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Biomedical subjects

Holly G Prigerson

Publications and source records attributed to Holly G Prigerson.

At least 19 recordsLinked to original sources
PubMed2007

Parental control, partner dependency, and complicated grief among widowed adults in the community.

Data from the Yale Bereavement Study, a community-based longitudinal study, were used to investigate the association of 192 widowed individuals' recollections of parenting affection and control during childhood with dependency on the deceased spouse and the development of severe grief symptoms following bereavement. The hypothesis that dependency on the deceased spouse mediates the association of parental affection and control during childhood with the development of severe grief following bereavement was investigated. Findings indicated that a high level of perceived parental control during childhood was associated with elevated levels of dependency on the deceased spouse and with symptoms of complicated grief. Dependency on the deceased spouse mediated the association of perceived parental control with the development of complicated grief following bereavement.

Adult↗
PubMed2006

Mutuality and specificity of mental disorders in advanced cancer patients and caregivers.

BACKGROUND: We sought to determine mutuality and specificity in rates of mental disorders between advanced cancer patients and their caregivers. METHOD: Data from 168 non-genetically related patient-caregiver dyads participating in the multi-site Coping with Cancer (CWC) study were included in this analysis. Multivariate logistic regression analyses were conducted to examine associations between diagnoses of a psychiatric disorder in patients with diagnoses of psychiatric disorders in caregivers, and vice versa, controlling for confounders. RESULTS: When patients met criteria for any psychiatric diagnosis, then caregivers were 7.9 times (P < 0.0001) more likely to meet criteria for any psychiatric diagnosis, and vice versa. Caregiver Panic Disorder (PD) diagnosis was associated with patient Generalized Anxiety Disorder (GAD). Patient GAD was also associated with caregiver PD. Finally, patient PD was associated with caregiver GAD and caregiver Post-Traumatic Stress Disorder (PTSD). CONCLUSIONS: To our knowledge, this is the first study that demonstrates the mutuality of psychiatric disorders in both advanced cancer patients and their informal caregivers. Specifically, the presence of anxiety disorders in one partner (either caregiver or patient) was associated with a greater likelihood of anxiety disorders in the other. Results suggest that psychiatric distress should be assessed in both patients and their caregivers, and that mental illness in one should raise concern about the possibility of a psychiatric disorder in the other. Results also suggest that targeted interventions to address shared fears and concerns of patients and caregivers might reduce anxiety in the end phases of the patient's illness.

Aged↗
PubMed2006

Preparing caregivers for the death of a loved one: a theoretical framework and suggestions for future research.

Caring for a terminally ill loved one and the death of that person are two of the most stressful human experiences. Recent research suggests that a substantial number of caregivers are unprepared for the death and that these caregivers may be at greater risk of psychological distress. The literature on preparedness and mental health, however, is in its infancy. The purpose of this paper, therefore, is to summarize the literature in order to stimulate discussion and research on preparedness. It is our view that preparedness for the death of a loved one is an important contributor to caregiver well-being and bereavement outcomes and that more work in this area is needed in order to improve the care provided to caregivers of seriously or terminally ill patients. We briefly review the literature on preparedness, present a theoretical model delineating the relationships between preparedness, caregiver-health care provider communication, and caregiver well-being, and provide suggestions for future research.

Caregivers↗
PubMed2006

Update on bereavement research: evidence-based guidelines for the diagnosis and treatment of complicated bereavement.

The past decade has witnessed considerable growth in the evidence-base from which clinical recommendations for bereavement care can be made. Research now provides guidance to assist clinicians in: a) recognizing differences between complicated and uncomplicated bereavement reactions, b) identifying risk factors that may make certain individuals more vulnerable to bereavement-related complications, c) appreciating and monitoring for potential adverse outcomes associated with bereavement and d) taking actions to prevent or minimize maladjustment to the loss. In this article we distinguish between the course of normal grief and abnormally prolonged, or complicated grief; clarify distinctions between Complicated Grief Disorder and other mental disorders secondary to bereavement; review outcomes associated with Complicated Grief Disorder; describe research on resilience in bereavement; present findings on stigmatization and the use of mental health services among recently bereaved persons; and summarize where the field is with respect to establishing the efficacy and effectiveness of bereavement interventions. Promising new psychotherapies for Complicated Grief Disorder have shown clinical efficacy. Nevertheless, further research is needed to enhance the detection of vulnerable bereaved persons, to promote resilience following significant interpersonal loss, and to tailor interventions to address the attachment issues that lie at the heart of this disorder.

