The study emphasizes the critical role of EOL doulas in bridging gaps in end-of-life care, providing personalized, compassionate support sometimes missing in institutional settings.
Grief responses range from minimal changes in functioning to debilitating, prolonged, complicated grief. The objective of the current study was to clarify the relationship between maladaptive personality characteristics, coping and situational factors associated with symptoms of complicated grief and health difficulties among bereaved individuals who had lost a loved one within the past six months to two years (
People who use drugs form a significant part of the community who are impacted by drug-related deaths, but their stigmatized positioning in society yields implications for their access to support and the social recognition of their grief. This project explores how the internalization of drug-related stigmas shapes the grief experience for peers bereaved by a DRD. Six individuals who experienced the drug death of a peer during their own time in active addiction participated in semi-structured interviews, analyzed by interpretative phenomenological analysis. Three superordinate themes are reported in this paper: (i) Forged Connections; (ii) The Condemnation Script; and (iii) Nowhere Left to Turn. Participants reported grief responses such as survivor’s guilt, shame, and increased drug use against the wider social invalidation of their close peer bonds. This paper appeals for a more health-based approach to supporting people in active addiction that recognizes and validates their grief experiences.
The meaning ascribed to death differs from one society to the other. This study adopts the descriptive method in unraveling the ritual of burial practices among the Ilaje people of Nigeria’s Niger delta. Based on linguistic similarities, Ilaje people are part of the Yoruba ethnic group of Nigeria’s Southwest area. Among the people, burial accorded to the dead is based on how the deceased died. The Ilaje groups death into five distinctive categories - death due to old-age, death caused by witchcraft or evil spirit, death through drowning by accident, death through curse, and death due to suicide. For the people, adult’s death has two layers of meaning: sorrow and merriment. We conclude that physical death is viewed as part of the continuum of life’s circle; it is the point when the dead pass to the realm of the ancestor who may be reborn into the family in the future.
During the COVID-19 pandemic, stringent measures were imposed in numerous countries, including France. These measures significantly disrupted societal practices, particularly mourning and funeral rituals. This study, conducted between June and September 2021 as part of the COVIDEUIL-France research, involved 242 participants, predominantly female (84%) with an average age of 49.64 years. The research aimed to investigate the consequences of the absence of funeral rituals and the adoption of personalized, domestic, and digital alternatives. Using online surveys and psychological tools, including the Traumatic Grief Inventory Self Report Version (TGI-SR), General Health Questionnaire-28 (GHQ-28), and Post-traumatic Growth Inventory (PTGI), the study found a significant correlation between the lack of traditional practices and grief complications. Despite 21.81% of participants compensating with personal commemorations, digital commemorations were underutilized, raising questions about their effectiveness. The study provides crucial insights, emphasizing the need to address the psychological effects of disrupted mourning practices in France.
Suicide is a serious public health concern, and people who are incarcerated represent a particularly high-risk group. Although research on the suicidality of persons in prison has gained interest in recent decades, the issue of suicide among older adults in prison has been understudied. Therefore, the aim of the present study was to explore the ways in which older adults in prison understood their experiences of suicidal ideation. Interpretive phenomenological analysis was utilized to analyze interviews with 16 incarcerated older adults. The analysis of the findings revealed four themes: (1) Suicide intentions as a control strategy; (2) Suicide intentions as an act of resistance; (3) Suicide intentions as a means of self-redemption, and (4) Suicide intentions in the absence of other choices. Guided by the life course perspective, the findings suggest that suicidal ideation serves as a means of expressing distinct emotional states that may be unique to older adults in carceral environments.


