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Suggested Citation:"Index." Institute of Medicine. 1984. Bereavement: Reactions, Consequences, and Care. Washington, DC: The National Academies Press. doi: 10.17226/8.
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Subject Index A Abandonment feelings in childhood bereavement, 119 in conjugal bereavement, 72 after suicide of relative, 87, 88, 89 Abdominal pain, in childhood bereavement, 111, 284 Absent grief, 18, 34, 54-56, 65 after death of parents, 84 delayed onset of grief in, 34, 56, 65, 228 Accidental deaths in automobile accidents, 87, 92 family support in, 222, 223 of older child, 79 ACTH activity, in bereavement, 149, 150, 153 Adaptation, in bereavement, 35, 52, 53 Adolescents. See Children Adoption of infant, animal models of, 191 Adrenal gland in bereavement, 149, 151, 152 in p sy choneuro immune endo crine system, 162 in separation experiences, 157-158 Adrenocorticotropic hormone, in bereavement, 149,1 50, 1 53 297 Adults bereavement reactions of, 7, 47-68 compared to childhood reactions, 100,101, 102, 120-121 future areas for research on, 93 inloss of child, 75-83. Seealso Parents, bereavement reac- tions of in loss of parent, 83-85 in loss of sibling, 85-86 in loss of spouse, 71-75, 93. See also Conjugal bereavement psychiatric consequences of child- hood bereavement in, 114-116 Age and adult bereavement reactions, 7, 47-68 and childhood bereavement reac- tions, 99-141 and health consequences of bereavement, 35-36 end separatior~response, 190 Aggression, in childhood bereave- ment, 109,111, 117

298 / Index Alcohol use, associated with bereavement, 16,27, 28-29, 33,39,40,50,84,284 Alcoholism health consequences of, 37 suicide and, 26-27, 37 Ambivalent relationships with deceased, bereavement reac- tions in, 57, 59-60 in childhood, 122 parental, 82 after separation, l 84 Anger, in bereavement reactions, 60,289 in childhood, 100 in grieving process, 54, 62 in stillbirths, 77 aftersuicideofrelative,88,89 Animal models of separation response, 7-8, 19,147, 154, 165-166,179-196. See also Separation response Anniversary reactions in childhood bereavement, 132 in adult bereavement, S3 Anti-anxiety drugs, in bereavement intervention programs, 269, 270 Anticipatory grief, 49 inconjugalbereavement, 75 future areas for research on, 292 in hospice programs, 25 6 psychotherapy related to, 264 instilIbirths, 76 Antidepressant drugs, inbereave- ment intervention programs, 269-270, 271, 272, 288, 295 Anxiety biological studies on, 153- 154, 168-169 in childhood bereavement reac- tions,119 intervention strategies for, 130, 133 drug therapy for, 269, 270 self-reported, 30, 31 after sibling's death, 86 after suicide of relative, 88 Appetite disturbances, 51, 151 in childhood bereavement reac- tions,104,105,111,284 Assist~nceforbereaved, 215-279 continuing responsibilities for, 224-229 in dying period, 217-220 health professionals and institu- tions in, 215-236 hospiceprogramsin,249-257 intervention programs in, 239-279 mutual support approach to, 240-249,252 psychotherapy in, 257-269 around time of death, 220-224 trends in, 239-240 Attachment behavior, 61-63, 186-189 and adult reactions to death of parent, 84-85 animal models of,147,186- 189 anxious, 187 to artificial mother surrogates, 189-190 and childhood bereavement reac- tions,101 environmental influences on, 188 secure, 187,189 tr~nsferof, 191 Automobile accidents, death in, 87, 92 Autonomic nervous system, in grief, 154-156,169 Autopsy requests, 223-224 Avoidance behavior, after separa- tion,184 B Bed-sharing, in childhood bereave- ment reactions, 105, 124 Behavioral response to bereavement. 50, 56, 57, 63-65, 148 animal models of, 165, 181-186

