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    Grief, Bereavement, and Coping With Loss (PDQ®): Supportive care - Health Professional Information [NCI] - Risk Factors for Complicated Grief and Other Negative Bereavement Outcomes

    One study [1] of 248 caregivers of terminally ill cancer patients investigated the presence of predeath complicated grief and its correlates. Results revealed the following variables associated with higher levels of predeath complicated grief:

    • Age younger than 60 years.
    • Lack of perceived available social support.
    • History of depression and current depression.
    • Lower income.
    • Pessimistic thinking.
    • Severity of stressful life events.

    Of these correlates, pessimistic thinking and severity of stressful life events were independent predictors of predeath complicated grief.

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    Other research has focused on predictors of outcomes such as symptoms of depression and overall negative health consequences. Three categories of variables have been investigated:

    • Situational (e.g., circumstances of the death).
    • Personal (e.g., personality characteristics, gender).
    • Interpersonal context (e.g., social support, kinship).

    Most research has focused on spousal/partner loss and is not uniquely focused on death via cancer.

    Situational: Expected or Unexpected Death

    Although theory suggests that a sudden, unexpected loss should lead to more difficult grief, empirical findings have been mixed.[2] The impact of an unexpected loss seems to be moderated by self-esteem and perceived control: Bereaved persons with low self-esteem and/or a sense that life is uncontrollable seem to suffer more depression and somatic complaints after an unexpected death than do bereaved persons with higher self-esteem and/or a sense of control.[2]

    Personal: Personality Characteristics

    Attachment theory [3] has suggested that the nature of one's earliest attachments (typically with parents) predicts how one would react to loss. Bereaved persons with secure attachment styles would be least likely to experience complicated grief, while those with either insecure styles or anxious-ambivalent styles would be most likely to experience negative outcomes.[4]

    In a study of 59 caregivers of terminally ill spouses, the nature of their attachment styles and marital quality were evaluated. Results showed that caregivers with insecure attachment styles or in marriages that were "security-increasing" were more likely to experience symptoms of complicated grief.[5] Persons with a tendency toward "ruminative coping," a pattern of excessively focusing on one's symptoms of distress, have also been shown to experience extended depression after a loss.[6]

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