Bereavement↗
PubMed2006

Peaceful awareness in patients with advanced cancer.

BACKGROUND: Previous studies have shown that prognostic awareness may be harmful to mental health yet beneficial for end of life care planning. The effects of prognostic awareness coupled with a sense of inner peace are unknown. METHODS: In the multisite, longitudinal Coping with Cancer Study, 280 patients with advanced cancer were interviewed at baseline. Patients defining themselves as "terminally ill" and/or "at peace" most days were paired with others on sociodemographic, mental health and advance care planning. Primary caregivers of deceased patients were interviewed 6 months postloss and compared on their physical and mental health and their perceptions of patients' end-of-life care and death. RESULTS: Overall, 17.5% of patients reported being both peaceful and aware. Peacefully aware patients had lower rates of psychological distress and higher rates of advance care planning (e.g., completing do-not-resuscitate [DNR] orders, advance care planning discussions with physicians) than those who were not peacefully aware. Additionally, peacefully aware patients had the highest overall quality of death as reported by their caretakers in a postmortem evaluation. Surviving caregivers of peacefully aware patients were more physically and mentally healthy 6 months postloss than caregivers of patients who were "aware" but not peaceful. CONCLUSIONS: Patients with advanced cancer who are peacefully aware have better mental health and quality of death outcomes, and their surviving caregivers have better bereavement outcomes. Peaceful awareness is associated with modifiable aspects of medical care (e.g., discussions about terminal treatment preferences).

Adaptation, Psychological↗
PubMed2006

Religious coping is associated with the quality of life of patients with advanced cancer.

BACKGROUND: For patients confronting a life-threatening illness such as advanced cancer, religious coping can be an important factor influencing their quality of life (QOL). OBJECTIVE: The study's main purpose was to examine the association between religious coping and QOL among 170 patients with advanced cancer. Both positive religious coping (e.g., benevolent religious appraisals) and negative religious coping (e.g., anger at God) and multiple dimensions of QOL (physical, physical symptom, psychological, existential, and support) were studied. DESIGN: Structured interviews were conducted with 170 patients recruited as part of an ongoing multi-institutional longitudinal evaluation of the prevalence of mental illness and patterns of mental health service utilization in advanced cancer patients and their primary informal caregivers. MEASUREMENTS: Patients completed measures of QOL (McGill QOL questionnaire), religious coping (Brief Measure of Religious Coping [RCOPE] and Multidimensional Measure of Religion/ Spirituality), self-efficacy (General Self-Efficacy Scale), and sociodemographic variables. RESULTS: Linear regression analyses revealed that after controlling for sociodemographic variables, lifetime history of depression and self-efficacy, greater use of positive religious coping was associated with better overall QOL as well as higher scores on the existential and support QOL dimensions. Greater use of positive religious coping was also related to more physical symptoms. In contrast, greater use of negative religious coping was related to poorer overall QOL and lower scores on the existential and psychological QOL dimensions. CONCLUSIONS: Findings show that religious coping plays an important role for the QOL of patients and the types of religious coping strategies used are related to better or poorer QOL.

Adaptation, Psychological↗
PubMed2006

An exploration of associations between separation anxiety in childhood and complicated grief in later life.

Recent studies have suggested that the vulnerability to complicated grief (CG) may be rooted in insecure attachment styles developed in childhood. The aim of this study was to examine the etiologic relevance of childhood separation anxiety (CSA) to the onset of CG relative to major depressive disorder, posttraumatic stress disorder, and generalized anxiety disorder in bereaved individuals. The Structured Clinical Interview for the DSM-IV, Inventory of Complicated Grief-Revised, and CSA items from the Panic Agoraphobic Spectrum Questionnaire were administered to 283 recently bereaved community-dwelling residents at an average of 10.6 months postloss. CSA was significantly associated with CG (OR = 3.2; 95% CI, 1.2-8.9), adjusting for sex, level of education, kinship relationship to the deceased, prior history of psychiatric disorder, and history of childhood abuse. CSA was not significantly associated with major depressive disorder, posttraumatic stress disorder, or generalized anxiety disorder.