Index / 299 in childhood, 104, 105, 106, 111-112, 113, 117 delayed, 116 in parental suicide, 126 warning signals in, 133 psychotherapy related to, 258, 260, 263 Benzodiazepines, in bereavement intervention programs, 269, 270, 271, 272 Bereavement, definition of, 9 Bereavement process definition of, 10 models of, 56-65 Bereavement reactions, definition of,9-10 Biological rhythms inbereavement,151-152,165-167 endocrine and iTnmune systems, 167-168 socialrelationshipsaffecting, 166, 167 Biological studies, 4, 6, 7, 145- 175 animalmodelsin, 7-8, 19, 147, 154, 165-166, 179-196 of bereaved h''manbeings, 148-150 conceptual frameworks of, 163-169 on depression and anxiety, 153-154, 168-169 compared to bereavement, 168-169 on epidemiology of bereavement, 152-153, 169 future areas for, 150-161, 169-170, 292 on neuroregulatory mechanisms, 154-161 on psychoneuro~mmunoendocnne system, 161- 163 on social relationships as biologi- cal regulators, 165- 168 on stress of bereavement, 163-164 on symptomatology of bereave- ment, 151-152, 169 Bonding parent-child, 186-189 prenatal, 76 and response to separation, 179-196 C Cancer anticipatory grief in. See Anticipa tory grief associated with bereavement, 32, 50,152, 158 death of older child from, 79, 80, 81, 82 hospice services in, 254,255 mutual support groups related to, 241 suicide in, 88-89 Cardiovascular changes in bereave- ment, 20,22,32-33,39,151, 152, 169 autonomic mechanisms in. 155-156 Children bereavement reactions of, 7, 99-141,284-285 age effecting, 121-122,126 anniversary reactions in, 132 behavioralconsequences of, 104 105,106, 111-112,113,116, 117,126,133 circumstances of death affecting, 125-126 common thoughts, concerns, end fantasias, ~n,119 compared to adult models of, 100,101, 102, 120-121 cultural factors affecting, 124-125, 129 in death of pet, 129 in death of sibling, 99, 107,113, 119 defensivestrategiesin, 120 developmental analysis of, 99-103, 116-117,121-122, 285

300 / Index family discussions about. 129-131 and funeral attendance 131-132, 134 future areas for research on 134-135, 291 grieving process in, 112, 1 16-121 idealization of dead parent in, 120 identification with deceased per- sonin, 118-119 immediate, 104-111 intermediate, 104, 111-113 . . . . intervention strategies 1:n, 127-134, 135 Tong-range, 104,113-116,132, 285, 288 major studies on, lOS-110 medicalconsequences of, 111, 114 methodological issues in research on, 103-104 outcomes of, 104-116 parental intervention strategies. An, 128-132 preexisting emotional difficul ties affecting, 121-122, 126 professionaThelpin, 132-133 psychiatric consequences of, 105,108-110,111-113, 114-116,126-127 psychotherapeutic intervention in, 260,263,268-269,274 remarriage of parent affecting, 124,127 serf-concept after, 117-118 sex differences in, 1 13,122,126 and suicidein adult life, 115 in suicide of parent, 125-126 support system affecting, 112, 123-124,126 in te~lllinal illness of parent, 125, 127 variables effecting, 121-127 wamingsignalsin, 133 born after death of sibling, as replacement, 83 death of, 75-83, 220 parental bereavement in. See Parents, bereavement reac- tions of loss of parents during adult life, 26, 83-85 responsibilities for care of, after death of spouse, 72, 73 separation response in, animal models of, 179-196 Chronic illness, anticipatory grief in, 40-41 Cigarette smoking, associated with bereavement, 16, 28-29, 33, 39, 40, 50, 284 Circadian rhythms in bereavement, 151-152, 167 Cirrhosis, associated with bereave- ment, 33, 39, 50, 284 Cognitive theories on bereavement process, 56, 57, 63-65 in childhood, 101, 108,1 16-1 17 in psychotherapuetic interven- tions, 258 Communication between dying patient and family, facilita- tion of, 218-219, 220 Completion of bereavement process, 52, 53 Conjugal bereavement, 4, 9, 71-75, 93 ambivalent relationship with deceased affecting, 60 anticipatory grief affecting, 75 change of address affecting, 24 child care responsibilities in, 72, 73 and childhood bereavement, 123 companionship needs in, 73 dependency affecting, 60-61, 72 depression in, 20,284 depressive symptoms in, 27,40 drug use in, 29 favorable outcomes of, 53

