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Forskningsenheden for Almen Praksis
A A R H U S U N I V E R S I T E T www.alm.au.dk
Afdeling for Almen Medicin
How can we organize bereavement care?
An intervention studyMai-Britt Guldin
Cand.Psych.Specialist i psykoterapi,
.
18-04-23 Mai-Britt Guldin
Background
• In Denmark approx. 55.000 deaths leave 200.000 close relatives bereaved annually.
• Grief is considered an existential condition most people will experience several times in their lifetime.
• An estimated 20% will develop complications as a result of suffering a loss.
18-04-23 Mai-Britt Guldin
Co-morbidity
• Bereavement related complications have been shown to be associated with:
- increased medicine consumption, - problems with job retention, - development of psychopathological disorders
(depression, anxiety disorders, suicidal ideation, post traumatic stress etc.)
- mortality
18-04-23 Mai-Britt Guldin
Complicated Grief
• A new clinical diagnosis is proposed for DSM-V
• Core items in the proposed diagnostical criteria are:
- longing, - denial of the loss, - traumatic components in connection with the loss,- lack of reduction in emotional distress over time, - disruption of normal everyday functioning.
18-04-23 Mai-Britt Guldin
Clinical issuesWhat kind of bereavement support is relevant in
primary care?
• How can we identify bereavement conditions in need of treatment?
• Is it possible to assess the risk of developing complicated grief?
• Can we develop a more systematic approach to bereavement reactions with clinical guidelines?
Mai-Britt Guldin
Bereavement managementDescription, assessment and care
A randomized controlled study
Supervisors:Frede Olesen, GP, Professor, Research Director¹Peter Vedsted, MD, Phd, Ass. Research Director¹Anders Bonde Jensen, MD, Oncologist, Senior Researcher²Bobby Zachariae, MSc (Psych.), Professor, Research Director31: Research Unit for General Practice, University of Aarhus2: Department of Oncology, Aarhus University Hospital3: Psykooncological Research Unit. University of Aarhus.
Aimof randomized controlled study
1. Implement a bereavement management programme in primary health care i Denmark and conduct a randomized controlled trial to measure it’s effect.
Mai-Britt GuldinD. 12.5.09
Intervention in the randomized controlled study
• Risk assessment
• Information for patients and GPs on grief reactions and how to identify complicated grief
• Suggestions on when to seek help/how to provide care
Mai-Britt GuldinD. 12.5.09
Project flow chart
Patient inclusion
Intervention group Control group
Information pamphlet to GPs.
Evaluation
6 weeks post loss
6 months post loss
Treatment as usual
Assessment
13 months post loss
Patients are encouraged to contact their GP if they worry about handling their bereavement reaction.
Both groups
Questionnaires
At hospital departments right after loss
Information pamphlet to patients
Randomization
Mai-Britt Guldin12.5.09
18-04-23 Mai-Britt Guldin
How to identify a bereaved person in need of treatment
• Emotional distress must decrease over time• Look for dynamic adaptation (change in the
reaction) • Acceptance of loss should move forward• Extreme social withdrawal is a warning sign• Assess psychopathological reactions: depression,
anxiety, suicidal ideation, post traumatic stress are signs of complicated grief.
18-04-23 Mai-Britt Guldin
How to provide care in general practice
___________________________________________________________________________________________________
• Initiate dialog about the grief reaction• Ask about level of distress (must decrease over
time)• Schedule follow up consultations to structure the
monitoring of the emotional regulation.• Refer the patient to specialized psychotherapy in
case of symptoms of complicated grief.
Forskningsenheden for Almen Praksis
A A R H U S U N I V E R S I T E T www.alm.au.dk
Thank you for your attention!