Age Factors↗
PubMed2006

Religious coping among caregivers of terminally ill cancer patients: main effects and psychosocial mediators.

This study investigated the association between religious coping, mental health and the caring experience, as well as potential explanatory mechanisms, among 162 informal caregivers of terminally ill cancer patients. Regression analyses indicated that, controlling for socio-demographic variables, more use of positive religious coping strategies was associated with more burden, yet, also more satisfaction. In contrast, more use of negative religious coping strategies was related to more burden, poorer quality of life and less satisfaction, and correlated with an increased likelihood of Major Depressive Disorder and anxiety disorders. In a number of models, negative religious coping was related to outcomes through its relationship with social support, optimism and self-efficacy. Implications for research and healthcare are discussed.

Adaptation, Psychological↗
PubMed2005

Psychiatric disorders and mental health service use in patients with advanced cancer: a report from the coping with cancer study.

BACKGROUND: Psychological morbidity has been proposed as a source of distress in cancer patients. This study aimed to: 1) determine the prevalence of diagnosable psychiatric illnesses, and 2) describe the mental health services received and predictors of service utilization in patients with advanced cancer. METHODS: This was a cross-sectional, multi-institutional study of 251 eligible patients with advanced cancer. Eligibility included: distant metastases, primary therapy failure, nonpaid caregiver, age > or =20 years, stamina for the interview, English or Spanish-speaking, and adequate cognitive ability. Trained interviewers administered the Structured Clinical Interview for the Diagnostic Statistical Manual IV (DSM-IV) modules for Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder, and a detailed questionnaire regarding mental health service utilization. RESULTS: Overall, 12% met criteria for a major psychiatric condition and 28% had accessed a mental health intervention for a psychiatric illness since the cancer diagnosis. Seventeen percent had discussions with a mental health professional; 90% were willing to receive treatment for emotional problems. Mental health services were not accessed by 55% of patients with major psychiatric disorders. Cancer patients who had discussed psychological concerns with mental health staff (odds ratio [OR] = 19.2; 95% confidence interval [95% CI], 8.90-41.50) and non-Hispanic white patients (OR = 2.7; 95% CI, 1.01-7.43) were more likely to receive mental health services in adjusted analysis. CONCLUSIONS: Advanced cancer patients experience major psychiatric disorders at a prevalence similar to the general population, but affected individuals have a low rate of utilizing mental health services. Oncology providers can enhance utilization of mental health services, and potentially improve clinical outcomes, by discussing mental health concerns with their patients.

Adaptation, Psychological↗
PubMed2005

Psychiatric disorders and mental health service use among caregivers of advanced cancer patients.

PURPOSE: Despite research demonstrating the psychological burden of caregiving for advanced cancer patients, limited information exists on the prevalence of psychiatric disorders and mental health service use among these informal caregivers. METHODS: Two hundred informal caregivers of advanced cancer patients were interviewed and administered the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition and an assessment of mental health service use. RESULTS: Thirteen percent of caregivers met criteria for a psychiatric disorder; 25% accessed treatment for mental health concerns since the patient's cancer diagnosis. The frequencies of current psychiatric disorders were as follows: panic disorder, 8.0% (95% CI, 4.6% to 12.7%), major depressive disorder, 4.5% (95% CI, 2.1% to 8.4%), post-traumatic stress disorder, 4.0% (95% CI, 1.7% to 7.7%), and generalized anxiety disorder, 3.5% (95% CI, 1.4% to 7.1%). Among caregivers with a current psychiatric disorder, 81% discussed mental health concerns with a health professional before the patient's cancer diagnosis compared with 46% after the diagnosis (McNemar test = 5.40; P = .02). Only 46% of caregivers with a current psychiatric disorder accessed mental health services. Caregivers who discussed mental health concerns with a clinician before the patient's cancer diagnosis (odds ratio [OR] = 3.51; 95% CI, 1.42 to 8.71) and after the diagnosis (OR = 21.23; 95% CI, 9.02 to 49.94) were more likely than caregivers not having these discussions to receive mental health services. CONCLUSION: Many caregivers of advanced cancer patients either meet criteria or are being treated for psychiatric problems. Discussing mental health issues positively influences the receipt of mental health services and should be actively pursued in this vulnerable population.