Index / 301 financial concerns in, 72 health consequences of, 20-25, 35, 37,39,74,284 immunologic cllanges in, 159-160 intervention programs in, 241, 242-245,273 efficacy of, 245-249 timing of, 243,245 mortality rates in, 20-25,87 prolonged grief in, 54 psychiatric morbidity in, 27,28, 29 psychotherapeutic interventions in, 259-260,261-266,267 recoil phase in, 243 recovery process in, 75 and remarriage, 18, 24,25 reactions of children to, 124, 127 role changes in, 51,62-63,73-74, 243-244,248 self-reported symptoms in, 30, 31 sex differences in, 74-75,244-245 sexual needs in, 73 social isolation in, 73 social supports in, 74 sociocultural influences on, 208, 209 suicide after, 25-26,39 in suicide of spouse, 24,87,88 Control, sense of, and stress response, 163-164, 170 Coping process, 9 in conjugal bereavement, 244 of health professionals, 232 in separation response, 192-193 environmental influences on, 192 sociocultural influences on, 203, 204-205 support system in, 203 Cortisol levels cyclical patterns of, 167 An grieving, 149 in separation experiences, 157, 158 Counseling by health professionals, 225 in hospice programs, 252 psychotherapeutic, 257-269 Creativity, after bereavement, 53 Cremation, 202 Crisis theory on bereavement process, 56, 63 Crying, 50' 179, 180 Cultural influences, 204-210. See also Sociocultural influences D Death of child, 4, 75-83 parental bereavement reactions in. See Parents, bereavement reactions of child's concept of development of, 101-102, 117 family discussions about, 128-131 circumstances of, and childhood bereavement reactions, 125-126 of parents,4,16 bereavement reactions of chil- dren in, 99-141. See also Chil- dren, bereavement reactions of practices around time of, 220-224 rates of. See Mortality rates of sibling, 85-86, 99, 107, 113, 119 of spouse, 4, 9, 71-75. See also Conjugal bereavement sudden, 38, 221-223. See also Sudden death in suicide, 4, 7, 9, 25-27. See also Suicide Defensive strategies, in childhood bereavement, 120 Delayed gnef, 34, 56, 65, 228 Delinquency, after childhood bereavement, 108,1 13, 1 16 Denial end absent grief, 55 in childhood bereavement, 109, 120, 121, 133 in suicide of relative, 89, 91

302 / Index Dependent relationships, bereave- mentreactions in, 60-61 during childhood, 122 Depression, 28, 54, 284, 285 in adults, afterdeathofparents,84 and ambivalent relationship with deceased, 57, 59-60 biological studies on, l 53- 154, 168-169 in childhood bereavement, 109, 110, 111,113,116 delayed, 115 cognitive model of, 63 compared to distress of grieving individuals, 19 in conjugal bereavement, 20, 284 drugtherapyfor, 269-270, 271 endocrine system in, l 68- 169 parental, in death of child, 28, 80 psychotherapeutic intervention in, 258, 261 in separationresponse, 182-184, 185,186 Depressive symptoms in bereave- ment,17-20,40 compared to clinicaidepression,19 in death of spouse, 27, 40 Despairphase of separation response, 165,182-184,186,191,192 Detachment phase of separation response, 184-186, 192 Developmental analysis of childhood bereavement, 99-103, 116-117,121-122,285 Diabetes mellitus, afterbereave- ment,32 Disbelief, in bereavement, 49, 62 Distress following bereavement, 18-20 Dreams about deceased, 49 Drugs therapy with, in bereavement intervention programs, 8, 269-272, 288 future areas of research on, 294, 295 recommendations for, 270-271 theoretical issues in, 270 use of, associated with bereave- ment, 16, 19, 27, 28-29, 35, 39, 40 biologic studies on, 153 after death of parent, 84 Duration of bereavement process, 52, 239, 243. See also Grief, duration of Dying period, 2i7-220 education of family in, 217-218, 219-220 , .. . . . tamlly VlSltS in day off from, 220 hours for, 219, 234 hospice services in, 249-260 and practices around time of death, 220-224 psychotherapeutic interventions in, 264, 268 resolution of family relationships in, 218-219, 220 roles of health care professionals during, 217-220 stress of, 229-231, 289 transfer to regional facilities in, 227 E Economic aspects. See Financial aspects Education of family, 233 after autopsy, 224 continuing after death, 226 in hospice programs, 251 in mutual support groups, 241 242 role of health professionals in, 217-218, 219-220, 226, 233 of health professionals, 225, 231-232, 286, 287 of hospice personnel, 250 of public on bereavement process, need for, 289-290

