Rate of Psychopathology in the First Degree Relatives of the Deceased during Bereavement Period

Journal:
Jan-March 2015 Volume 12(1)

Original Article

Author(s):
Nighat Haider, Iffat Batool
Page No:
18

Rate of Psychopathology in the First Degree Relatives of the Deceased during Bereavement Period

 

Nighat Haider1  , Iffat Batool2

1 Ph. D. Scholar, Department of Psychology, G. C. University, Lahore,     2  Assistant Professor, Department of Psychology, G. C. University, Lahore

 

Corresponding Author;

Nighat Haider  Phone- 03087778123             E-mail nighathaider@gmail.com


 

Abstract

Objective: To measure the rate of psychopathology in the first degree relatives of the deceased within the period of bereavement.

Design: Cross sectional exploratory study

Place and duration of the study: The study was carried out in five cities of Pakistan from June 2011 to May 2013

Subjects and Methods: A purposive convenient sample of 290 participant was drawn from different government colleges, public and private sector universities, public hospitals, and members of general society. Inclusion criterion restricts the participants to be selected irrespective of gender, aged at least 16 and having experienced the death of a first-degree relative in the past one year. Exclusion criterion is defined as the presence of any already existing psychiatric disorder before the death of the deceased relative.  

Results: Majority of the participants were female, married, and were living in rural residences. Split up of participants as per categories of age range and education level were almost equal. 74.8 percent of the participants reported considerable levels of psychopathology in the bereavement period.

Conclusion: The instance of psychopathology is quite high among the first degree relatives during the period of bereavement so the general public, health care providers and mental health professionals should be sensitized to pick up the early signs of psychiatric disorders in the bereaved population to avoid the complications and burden of full blown disorder so that it may save the bereaved families from the disadvantages additional to the bereavement and its loss.   

Key words: Psychopathology, First degree relatives, Bereavement.

 

 

 

Introduction

 

Death of a loved and significant individual starts the process of grief.1 Death of a first degree relative and bereavement is found to accompany psychiatric morbidity. Studies hint that grief may harbor other psychological problems and risks. 2,3,4,5,6,7,8,9 

Distress related to death of self or significant others was found most salient common factor in a number of samples compared together; on the other hand death distress also incorporates anxiety, depression, and obsession.10 Researchers have long been agreed that a unified element of emotional distress comprising mal adaptive symptoms of grief is found in bereaved individuals other that pure anxiety and depression.11,12  Quality of life and sense of well being of the bereaving individual gets affected also due to the bereavement process.13

Dietrich found out that in 50% of the bereaved individuals, two or more MMPI-168 clinical scales were pathologically abnormal while that rate was 28% in controls. The interaction between parent loss and child's sex was found significant as affecting the scores on Psychopathic Deviate, Masculinity-Femininity, Psychasthenia, and Schizophrenia scales.14

A study demonstrated that prolonged grief disorder represents the symptoms of depression along with the cognitive, emotional, and behavioral symptoms of prolonged grief disorder. However, the symptom cluster of separation distress presents a grief specific dimension that may surface unrelated to depressive symptoms.15

Although extensive research has been conducted in developed countries regarding this phenomenon so far, but its evidence in developing countries is not well documented and studies from Pakistan are not found easily. Current study was conceived to assess the rate of psychopathology during the period of bereavement in our local settings.

 

 

 

 

Method

Participants

A purposive sample of 290 participants from the general strata of the society was included. Inclusion criterion was defined as participants to be selected irrespective of gender, aged at least 16 and having experienced the death of a first-degree relative in the past one year. Exclusion criterion is defined as the presence of any already existing psychiatric disorder before the death of the deceased.

 

Instruments   

Demographic Variable Performa

A demographic variable Performa constructed by the researcher would be used. This Performa would include questions about bio data, relation of the bereaved to the deceased, time passed since death of the relation, how and when they got the news.

 

Self Reporting Questionnaire 24(SRQ-24)

            Self Reporting Questionnaire is a 24-item screening questionnaire developed by World health Organization to use in developing countries in general medical settings. It is a self-administered questionnaire that gives a single score indicating the degree of psychiatric disturbances characterizing different psychiatric disorders. First 20 items deal with the neurotic disorders and general health while last 4 items cover psychotic disorders. It has been translated into several languages. The SRQ -24 responses are given in ‘yes’ or ‘no’ format. It can also be used as a 20-item instrument instead of 24 items. It has been validated in 1980.16 Validation of SRQ-24 urdu version in primary care settings of Pakistan was carried out by Minhas et al. 17At the cut of score of 4/5 sensitivity was calculated to be 63% and specificity was calculated to be 77%. Positive predictive value was 47% while negative predictive value was 0.85%.

