Hostname: page-component-6d856f89d9-mhpxw Total loading time: 0 Render date: 2024-07-16T04:25:35.654Z Has data issue: false hasContentIssue false

Subjective and objective traumatic death: distinct roles in developing complicated grief and depression among older adults in Hong Kong

Published online by Cambridge University Press:  17 November 2016

Suqin Tang
Affiliation:
Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
Amy Y. M. Chow*
Affiliation:
Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
*
Correspondence should be addressed to: Amy Y. M. Chow, Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China. Phone: +852 39175530; Fax: +852 2858 7604. Email: [email protected].

Abstract

Background:

Symptoms of complicated grief are associated with a traumatic death. However, the subjective experience of whether or not the death was considered traumatic has not been substantially explored. This study first examined the difference between objective and subjective traumatic death, and then investigated their respective impacts on complicated grief and depressive symptoms following bereavement among older adults in Hong Kong.

Methods:

Participants were 187 Hong Kong adults aged 65 years or above who had lost a family member within the past five years. Demographic information, the Inventory of Complicated Grief (ICG), the Geriatric Depression Scale (GDS), and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS) were utilized.

Results:

The subjective traumatic level of the death did not differ between the objective traumatic and non-traumatic death as defined by nature of death (t = −1.554, p = 0.122). Higher subjective traumatic levels and younger age of the deceased, were positively related to complicated grief symptoms, F (10, 161) = 14.222, p < 0.001, R2 = 0.469. Higher subjective traumatic levels and older age of the bereaved were positively associated with symptoms of depression, F (10, 160) = 2.855, p = 0.003, R2 = 0.151. However, objective traumatic death was found to have no relation to either complicated grief or depressive symptoms.

Conclusions:

Subjective and objective traumatic death may be two distinct concepts, and the subjective experience of the death as a trauma may be a more important factor that contributes to complicated grief and depressive symptoms.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Boals, A. and Schuettler, D. (2009). PTSD symptoms in response to traumatic and non-traumatic events: the role of respondent perception and A2 criterion. Journal of Anxiety Disorders, 23, 458462. doi:10.1016/j.janxdis.2008.09.003 CrossRefGoogle ScholarPubMed
Boelen, P. A. (2013). Symptoms of prolonged grief, depression, and adult separation anxiety: distinctiveness and correlates. Psychiatry Research, 207, 6872. doi:10.1016/j.psychres.2012.09.021 CrossRefGoogle ScholarPubMed
Boelen, P. A. and Klugkist, I. (2011). Cognitive behavioral variables mediate the associations of neuroticism and attachment insecurity with prolonged grief disorder severity. Anxiety, Stress, and Coping, 24, 291307. doi:10.1080/10615806.2010.527335 CrossRefGoogle ScholarPubMed
Boelen, P. A., van de Schoot, R., van den Hout, M. A., de Keijser, J. and van den Bout, J. (2010). Prolonged grief disorder, depression, and posttraumatic stress disorder are distinguishable syndromes. Journal of Affective Disorders, 125, 374378. doi:10.1016/j.jad.2010.01.076 CrossRefGoogle ScholarPubMed
Boelen, P. A., Van Den Hout, M. A. and Van Den Bout, J. (2006). A cognitive‐behavioral conceptualization of complicated grief. Clinical Psychology: Science and Practice, 13, 109128. doi:10.1111/j.1468-2850.2006.00013.x Google Scholar
Cameron, A., Palm, K. and Follette, V. (2010). Reaction to stressful life events: what predicts symptom severity?. Journal of Anxiety Disorders, 24, 645649. doi:10.1016/j.janxdis.2010.04.008 CrossRefGoogle ScholarPubMed
Fujisawa, D., Miyashita, M., Nakajima, S., Ito, M., Kato, M. and Kim, Y. (2010). Prevalence and determinants of complicated grief in general population. Journal of Affective Disorders, 127, 352358. doi:10.1016/j.jad.2010.06.008 CrossRefGoogle ScholarPubMed
Gold, S. D., Marx, B. P., Soler-Baillo, J. M. and Sloan, D. M. (2005). Is life stress more traumatic than traumatic stress?. Journal of Anxiety Disorders, 19, 687698. doi:10.1016/j.janxdis.2004.06.002 CrossRefGoogle ScholarPubMed
He, L., Tang, S., Yu, W., Xu, W., Xie, Q. and Wang, J. (2014). The prevalence, comorbidity and risks of prolonged grief disorder among bereaved Chinese adults. Psychiatry Research, 219, 347352. doi:10.1016/j.psychres.2014.05.022 CrossRefGoogle ScholarPubMed
Hibberd, R., Elwood, L. S. and Galovski, T. E. (2010). Risk and protective factors for posttraumatic stress disorder, prolonged grief, and depression in survivors of the violent death of a loved one. Journal of Loss and Trauma, 15, 426447. doi:10.1080/15325024.2010.507660 CrossRefGoogle Scholar
Kaltman, S. and Bonanno, G. A. (2003). Trauma and bereavement: examining the impact of sudden and violent deaths. Journal of Anxiety Disorders, 17, 131147. doi:10.1016/S0887-6185(02)00184-6 CrossRefGoogle ScholarPubMed
Kersting, A., Brähler, E., Glaesmer, H. and Wagner, B. (2011). Prevalence of complicated grief in a representative population-based sample. Journal of Affective Disorders, 131, 339343. doi:10.1016/j.jad.2010.11.032 CrossRefGoogle Scholar
Lee, H. C. B., Chiu, H. F. K. and Kwong, P. P. K. (1994). Cross-validation of the geriatric depression scale short form in the Hong Kong elderly. Bulletin of Hong Kong Psychological Society, 32, 7277.Google Scholar
Leung, C. M., Ho, S., Kan, S. S., Hung, C. H. and Chen, C. N. (1993). The Chinese version of the hospital anxiety and depression scale: a cross-cultural perspective. International Journal of Psychosomatics, 40, 2933.Google Scholar
Leung, K. (1996). The role of beliefs in Chinese culture. In Bond, M. H. (ed.), The Handbook of Chinese Psychology (pp. 246262). Hong Kong: Oxford University Press.Google Scholar
Li, J., Chow, A. Y. M., Shi, Z. and Chan, C. L. W. (2015). Prevalence and risk factors of complicated grief among Sichuan earthquake survivors. Journal of Affective Disorders, 175, 218223. doi:10.1016/j.jad.2015.01.003 CrossRefGoogle ScholarPubMed
Luppa, M. et al. (2012). Age-and gender-specific prevalence of depression in latest-life–systematic review and meta-analysis. Journal of Affective Disorders, 136, 212221. doi:10.1016/j.jad.2010.11.033 CrossRefGoogle ScholarPubMed
Maercker, A. et al. (2013). Proposals for mental disorders specifically associated with stress in the international classification of diseases-11. The Lancet, 381, 16831685. doi:10.1016/S0140-6736(12)62191-6 CrossRefGoogle ScholarPubMed
Melhem, N. M., Moritz, G., Walker, M., Shear, M. K. and Brent, D. (2007). Phenomenology and correlates of complicated grief in children and Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 493499. doi:10.1097/chi.0b013e31803062a9 CrossRefGoogle ScholarPubMed
Nagy, D. and Szamosközi, Ş. (2014). The relationship between irrational cognitions, autobiographical memory, coping strategies and complicated grief. Procedia–Social and Behavioral Sciences, 127, 524528. doi:10.1016/j.sbspro.2014.03.303 CrossRefGoogle Scholar
Newson, R. S., Boelen, P. A., Hek, K., Hofman, A. and Tiemeier, H. (2011). The prevalence and characteristics of complicated grief in older adults. Journal of Affective Disorders, 132, 231238. doi:10.1016/j.jad.2011.02.021 CrossRefGoogle ScholarPubMed
Prigerson, H. G. et al. (1995). Inventory of complicated grief: a scale to measure maladaptive symptoms of loss. Psychiatry Research, 59, 6579. doi:10.1016/0165-1781(95)02757-2 CrossRefGoogle ScholarPubMed
Schaal, S., Jacob, N., Dusingizemungu, J. P. and Elbert, T. (2010). Rates and risks for prolonged grief disorder in a sample of orphaned and widowed genocide survivors. BMC Psychiatry, 10, 19. doi:10.1186/1471-244X-10-55 CrossRefGoogle Scholar
Sheik, J. I. and Yesavage, J. A. (1986). Geriatric depression scale (GDS): recent evidence and development of a shorter version. In Brink, T. L. (ed.), A Guide to Assessment and Intervention (pp. 165173). New York: Haworth Press.Google Scholar
Spuij, M., Reitz, E., Prinzie, P., Stikkelbroek, Y., de Roos, C. and Boelen, P. A. (2012). Distinctiveness of symptoms of prolonged grief, depression, and post-traumatic stress in bereaved children and adolescents. European Child & Adolescent Psychiatry, 21, 673679. doi:10.1007/s00787-012-0307-4 CrossRefGoogle ScholarPubMed
Stroebe, M. S., Folkman, S., Hansson, R. O. and Schut, H. (2006). The prediction of bereavement outcome: development of an integrative risk factor framework. Social Science & Medicine, 63, 24402451. doi:10.1016/j.socscimed.2006.06.012 CrossRefGoogle ScholarPubMed
Stroebe, M., Schut, H. and Stroebe, W. (2007). Health outcomes of bereavement. The Lancet, 370, 19601973. doi:10.1016/S0140-6736(07)61816-9 CrossRefGoogle ScholarPubMed
Tomarken, A. et al. (2012). Examining the role of trauma, personality, and meaning in young prolonged grievers. Psycho–Oncology, 21, 771777. doi:10.1002/pon.1983 CrossRefGoogle ScholarPubMed
van der Houwen, K., Stroebe, M., Stroebe, W., Schut, H., Bout, J. V. D. and Meij, L. W. D. (2010). Risk factors for bereavement outcome: a multivariate approach. Death Studies, 34, 195220. doi:10.1080/07481180903559196 CrossRefGoogle ScholarPubMed
Weinberg, M. and Gil, , S. (2016). Trauma as an objective or subjective experience: the association between types of traumatic events, personality traits, subjective experience of the event, and posttraumatic symptoms. Journal of Loss and Trauma, 21, 137146. doi:10.1080/15325024.2015.1011986 CrossRefGoogle Scholar
Zigmond, A. S. and Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361370.CrossRefGoogle ScholarPubMed