Index / 303 Ego development, childhood bereavement affecting, 116 Emotional responses in bereavement reactions, 49-50 dunug childhood, 105, 106, 107, 108 to impending death, 48-49 Employment. See Work Endocrine system, 156-158, 164, 169 in depression, 168-169 ingneving, 149-150, 151, 152, 153, 161-163, 292 in psychoneuroimmunoendocrine system, 161-163 rhythms in, 167-168 in separation experiences, 157- ~ 58 in stress response, 156-157, 158 Environmental influences on family visits to dying patient, 219 on separation response, 188, 190-192, 193 Epidemiologic studies, on health consequences of bereavement, 6, 15-44, 152-153, 169 case control design of, 17 conflicting results of, 17 of general population, 16 outcome questions in, 17-18 prospective design of, 16-17 retrospective design of, 16 Ethnic influences, 205-206, 207. See also Sociocultural influences F Family care in bereavement, 215-216 in accidental deaths, 223 and in autopsy requests, 223-224 conflicting with patient care, 219 continuing responsibilities for, 224-229,232 and in dying period, 217-220 in hospice programs, 249-257 psychotherapeutic interventions in, 257-269 in sudden death, 221-223 around time of death, 220-224 Fantasies, in childhood bereavement, 119, 120 intervention strategies for, 130 Favorable outcomes of bereavement 53 Fears, in childhood bereavement, 119 intervention strategies for, 130, 133 Financial aspects in childhood bereavement, 124 in conjugal bereavement, 72 in follow-up care of family, 228-229, 287 in health consequences of bereave- ment, 37 in hospice programs, 252, 253, 294 in sociocultural variations in bereavement, 204, 205, 206, 207 Foster care of infant, animal models of, 191 Freudian theory on bereavement, 57 Funeral ceremonies burial in, 202 children attending, 131-132, 134 cremation in, 202 laws governing, 201 open caskets in, 132 sociocultural influences on, 200, 201, 206, 209 Funeral directors, roles of, 201, 207 G Genetic influences on separation response, 181 Grief, 18-20 absent, 18, 34, 54-56, 65 after death of parent, 84 adaptive function of, 35 in adults, 48-52 after death of parents, 84-85

304 / Index anticipatory, 49. See also Anticipa- tory grief behavioral changes in, 50 biological studies on, 145-175 in childhood bereavement, 100-101, 116-121 research on, 107 compared to clinical depression, 19 definitionof,10 delayed, 34, 56, 65,228 duration of, 65,80, 283. See also Duration of bereavement process emotions andthoughtprocesses in, 48-50 interpersonal and social changes in,50-S1 normal signs and symptoms of, 65 pathological, 54-56 inbehavioralmodel, 64-65 inchildhoodbereavement,106, 112,132-133 psychotherapeutic interven- tions in, 257-269 socialreinforcementof, 64-65 phases of, 48-50, 65 physical complaints in,51-52 prolonged, 18, 54, 65 psychoneuroimm, in oendocrine systemin,161-163 resolution of, 50, 52 ,~ncomplicated,48 Growth ho~ll~onelevels, in grieving, 149,150 Guilt feelings in childhood bereavement, 118, 126 intervention strategies for, 130, 133 of doctors after death of patient, 226 in perinatal death of child, 78 prolonged or chronic grief in, 54 role of health professionals in relief of, 219-220 in sudden infant death syndrome, 79 in suicide of relative, 88, 89, 90, 126 H Hallucinations about deceased, 49 Handicapped child, death of, 78 Health care institutions, 215-236 hospice programs based in, 254 memorial services in, 221 parental bereavement reactions to death of child in, 80-81 practices of in autopsy requests, 223-224 in dying period, 217-220 in sudden death, 221-223 around time of death, 220-224 supportive atmosphere of, 288-289 forbereavedf~mily, 234 for staff members, 229-231, 234, 289 risitingpoliciesof,219, 220, 234, 289 Health care professionals, roles of, 4, 8,215-236,286-287 in autopsy requests, 223-224 conflicting responsibilities in,219 continuing responsibilities in, 224-229,232 payment for, 228-229, 287 during dying period, 217-220 education and training for, 225, 231-232,233,286,287 education of bereaved family, 217-218,219-220,226,233 in hospice programs, 250, 251 institutional support of, 229-231, 234,289 in recognition of abnormal bereavement, 217, 225,228, 233,287-288 stressrelatedto, 229-231,234, 289 in sudden death, 221-223 around time of death, 220-224

