The Prevalence Of Unresolved Grief Among Bereaved Parents Implications For Counselling

Project and Seminar Material for Guidance and Counselling

The Prevalence Of Unresolved Grief Among Bereaved Parents Implications For Counselling


Abstract


The loss of an infant through stillbirth, miscarriage, or neonatal death is recognized as a traumatic life event. Predictors of development of complicated grief after prenatal loss include lack of social support, pre-existing relationship difficulties, or absence of surviving children, as well as ambivalent attitudes or heightened perception of the reality of the pregnancy. Risk of complicated grief was found to be especially high after termination of a pregnancy due to fetal abnormality. Studies have revealed that men and women show different patterns of grief, potentially exacerbating decline in a relationship. Although it is clear that prenatal loss has a large psychological impact, it is concluded that there is a substantial lack of randomized controlled studies in this field of research. This article reviews literature on CG reactions to perinatal loss. Typical grief reactions and unique aspects of bereavement after perinatal loss are described, before a summary of the risk factors which influence grief outcome. The specific issue of termination of pregnancy due to abnormality is outlined and gender differences between fathers and mothers after prenatal loss are then addressed. Finally, clinical implications for parents after pregnancy loss are discussed. Unresolved Grief.


Chapter One


Introduction

1.1 Background of the Study

Although death is an integral part of life, losing a loved one is a difficult experience that entails a painful adaptation process. This adjustment process is often described as shift between three main phases that, while not necessarily linear and sometimes overlapping, represent a process of gradual separation from the deceased, acceptance of the loss, and adaptation to the new reality [1]. The first phase is characterized by shock and denial of the loss, often accompanied by sense of emotional numbness [2]. The second phase begins with the cognitive and emotional acknowledgment of the reality of the loss. It is characterized by intensive preoccupation with the loss along with elevated levels of cognitive, behavioural, somatic, and social manifestations of distress [3].

During the final phase of the grief process, the bereaved gradually integrates the meaning of the loss. While many manifestations of the grief work, such as yearning for the deceased may be experienced, the high levels of distress are decreased. The bereaved can invest himself in daily life and regain his or her sense of satisfaction and optimism [4].While many of the bereaved go through this adjustment process and resume their previous levels of functioning [4], some experience considerable difficulties in adaptation to the new reality. These bereaved are considered as manifesting a complicated grief reaction. In the absence of accepted diagnostic criteria for complicated grief reaction, most theoreticians use a normative definition: a particular grief process that seems as deviant from the expected in a given society or culture, is defined as complicated grief [5].

Three major types of complicated grief reactions that diverge from the normative, either by intensity or temporal parameters were identified. Absent grief is defined as the inhibition of typical expressions of grief, denial of the loss or feelings related to the loss [6]. Delayed grief is determined when there is a significant interval between the loss and the onset of grief reaction. The length of the interval may vary from weeks to years [7]. Lindemann [8] suggested that delayed grief reactions are the most common form of complicated grief in clinical populations. This impression was supported in a survey conducted among professionals. Jacobs [9] impression was that delayed grief occurs in 10-15 percent and absent grief in 5 percent of the cases of complicated grief reaction. On the other hand, in acommunity-based study Middleton, Burnett, Raphael, and Martinek [10] did not find support for the pattern of either absent or delayed grief reactions.

Prolonged, chronic, or unresolved grief is manifested in prolonged persistent depression, preoccupation with the loss, overidentification and intense yearning for the deceased, and social inhibition, that do not decline over time[11]. Jacobs [9]suggests that this is the most common form observed in clinical practice. Other reports ranged between 9 to 14 percent in community-based samples and 17 percent in clinical populations. When the sample was comprised of bereaved parents, the rates of prolonged reaction were raised to 63 percent of the sample [7].

As can be seen, the distinction between normative and complicated grief reactions is not dichotomous, but rather a matter of degree. The theoreticians disagree regarding the duration of the time criterion. Some authors suggest that the normative grief process lasts for about a year , others imply a longer period, while some claim that the time limit is not adequate [8]. The parameter of intensity is even more problematic, since the mouming process is highly idiosyncratic by nature. Therefore, it is not surprising that the reports on the prevalence of the variants of complicated grief reactions are not consistent.