Adult↗
PubMed2005

Communication between physicians and family caregivers about care at the end of life: when do discussions occur and what is said?

BACKGROUND: Few studies have examined physician-family caregiver communication at the end of life, despite the important role families have in end-of-life care decisions. We examined family caregiver reports of physician communication about incurable illness, life expectancy, and hospice; the timing of these discussions; and subsequent family understanding of these issues. DESIGN: Mixed methods study using a closed-ended survey of 206 family caregivers and open-ended, in-depth interviews with 12 additional family caregivers. SETTING/SUBJECTS: Two hundred eighteen primary family caregivers of patients with cancer enrolled with hospice between October 1999 and June 2002. MEASUREMENTS: Family caregiver reports provided at the time of hospice enrollment of physician discussions of incurable illness, life expectancy, and hospice. RESULTS: Many family caregivers reported that a physician never told them the patient's illness could not be cured (20.8%), never provided life expectancy (40% of those reportedly told illness was incurable), and never discussed using hospice (32.2%). Caregivers reported the first discussion of the illness being incurable and of hospice as a possibility occurred within 1 month of the patient's death in many cases (23.5% and 41.1%, respectively). In open-ended interviews, however, family caregivers expressed ambivalence about what they wanted to know, and their difficulty comprehending and accepting "bad news" was apparent in both qualitative and quantitative data. CONCLUSION: Our findings suggest that ineffective communication about end-of-life issues likely results from both physician's lack of discussion and family caregiver's difficulty hearing the news. Future studies should examine strategies for optimal physician-family caregiver communication about incurable illness, so that families and patients can begin the physical, emotional, and spiritual work that can lead to acceptance of the irreversible condition.

Caregivers↗
PubMed2005

Health behaviors associated with better quality of life for older bereaved persons.

BACKGROUND: Bereavement is a risk factor for declines in health, adverse health behaviors, increased physician visits, and mortality, and occurs with greatest frequency in later life. Little is known about health behaviors that are associated with better quality of life among recently bereaved older persons. OBJECTIVE: The objective of this community-based longitudinal, observational study was to examine the influence of health behaviors on the quality of life of 200 elderly bereaved persons. DESIGN AND MEASUREMENTS: Health behaviors (i.e., exercise, monitoring caloric intake, sleep, daily vitamin intake, annual health check-ups) were examined at approximately 6 months postloss (baseline) and 11 months postloss (Wave 2). Quality of life was assessed at approximately 11 months postloss and 19 months postloss (Wave 3), using the RAND 36-Item Health Survey, which measures 8 domains of health and functioning, plus a single item assessing change in health. RESULTS: Consistently exercising 1 or more days per week at Waves 1 and 2 significantly (p < .05) predicted better self-rated health, physical functioning, fewer physical role limitations, and greater energy at Wave 3 in models that adjusted for age, gender, prior psychiatric disorder, baseline reports of functional disabilities and chronic conditions. Consistently monitoring caloric intake at Waves 1 and 2 predicted better self-rated health (p < .05), greater energy (p < .01), and positive change in health (p < .05) at Wave 3 in models that adjusted for the above set of control variables. Sleeping 6.5-9 hours per night at baseline alone predicted better social functioning (p < .001), fewer emotional role limitations (p < .01), better emotional health (p < .001), and greater energy (p < .01). CONCLUSIONS: Should future research confirm these results, clinicians would be advised to recommend the identified preventive and protective health behaviors to recently bereaved older patients.

Aged↗
PubMed2005

Complicated grief and suicidal ideation in adult survivors of suicide.