Index / 305 Health consequences of bereave- ment,3-4,5, 6-7,27-34,39, 40,50,51-52, 152,170, 283-285 abnormal, recognitionof, 228, 288 inabsentgrief,55 biologicalstudieson,145-146 cancerin,32,50,152, 158 cardiovascular, 20, 22, 32-33, 39, 151,152,155-156,169 in childhood, l 11, 114 after chronic illness, 40-41 cirrhosis in, 33, 39, 50, 284 compared to depression, l 68 compared to illness of deceased, 51 diabetes in, 32 epidemiologic studies of,6, 15-44, 152-153,169 afterfirstyear, 34-35, 40 futureareasforresearchon,40-41, 290-291,292 in hospice programs, 256 and mortality rates, 20-27 physical illness in, 27-34,35,39, 40,51-52 preexisting illness affecting, 36, 40 psychiatric illness in, 27-29 psychotherapeutic interventions affecting, 267 risk factors affecting, 35-39, 40 self-reported symptoms in, 29-31, 40 sociocultural influences on, 37, 205-206,207,210,228,287 after sudden death, 38 in widows and widowers, 20-25, 35,37,39,74, 284 Helplessness, learned animalmodels of, 147 in childhood bereavement, l l 8 Home care of dying, 215 hospice services in, 251,254 parental bereavement reactions in, 80-81 Hormones. See Endocrine system Hospice programs,8, 249-257, 273 continuing after death, 251-252 future areas for research on, 294 impactof, 253-260 multidisciplinary team in, 250 payment for, 252, 253, 294 psychotherapeutic counseling in, 252 training for, 250 Hospital care. See Health care institutions Hospitalization, psychiatric, after bereavement, 27-28, 37 Hostility inbereavementreactions, 60 in childhood, 1 18, 120 17-Hydroxycorticosteroid levels, in stress, 156, 157 H y p e r t h y r 0 i d i s m , a f t e r b e r e a v e - ment,31 Hypnotic drug use after bereavement, 39, 40 inintervention programs, 269 Hypothalamus in psychoneuroimmunoendocrine system, 161 in stress response, 156, 157 Idealization of deceased, in childhood bereavement, 120, 122 Identification with deceased parent, in childhood bereavement, 118-119, 126,130 Illness, as consequence of bereave- ment. See Health conse- quences of bereavement Immune system,158- 161 behavioral conditioning studies on, 160 in bereavement, 32, 150, 152, 159-161,164,169, 170 endocrine changes affecting, 158 ingrief, 169

306 / Index psychological events affecting, 158-161 in psychoneuroimmunoendocrine interactions, 161-163 rhythms in, 167-168 instress, 158-159 Infants. See also Children sudden death of, 78-79, 82, 83, 149, 222 Infectious diseases associated with bereavement, 39, 40, 152. See also Health consequences of bereavement; Morbidity Institutional health care, 215-236. See also Health care institutions Interpersonal changes associated with bereavement, 50-51, 56, 61-63 psychotherapy related to, 258 Intervention programs, 4, 6, 7, 8, 239-279 in childhood bereavement. 127-134,135 , parent's role in, 128-132 profes s tonal help in, 132-133 consciousness ralsmggroups In, 248 cultural variations in attitudes towards, 206,207 effectiveness of, 274-275 inhospice cervices, 253-260 in mutual support groups, 245-249 in psychotherapy, 260-269 future areas for research on, 272. 275-276,293-295 for guided mouming, 268 high-risk individuals in, 243,255, 267 hospice services in, 249-257,273 medications in, 269-272,288 mutual support groups in, 240-249,252,273 preventive, 286-209 psychotherapeutic, 257-269,274 selection of bereaved people for, 272-274 self-refenals to, 243, 266 after suicide of relative, 91 timing of, 273-274 Isolation, social, 51 and health professions, 225,230, 289 outcome of bereavement in, 204 in parental bereavement, after stillbirth, 77 after suicide of relative, 90, 91 of widows end widowers, 73 J Jet lag, symptoms of, compared with bereavement reactions, 166, 167 K Kibbutz children, bereavement reac- tionsof, 107,112,117 Kinship, and bereavement reactions, 37 in death of child, 75-83 in death of parent, 99-141 in death of sibling, 85-86,99,107, 113, 119 in death of spouse, 71-75 Leamed helplessness animal models of, 147 in childhood bereavement, 118 Leave of absence from work, after bereavement, 202 Legislation influencing bereavement practices, 201 Leisure activities, afterbereavement, 50 Life cycle transitions, 9 social support in, 203 Listening skills, of health profes- sionals, 226, 232