1.2 Statement of the Problem

The loss of a child is recognized as a very difficult life experience, which can often cause complicated grief (CG) reactions that risk negatively affecting psychological and physical well-being. In a population-based sample, bereaved individuals who had lost a child showed the highest prevalence of CG. Perinatal loss is a relatively common occurrence which, in this article, refers to the death of an infant due to miscarriage, stillbirth, and neonatal death. In 2007 in the United States the infant mortality rate was 6.9 deaths per 1000 live births. Miscarriage, generally defined as an unintended termination of the pregnancy prior to 20 weeks of gestation, is the most common type of pregnancy loss. The overall prevalence is 15% to 27% for women aged between 25 and 29, increasing to 75% in women older than 45 years, with elevated risk for women who have lost a previous pregnancy. The death of a fetus after 20 weeks’ gestation with a birth weight of over 500 g is referred to as a stillbirth. In these cases, the fetus has either died before or during labour, often unexpectedly or after an uncomplicated pregnancy. A relatively new issue that has emerged in the field of perinatal loss is that continuing development of prenatal diagnostics has increased diagnosis of fetal abnormalities, with relatively high corresponding termination rates. A European survey found average termination rates of 88% for Down’s syndrome as well as in cases of neural tube defects.Unresolved Grief

Although parents have not built up a relationship with their infant, grief after pregnancy loss does not differ significantly in intensity from other loss scenarios. As has been found in bereavement involving first-degree relatives, grief symptoms usually decrease in intensity over the first 12 months. Longitudinal studies have demonstrated that in a normal grieving process, grief declines over a period of 2 years after the pregnancy loss. Perinatal losses have also been shown to have a substantial psychological impact on parents and families, and are associated with post-traumatic stress, depression, anxiety, and sleeping disorders. Overall, high levels of CG are generally associated with a poorer state of mental health.


1.3 Objectives of the Study

The main objective of the study is to examine the prevalence of unresolved grief among bereaved parents implications for counselling

The specific objectives of the study are to:

  1. To investigate the cause of grief among parents
  2. To examine types of grief reaction among bereaved parents
  3. To find out the predictors of unresolved grief among bereaved parents
  4. To find out whether complicated grief has a psychological and physical well-being of parents.

1.4 Research Question

  1. What are the cause of grief among parents?
  2. What are types of greif reaction among bereaved parents?
  3. What are the predictors of unresolved grief among bereaved parents?
  4. Does complicated grief has a psychological and phsyical well-being of parents?

1.5 Significance of the Study

This study is carried out on CG reactions to perinatal loss. Typical grief reactions and unique aspects of bereavement after perinatal loss are described, before a summary of the risk factors which influence grief outcome. The specific issue of termination of pregnancy due to abnormality is outlined and gender differences between fathers and mothers after prenatal loss are then addressed. Finally, clinical implications for parents after pregnancy loss are discussed.


1.6 Scope of the Study

This study was carried out on the prevalence of unresolved grief among bereaved parents implications for counselling. Although a lot of attempt and endeavor to help and support the bereaved families were continued, any systemized investigation about mental health state of the bereaved parents could not perform due to the difficulty of getting consent of the bereaved parents for 1 year due to social and political issue. Various types of disasters can adversely affect mental health. A large body of research has demonstrated that various traumatic experiences such as physical injury, a property loss or loss of loved one originate from disasters and are related to significant psychological difficulties for many people. The study is delimited to selected bereaved parent in Lokoja local government area. Kogi State.


1.7 Limitation of the Study

This research project, like all human endeavors, had some challenges that threatened to derail the study’s completion. One of the reasons is that the time allotted for this work was so limited that the researcher did not have enough time to complete the task thoroughly. During data collection, the researcher also had to put forth extra effort to understand the respondents’ interview schedules, several of whom fell into the incomprehensible age group. Also, there were financial and transportation constraints to deal with. Insufficient funds tend to impede the efficiency of the researcher in sourcing the relevant materials, literature, or information and in the process of data collection (internet, questionnaire, interview).


Chapter Five


Summary, Conclusions and Recommendations

5.1 Summary

This study was carried out on the prevalence of unresolved grief among bereaved parents implications for counselling. Although a lot of attempt and endeavor to help and support the bereaved families were continued, any systemized investigation about mental health state of the bereaved parents could not perform due to the difficulty of getting consent of the bereaved parents for 1 year due to social and political issue. Various types of disasters can adversely affect mental health. A large body of research has demonstrated that various traumatic experiences such as physical injury, a property loss or loss of loved one originate from disasters and are related to significant psychological difficulties for many people. The study further investigate the cause of grief among parents, examine types of grief reaction among bereaved parents, find out the predictors of unresolved grief among bereaved parents, find out whether complicated grief has a psychological and physical well-being of parents. The study is delimited to selected bereaved parent in Lokoja local government area. Kogi State.