 

Procedure 

            Participants were approached. Written informed consent was obtained from all the participants before data collection. The instruments were applied onto the literate participants as self administered scales while onto the illiterate participants instruments were applied in an interview format. All the ethical standards were strictly observed during the course of research.  The data were analyzed on SPSS version 14.

 

Results

The descriptive statistics have shown that out of 290 bereaved individuals included in the study, 121 (41.7 %) were male and 169 (58.3 %) were females. The age range of the sample was between 16 to 92 years. The sample is almost distributed equally to all age groups. 45 (15.5 %) of the participants were between the ages of 21 to 15 years, 39 (13.4 %) participants were between the age of 51 to 60 years, 37 (12.8 %) were between the age of 26 to 30 years (see table 1). 22 (7.6 %) participants were illiterate, 53 (18.3 %) of the participants were educated up to the matriculation, 47 (16.2 %) up to intermediate level, 67 (23.1 %) up to graduation, and 54 (18.6 %) participants were educated up to masters level (see table 2). 97 (33.4 %) were single, while 165 (56.9 %) were married. Majority of the participants were living in rural residences i-e- 256 (88.3 %).

The SRQ-24 scores of the first degree relatives of the deceased in the period of bereavement showed that most of the participants were experiencing psychopathology. Keeping the score of 5 and above as cut off point, about three forth of the participants obtained a score above the cut off (see table 3).

Discussion

Majority of the participants were female, married, and were living in rural residences. Split up of participants as per categories of age range and education level were almost equal. Three forth percentage of the participants reported considerable levels of psychopathology in the bereavement period. They were experiencing five or more psychiatric symptoms at the time of interview. The participants consisted of the first degree relatives of the deceased who were in the period of bereavement i-e- one year after the death. This period is said to be the bereavement period in which the grief usually settles down by itself.  Previous research reported that first year after the death of a family member or relative is important for the instance of psychopathology. 18

This evidence also established that death of a first degree relative accompanied psychiatric disturbances in most of the people. A recent research found that significant psychopathology was seen in 50% of the bereaved individuals, whereas rate was 28 % in control population.14 Previous research agrees that psychiatric disturbances accompany the period of bereavement.2,3,4,5,7,8,9,10,11,12,15

Why psychopathology is seen increased in the first degree relatives of the deceased in the period of bereavement (after the death of a relative)? At one hand it may be because of the perception of loss but on the other hand, some previous researches report that experiencing the death of a friend or relation increases the likelihood of fear and awareness of death in terms of personal life and ideal self. The awareness magnifies the perception of threat.19 Other studies also concluded after meta analysis that awareness of death increased the fear of death.20,21 These researches talked about the awareness of death in general; not the awareness of death of a first degree relative which is more impact creating. This increased fear of death after the experience of the death of a first degree relative may contribute the symptoms that may be translated as psychopathology.

Conclusion

The instance of psychopathology is quite high among the first degree relatives during the period of bereavement so the general public, health care providers and mental health professionals should be sensitized to pick up the early signs of psychiatric disorders in the bereaved population to avoid the complications and burden of full blown disorder so that it may save the bereaved families from the disadvantages additional to the bereavement and its loss.    


References

 

1     Bailley  SE, Dunham K,  Kral MJ. Factor structure of the grief experience  questionnaire (GEQ). Death Studies 2000; 24: 721-738.

2    Lund D, Caserta M, Dimond M F. The course of spousal bereavement in later life. In M. S. Stroebe, W. Stroebe, & R. O. Hansson (Eds.), Hand book of bereavement: Theory, research, and intervention (pp. 240-254). New York: Cambridge University. 1993.

3    Sanders C. Risk factors in bereavement out come. In M. S. Stroebe, W. Stroebe, & R. O. Hansson (Eds.), Hand book of bereavement: Theory, research, and intervention (pp. 255-267). New York: Cambridge University. 1993.

4    Stroebe MS, Stroebe W. Determinats of adjustments to bereavements in younger widows and widowers. In M. S. Stroebe, W. Stroebe, & R. O. Hansson (Eds.), Hand book of bereavement: Theory, research, and intervention (pp. 208-226). New York: Cambridge University. 1993.