Index / 307 M Manic-depressive disorders, and childhood bereavement, 109, 115 Marital parmer, death of, 71-75. See also Conjugal bereavement Marriage, discord and divorce in, after death of child, 81-82 Medical consequences of bereave- ment. See Health conse- quences of bereavement Medications. See Drugs Military personnel, death of, 202, 222-223 Models of bereavement process, 56-65 Monkeys, separation response of, 179-196. See also Separation response Moods, in bereavement, 49-50, 289 Morbidity associated with bereave- ment, 27-34. See also Health c o n s e q u e n c e s o f b e r e a v e m e n t ; Infectious diseases associated with bereavement Mortality rates, 3-4, 6, 20-27, 39, 80, 284 biologicalstudies on, 155-156 after death of child, 25,80 after death of parent, 25, 26 after death of spouse, 20-25, 87 afterfirstyearofbereavement, 35, 39 historical/rends in, 199-200 Mother-infant separation, responses in,179-196.SeeaZsoSepara- tionresponse Mouming in childhood bereavement, 101, 102 definition of, lo in psychotherapy, 268 sociocultural influences on, 200-201,202,208-210 Multidisciplinary approach in bereavement research, need for, 293, 295 inhospiceprograms, 250 Mutualsupportgroups, 240-249, 252,273,294 compared to psychotherapeutic interventions, 259 N Neurological changes in bereave- ment, 151, 152,154-161,169 animal models of, 154 in autonomic system, 154-156 cardiovascular disorders related to 155-156 endocrine system in, 156-158 i, immune system in, 158-161 psychoneuroimmunoendocrine in- teractions in, 161-163 Neurosis, after childhood bereave- ment, 105, 108, 111 delayed, 114, 115 Neuronansmitter system, in depres- sion, 153, 154 Numbness, in bereavement, 49 Nurses, roles of. See also Health care professionals, roles of continuing after death of patient, 225, 227 during dying period, 218 in hospice programs, 250, 251 training and education for, 225, 232 o Observational skills, of health pro- fessionals, 232 Organ donations, requests for, 224 Outcomes of bereavement, 17, 18 in childhood, 104- 116 favorable, 53 measurement of, 41, 292-293 pathological, 54-56, 64-65

308 / Index p Panic disorders, biological studies on, 153,168, 169 Parents bereavement reactions of, 4, 75-83 mbiv~ent relationship with deceased child affecting, 82 in death of handicapped child, 78 in death of marital partner, 71-75 in death of older child, 79-81 in death of one twin, 78 depression in, 28, 80 after home care of dying child, 80-81 intervention programs in, 247, 248,273-274 marital discord and divorce in, 81-82 medical intervention decisions affecting, 78 mortality rate in, 25,80 in perinatal death of child, 77-78 physical contact with dead infant affecting, 77,222 psychotherapy in, 258,265,268 replacement pregnancy in, 83 sex differences in, 82,84 in stillbirths, 76-77 in sudden infant death syn drome, 78-79,82,83,149,222 support groups for, 289 death of, 4,16,25,99 during adult life of children, 83-85,266 during childhood. See Children, bereavement reactions of suicidal, 90, 125-126 infant response to separation from. See Separation response role in childhood bereavement intervention, 128-132 Pathological bereavement, 54-56, 64-65 in children, 106, 112, 132-133 psychotherapeutic interventions in, 257-269 Perinatal death of child, 77-78 Personality, and bereavement reac- tions, 37, 58-59, 63, 65 Pets, death of, 129 Physical illness associated with bereavement, 51-52. See also Health consequences of bereavement; Infectious diseases associated with bereavement; Morbidity Physicians. See also Health care professionals, roles of guilt feelings of, after death of patient, 226 training and education of, 231 Physiologic changes in bereavement, 148-150, 165, 183, 292 Pituitary gland in bereavement, 149,151, 153 in stress response, 156, 157 Play activities of monkeys, in sepa- rationresponses, 182, 183, 191 Postural changes of monkeys, in separation responses, 182, 183, 185 Pregnancy, after death of child, 83 Preventive intervention programs, 286-290 Problem-solving, social support in, 203 Prolactin secretion in grieving, 149, 150, 153 in stress, 156 Prolonged grief, 18, 54, 65 Protest phase of separation response, 157, 158, 165, 181-182, 191, 192 Psychoanalytic approach to bereave- ment, 56, 57, 257 Psychodynamic approach to bereave- ment, 56-57, 58-61, 257, 259, 260, 261, 266