This research is reported in five distinct yet interrelated chapters. In the chapter one we describes the study objectives clearly by stating the motive behind this study. The research adopted the survey descriptive design and with the aid of convenience sampling method, the researcher conveniently selected eighty (80) participant who are bereaved parent in Lokoja local government area. Kogi State. Self- structure questionnaire was issued to the respondent of which seventy-seven (77) responses were retrieved and validated for the study. The study made use of of descriptive analysis and inferential statistics where data from field survey was analysed using simple percentage, mean and standard deviation presented in frequencies and tables.


5.2 Conclusion

Grief is an inevitable experience for each human being. But adjustment to loss has substantial variations between individuals, and various responses to loss follow several distinct trajectories. After the initial period of losing a loved one, some people may gradually adapt to their new life and move on with the love and memories of the deceased; for others, however, there are some factors that may hinder their adjusting process to grief; and for a few people, negative mental and physical health consequences may be extreme and persistent after loss. Grief resulting from the loss of an infant through stillbirth, miscarriage, neonatal death and unintended termination of a pregnancy due to foetal abnormality may be complicated with several factors (e.g., experiencing multiple losses, lack of traditional rituals) and may thus prove to be more persistent or extreme. The trajectories of bereavement could be affected by socio-cultural factors.

Findings of the study reveals that there are three major types of greif reactions which includes: absence reaction characterized by shock and denial of the loss, often accompanied by sense of emotional numbness, delayed reaction which begins with the cognitive and emotional acknowledgement of the reality of the loss and prolonged, chronic, or unresolved grief manifested in prolonged persistent depression, preoccupation with the loss, over-identification and intense yearning for the deceased, and social inhibition.

Further findings reveals that Predictors of development of complicated grief after prenatal loss include lack of social support, pre-existing relationship difficulties, or absence of surviving children, as well as ambivalent attitudes or heightened perception of the reality of the pregnancy. The study therefore concludes that complicated grief has a psychological and physical well-being of parents.


5.3 Implication for Counselling

Considering the large number of bereaved individuals who are suffering from grief and other mental health problems, it is significant to develop a suitable and effective intervention protocol immediately. With this research, we hope that this research help fill in the gap and proffer therapy of bereaved parents during this critical period of their lives. To the best of our knowledge, this will be the first time that such a large-scale grief research project will have been conducted among bereaved parents in Lokoja Local Government Area, Kogi State.

This project will carry positive implications for practice, research, policy. In terms of practical significance, this project will be beneficial to increasing understanding of the mental health status of the bereaved individuals, and promoting awareness of mental health in Lokoja Local Government Area, Kogi State.. Since there are very few professional grief counsellors in Lokoja Local Government Area, Kogi State., one of the aims of this project is to provide grief theory and grief counselling training to experienced counsellors, to improve their competence, and provide professional grief counseling services for bereaved individuals in the future. This research develops, conducts, and evaluates the training program of grief counselling in Lokoja Local Government Area, Kogi State. for the first time, which will largely promote the development of grief counselling in Lokoja Local Government Area, Kogi State.

From a research perspective, as far as we know, this is the first study in Nigeria to explore the training effect of grief counselors, and to evaluate the efficacy of RCT grief counselling for bereaved individuals. This study is rooted in Lokoja Local Government Area, Kogi State. local culture and policy conditions. This study may improve grief theories under the background of Nigeria culture, expands the depth and breadth of grief research culturally, and also provides theoretical support for further grief research and grief intervention.

As for policy perspective,Nigerians mental health work is still in its infancy. Our project may help raise awareness of the area of grief, and promote the development of policies for the physical and mental health of the bereaved individuals.


5.4 Recommendation

it is recommended that future studies focus on randomized controlled trials, especially in the areas of general prevention of CG development, tackling of high-risk subgroups and possible courses of action to help parents already suffering from CG. Having had an okay way to grieve in the immediate post-loss phase was predicted by male gender, good family cohesion and having had a last conversation with the dying parent. Pre- and post-loss communication between health care professionals and the family, including the teenage children, about the imminent death, and about common acute grief experiences and reactions, normalizing the sometimes abysmal emotions that may be experienced, could facilitate coping with grief in the acute phase of bereavement, thus possibly reducing the risk of unresolved long-term grief.


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