5    Brown GW. Loss and depressive disorders. In B. P. Dohrenwend (Ed.), Adversity, stress, and psychopathology (pp. 358-375). New York: Oxford University. 1998.

6    Clayton PJ. The model of stress: The bereavement reaction. In B. P. Dohrenwend (Ed.), Adversity, stress, and psychopathology (pp. 96-110). New York: Oxford University. 1998.

7    Stroebe W,  Schut H. Risk factors in bereavement out come: A methodological and empirical review. In M. Stroebe, R. O. Hansson, W. Stroebe, & H. Schut (Eds.), Hand book of bereavement research: Consequences, coping and care (pp. 349-372). Washington DC: American Psychological Association. 2001.

8    Parkes CM. Grief: Lesson from the past, visions for the future. Death Studies 2002; 26: 367-385.

9    Jordan JR, Baker J, Matteis M, Rosenthal S, Ware ES. The grief evaluation measure (GEM): An initial validation study. Death Studies 2005; 29: 301-332.

10  Abdel-Khalek AM. A general factor of death distress in seven clinical and non clinical groups.  Death Studies  2004;28: 889-898.

11  Jacobs S. Traumatic Greif: Diagnosis, treatment, and prevention. London: Brunner/Mazel. 1999.

12  Prigerson HG, Jacobs SC. Traumatic grief as a distinct disorder: A rational consensus criteria, and a preliminary empirical test. In M. S. Stroebe, R. O. Hansson, W. Stroebe, & H. Schut (Eds.), Handbook of bereavement research: Consequences, Coping and Care (pp. 613-645). Washington, DC: American Psychological Association. 2001.

13  Hogan NS, Greenfield DB, Schmidt L A. Development and validation of the Hogan Grief Reaction Checklist. Death Studies  2001; 25: 1-32.

14  Dietrich DR. Psychological health of young adults who experienced early parent death: MMPI trends. Journal of clinical psychology 2006; 40(4): 901-908.

15  Schaal S, Dusingizemungu JP, Jacob N, Neuner F, Elbert T. Association between prolonged grief disorder, depression, posttraumatic stress disorder, and anxiety in Rwandan genocide survivors. Death studies 2012; 36 (2): 97-117.

16     Harding T W, Arngo MV, Balthazar J et al. Mental disorders in primary care: a study of their frequency and diagnosis in four developing countries. Psychological Medicine 1980; 10: 231-242.

17     Minhas FA, Iqbal K,Mubbashar M H. Validation of Self Reporting Questionnaire in primary care settings of Pakistan.  The Pakistan Journal of Clinical Psychiatry 1995; 5(2): 60-64.

18   Kiwimaki M, Vahtera J, Elovainio M, Lillrank B, Kervin MV. Death or Illness of a Family Member, Violence, Interpersonal Conflict, and Financial Difficulties as Predictors of Sickness Absence: Longitudinal Cohort Study on Psychological and Behavioral Links. Psychosomatic Medicine 2002; 64: 817-825.

19   Schiappa E, Gregg PB, Hewes DE. Can a television series change attitudes about death? A study of college students and six feet under. Death Studies 2004; 28: 459-474.

20  Durlak JA, Riesenberg LA. The impact of death education. Death Studies 1991;15: 39-58.

21  Maglio CJ, Robinson SE. The effects of death education on death anxiety: A meta analysis. Omega 1994; 29: 319-335.

 

 

 


 

 Table: 1        

Descriptive statistics for the bereaved first degree relatives.

Variables

Frequency

Percent

Gender

Male

121

40.9

Female

169

57.1

Age Range

16-20 years

34

11.7

21-25 years

45

15.5

26-30 years

37

12.8

31-35 years

32

11

36-40 years

33

11.4

41-45 years

24

8.3

46-50 years

18

6.2

51-55 years

17

5.8

56-60 years

21

7.2

60+ years

29

10.1

N= 290

 

 


 

Table: 2         

Descriptive statistics for the bereaved first degree relatives.

 

Education

Illiterate

22

7.6

Primary

10

3.4

Middle

14

8.3

Matriculation

53

18.3

Intermediate

47

16.2

Graduation

67

23.1

Masters

54

18.6

Professional

13

4.5

Marital Status

Single

97