Index / 309 Psychological consequences of bereavement, 6, 27-29, 49-50 in absent grief, 55 in adults, 47-69 in childhood, 105, 106, 107, 108-110, 111-113, 126 delayed,ll4-116 risk factors for, 126-127 after first year, 34-35 preexisting illness affecting, 36, 40 in psychoneuroimmunoendocrine system, 161-163 after suicide, 38, 126 Psychoneuroimmune reactions, 158-161 Psychoneuroimmunoendocrine sys tem,l46,161-163 Psychosis, after childhood bereave ment, 114, 115-116 Psychotherapeutic interventions, 8, 257-269, 274, 294 behavioral approach to, 258, 260, 263 cognitive approach to, 258 compared to mutual support groups, 259 guided mourning in, 268 in hospice programs, 252 impact of, 260-269 individual and group counseling Research in, 259 interpersonal approach to, 258 psychodynamic or psychoanalytic approach to, 257-258, 259, 260, 261, 266 short-term, 267 after suicide of relative, 91 R Reconciliation of family relation ships, in dying period, 218-219, 220 Recovery process in bereavement, 52 favorable outcome of, 53 and return to work, 18, 202 of widows and widowers, 75 Regressive behavior, in childhood bereavement, 133 Reinforcement of grieving behavior, in behavioral theory, 64-65 Rejection, feelings of, after suicide of relative, 87, 90 Relationship with deceased, and bereavement reactions, 37, 65 in ambivalent relationship, 57, 59-60 in dependent relationship, 60-61 in loss of child, 75-83 in loss of parent, 83-85 in loss of sibling, 85-86 in Toss of spouse, 71-75 Relief, feelings of, after suicide of relative, 88, 89 Religious beliefs, 81, 201, 206, 207, 209-210 and childhood bereavement reac- tions, 129 and stigma of suicide, 90 Remarriage, after death of spouse, 18, 24, 25 reactions of children to, 124,127 Reorganization, in bereavement reactions, 50 on adult bereavement reactions. 93 biological studies in, 145-175. See also Biological studies on childhood bereavement. 105-1 10 future areas for, 134-135,291 methodological issues in, 103-104 on drugs in bereavement intervention, 272 epidemiologic studies in, 6, 152-153,169 future areas for, 290-295 on health consequences of 15-45

310 / Index bereavement, 6, 15-44, 152-153, 290-291, 292 on intervention strategies, 272, 275-276, 293-295 methodological issues ill, 103-104,292-293 multidisciplinary approach in, 293,295 on separationresponse animal models in, l 79- 196 futureareasfor, 192-194 onsuicidebereavement,92 Resolution of grief, 50 Respiratory changes inbereavement, 148-149,151,152,169,292 Risk factors forpoorbereavement outcomes, 35-39,40,285, 290-291 Risk-takingbehavior, associated withbereavement,50 Role changes in bereavement process, 50-51, 62-63,73-74 after death of parent, 85, 118-119 after death of sibling, 86 after death of spouse, 51, 62-63, 73-74,243-244,248 psychotherapeutic interventions in, 258 sociocultural influences on, 208, 210 S Schizophrenia, and childhood bereavement, 115- 116 School functioning, childhood bereavement affecting, 106, 113, 116 Searching behaviors, in bereave- ment, 49, 62 Sedative drug use associated with bereavement, 29 precautions about, 269 Self-blame. See Guilt feelings Self-concept, 57, 59 childhood bereavement affecting, 117-118 in parental suicide, 126 in cognitive model, 63-64 of health professionals, work- related stress affecting, 230 in interpersonal model, 62-63 in psychodynamic theory, 59 social support enhancing, 203 stillbirths affecting, 77 Self-help groups, for mutual support, 240-249 Self-reported symptoms, after bereavement, 29-31, 40 Sensory deprivation, compared with bereavement reactions, 166, 167 Separation response, 117 acute phase of, 165 age affecting, 190 animal models of, 7-8, 147, 154, 157-158, 159, 165-166, 179-196 attachment bond affecting, 186-189 behavioral components of, 165, 181-186 chronic, slow phase of, 165- 166 despair phase of, 165, 182-184, 186, 191, 192 detachment phase of, 184-186, 192 development of, 102, 117 endocrine system in, 157-158 environmental influences on, 188, 190-192, 193 in excessive dependency, 62 immune system in, 159 in loss of artificial mother surro gates, 189-190 neurologic changes in, 154, 155 phases of, 181-186 physiologic components of, 165, 183 preseparation influences on, 186-190, 193 protest phase of, 157, 158, 165, 181-182, 191, 192