While the prevalence of complicated grief has been demonstrated to be elevated in survivors of suicide, the association between complicated grief and suicidal ideation among adult survivors of suicide has not been explored. The purpose of the present study is to examine the association between complicated grief and suicidal ideation in suicide survivors. The Inventory of Complicated Grief and the Beck Depression Inventory were administered to 60 adult survivors within 1 month of a death by suicide of a family member or significant other. Complicated grief was associated with a 9.68 (CI: 1.036, 90.417) times greater likelihood of suicidal ideation after controlling for depression, suggesting that syndromal complicated grief heightens vulnerability to suicidal ideation. Clinicians may provide more comprehensive assessments by recognizing the possibility of suicidal ideation in those with complicated grief.

Adult↗
PubMed2004

A case for establishing complicated grief as a distinct mental disorder in DSM-V.

In this paper, we contend that complicated grief (CG) constitutes a distinct psychopathological diagnostic entity and thus warrants a place in standardized psychiatric diagnostic taxonomies. CG is characterized by a unique pattern of symptoms following bereavement that are typically slow to resolve and can persist for years if left untreated. This paper will demonstrate that existing diagnoses are not sufficient, as the phenomenology, risk factors, clinical correlates, course, and outcomes for CG are distinct from those of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and adjustment disorder (AD). It is argued that the establishment of CG as a diagnostic entity is essential because its symptoms are associated with enduring mental and physical health morbidity and require specifically designed clinical interventions. We conduct a critical review of all published evidence on this topic to date, demonstrating that the advantages of standardizing the diagnostic criteria of CG outweigh the disadvantages. In addition, recommendations for future lines of research are made. This paper concludes that CG must be established in the current nosology to address the needs of individuals who are significantly suffering and impaired by this disorder.

Adjustment Disorders↗
PubMed2004

Complicated grief in survivors of suicide.

Complicated grief is a newly defined and distinctive psychiatric disorder that occurs in response to a significant loss through death. New findings suggest that survivors who were close to the deceased are at heightened risk for complicated grief. Little is known about whether close kinship (spouses, parents, children, siblings, vs. in-laws, aunts/uncles, nieces/nephews, friends, or coworkers) to a suicide victim also represents a heightened risk for complicated grief. Assessing for complicated grief is important, especially with survivors of suicide, because of the potential for associated health risks. This report contains preliminary data from an exploratory, descriptive pilot study examining complicated grief in adult survivors of suicide. Sixty bereaved subjects, within one month after the suicide of a family member or significant other, were assessed for complicated grief symptoms. Statistically significant differences, as measured with the Inventory of Complicated Grief, were noted between closely related and distantly related survivors of the suicide victim. These preliminary results indicate that health care professional's assessments and interventions for complicated grief should take into consideration the bereaved's familial and/or social relationship to the deceased. The closely related survivors of suicide had higher levels of complicated grief and could be at risk of developing physical and/or mental health problems, including suicidal ideation, in the future.

Adolescent↗
PubMed2004

Suicidality and bereavement: complicated grief as psychiatric disorder presenting greatest risk for suicidality.

The influence of complicated grief (CG) on suicidality among bereaved adults was examined. The Yale Evaluation of Suicidality scale and the Inventory of Complicated Grief-Revised were administered to 309 bereaved adults in face-to-face interviews conducted at baseline (6.2 months post-loss) and at follow-up (10.8 months post-loss). Cross-sectionally, CG was associated with a 6.58 (95% CI: 1.74-18.0) times greater likelihood of "high suicidality" at baseline, and an 11.30 (95% CI: 3.33-38.10) times greater risk of high suicidality at follow-up, after controlling for gender, race, major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and social support. Longitudinally, CG at baseline was associated with an 8.21 (95% CI: 2.49-27.0) times greater likelihood of high suicidality at follow-up, controlling for the above confounders. The study results indicate that CG substantially heightened the risk of suicidality after controlling for important confounders such as MDD and PTSD, suggesting that CG poses an independent psychiatric risk for suicidal thoughts and actions.

Bereavement↗