Index / 311 research recommendations on, 192-194 variations in, 180-181 Sex differences i in childhood bereavement, 113, 122, 126 n conjugal bereavement, 74-75, 244-245 in health consequences of bereave- ment, 35, 39 In parental bereavement, 82, 84 Sexual behavior, in conjugal bereavement, 73 Shame, in suicide of relative, 89, 90-91 Siblings of adult, death of, 85-86 of child, death of, 99, 107, 113, 119 Sleep disturbances ~ bereavement, 29, 51, 151, 153, 183, 269, 270, 288 in childhood, 104, 111, 284 Sleeping pill use, associated with bereavement, 29, 269, 270 Smoking, associated with bereave- ment, 16, 28-29, 33, 39, 40, 50, 284 Social influences. See also Sociocul- tural influences on bereavement reactions. 199-204 on biologic rhythms, 1 65-168 on role changes, 50-51. See also Role changes in bereavement on separation response, 190-191, 193 on stigma of suicide, 90-91 Social workers, in health care insti- tutions, 221,225,227,289 training and education of, 231-232 Sociocultural influences, 4, 5, 8,34, 65,199-212,227-228,233, 287 on childhood bereavement, 124-125, 129 future areas for research on, 291 on health consequences of bereave- ment, 37, 205-206, 207,210 228,287 on help-seeking behavior, 206, 207 on leave of absence from work, 202 legal aspects of, 201 on mortality rates in bereavement, 199-200 on mourning ntuals, 200-201, 202, 208-210 on parental bereavement, in sudden death of infant, 222 religious ntuals in, 209-210 support system in, 202-204 Somatization of distress, cultural variations in, 205-206 Spouse, death of, 71-75. See also Conjugal bereavement Stillbirths, parental bereavement reactions in, 76-77 conspiracy of silence affecting, 77 physical contact with dead infant affecting, 77 prenatal bonding affecting, 76 psychotherapeutic interventions in, 264,268 Stress of bereavement, 8-9 antianxiety drugs for, 269, 270 biological studies on, 163-164 of health care professionals, 229-231,234,289 unavoidable, response to, 164 Sudden death, 38, 221,223 accidental, 222,223 in combat, 222-223 health consequences of bereave- ment in, 38 of infants, 78-79,82,83,149,222 psychotherapeutic interventions after, 262,267 Suicide, 4, 7, 9, 25-27 associated with bereavement, 25-27,38-39,168,284,285 in alcoholism, 26-27,37 in childhood, 115

312 / Index in death of parent, 26, 84 in death of spouse, 25-26, 39 sociocultural influences on, 209 bereavement reactions after, 24, 87-92, 125-126 guilt in, 88 psychotherapeutic interven- tions in, 274 in spouse, 24, 87, 88 in depression, 168 family patterns of, 89-90, 126 notes left in, blaming survivors, 89 of parent, 90 childhood bereavement reac- tions in, 125-126 repeated threats of, 88 research issues on, 92 social stigma of, 90-91 Support system, 5, 8, 202-204, 285 in childhood bereavement, 112, 123-124, 126 parental role in, 128-132 continuing after death of patient, 224-229 during dying period, 217-220 elements of, 203 enhancing self-esteem, 203 health professionals and institu- tions in, 215-236 for health professionals working with dying patients, 229-231, 234, 289 in hospice programs, 251, 252 perceived lack of, 39, 40 personality affecting, 58-59 self-help groups in, 240-249 sociocultural variations in, 204 after suicide of relative, 90, 91 around time of death, 220-224 of widows and widowers, 74 Surrogate mothers, artificial, emotional attachment to, in monkeys, 189- 190 Symptomatology of bereavement 151-152, 169 T J Terminal illness. See also Cancer anticipatory grief in. See Anticipa- tory grief hospice services in, 249-257 mutual support groups related to, 241 of parent, childhood bereavement in, 125, 127 roles of health professionals during dying period in, 217-220 suicide in, 88-89, 92 transfer to regional facility in, 227 Thyroid grand, in bereavement, 31, 151 Tranquilizer use, associated with bereavement, 29, 35, 40, 269, 270, 288 Twins, death of one of, 78 V Visiting policies in health institu- tions, 219,220,234,289 W War casualities, 222-223 Widow-to-Widow Program, 242-245 Widows and widowers, bereavement reactions of, 71-75. See also Conjugal bereavement Work maternal, animal models of in- fant response to, 188 return to, after bereavement, 18, 202 shift change in, 166, 167

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"The book is well organized, well detailed, and well referenced; it is an invaluable sourcebook for researchers and clinicians working in the area of bereavement. For those with limited knowledge about bereavement, this volume provides an excellent introduction to the field and should be of use to students as well as to professionals," states Contemporary Psychology. The Lancet comments that this book "makes good and compelling reading....It was mandated to address three questions: what is known about the health consequences of bereavement; what further research would be important and promising; and whether there are preventive interventions that should either be widely adopted or further tested to evaluate their efficacy. The writers have fulfilled this mandate well."

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