Some individuals experience abnormally persistent and intense symptoms of grief that significantly interfere with daily functioning. This condition has been described using terms such as complicated or prolonged grief and prolonged grief disorder (PGD).

To identify the availability of evidence addressing a range of policy relevant issues related to grief, bereavement and PGD. In this paper we focus on the availability of evidence from systematic reviews.

We searched 12 databases and the websites of 18 grief- or bereavement-related organisations. Using key characteristics extracted from included reviews, we produced a high-level overview of the available evidence that enabled potential research gaps to be identified.

We identified 212 reviews – 103 focused on people’s experiences of grief/bereavement including service use; 22 reported on PGD prevalence, 42 on PGD risk factors, 37 on factors that influence grief more broadly and 80 on the effectiveness of grief-related interventions. Fifty-five reviews focused on multiple issues of interest. Half of reviews focused on a specific cause/type of death (n = 108). Of these reviews, most focused on three main causes/types of death: a specific health condition or terminal illness (n = 36), perinatal loss (n = 34) and suicide (n = 20).

We identified a large number of reviews, but key evidence gaps exist, particularly in relation to intervention cost-effectiveness and social, organisational or structural-level interventions that are needed for addressing inequities and other modifiable factors that can impair grieving and potentially increase the risk of PGD.

Anger may increase the risk for prolonged grief disorder (PGD) after violent loss. A source of anger for violently bereaved people can be the criminal proceedings that ensue following the loss. The present study explored the reciprocal associations between PGD and state anger and whether aspects of involvement in the criminal justice system (CJS) relate to PGD and state anger.

We analyzed data of 237 MH17-bereaved people collected 67, 79, 88, and 103 months after the loss. Cross-lagged panel modeling was employed to examine the reciprocal associations between PGD and state anger. In the optimal model, we regressed PGD and state anger levels on different aspects of CJS involvement.

Higher PGD levels significantly predicted higher state anger levels at each wave (β = .112–.130) but not the other way around. This was found while constraining autoregressive and cross-lagged paths. When adding predictors and covariates to the model, PGD levels still consistently predicted state anger levels over time (β = .107–.121), with state anger levels predicting PGD levels to a lesser extent (β = .064–.070). None of the aspects of CJS involvement were related to either PGD or state anger levels.

If replicated, a clinical implication could be that targeting PGD levels in treatment may reduce state anger levels and, to a lesser extent, vice versa. Also, CJS involvement does not seem to have an impact on PGD and state anger in people confronted with violent loss.

Effective, evidence-based psychological therapies for prolonged grief reactions exist but are not routinely available in United Kingdom National Health Service (NHS) services. This audit evaluated the feasibility and clinical effectiveness of a high-intensity prolonged grief disorder therapy (PGDT) treatment pathway in an NHS Talking Therapies (NHS-TT) context for clients with a prolonged grief reaction alongside depression, anxiety and/or post-traumatic stress disorder. Seventeen experienced high-intensity therapists were trained to deliver PGDT. Ninety-one clients were treated between April 2022 and April 2024, 80 of whom met criteria and were included in this audit; 83% of clients completed at least four treatment sessions (a liberal estimate of minimum adequate dose), the mean number of sessions attended was 10.29 (SD=5.81) and rates of drop-out were low (16%). Data completeness rates were 100% depression, anxiety and functioning measures and 61% for the grief outcome (Brief Grief Questionnaire; BGQ). There was no evidence of treatment-related harms. There were statistically significant, large pre–post treatment effect size improvements across outcomes from intake to last treatment session (p<.001; Cohen’s d>1.05). According to NHS-TT outcome metrics for combined changes in anxiety and depression, 82% of clients exhibited reliable improvement, 72% showed recovery, and 68% of clients achieved reliable recovery. On the BGQ, rates of reliable improvement were 77% and rates of recovery were 63%. Effects held when focusing on the subgroup with more severe grief symptoms (intake BGQ≥8; n=40). These findings suggest it is feasible and probably effective to implement a PGDT pathway in an NHS-TT context.

1. (1) To become familiar with prolonged grief disorder (PGD) as a diagnostic construct.

2. (2) To gain insight into using prolonged grief disorder therapy (PGDT) to treat PGD.

3. (3) To understand ways to train and supervise National Health Service Talking Therapies (NHS-TT) high-intensity therapists to implement PGDT.

4. (4) To evaluate the potential feasibility and effectiveness of implementing PGDT in an NHS-TT context.

Supporting family caregivers (FCs) is a critical core function of palliative care. Brief, reliable tools suitable for busy clinical work in Taiwan are needed to assess bereavement risk factors accurately. The aim is to develop and evaluate a brief bereavement scale completed by FCs and applicable to medical staff.

This study adopted convenience sampling. Participants were approached through an intentional sampling of patients’ FCs at 1 palliative care center in Taiwan. This cross-sectional study referred to 4 theories to generate the initial version of the Hospice Foundation of Taiwan Bereavement Assessment Scale (HFT-BAS). A 9-item questionnaire was initially developed by 12 palliative care experts through Delphi and verified by content validity. A combination of exploratory factor analysis (EFA), reliability measures including items analysis, Cronbach’s alpha and inter-subscale correlations, and confirmatory factor analysis (CFA) was employed to test its psychometric properties.

Two hundred seventy-eight participants conducted the questionnaire. Three dimensions were subsequently extracted by EFA: “Intimate relationship,” “Existential meaning,” and “Disorganization.” The Cronbach’s alpha of the HFT-BAS scale was 0.70, while the 3 dimensions were all significantly correlated with total scores. CFA was the measurement model: chi-squared/degrees of freedom ratio = 1.9, Goodness of Fit Index = 0.93, Comparative Fit Index = 0.92, root mean square error of approximation = 0.08. CFA confirmed the scale’s construct validity with a good model fit.

This study developed an HFT-BAS and assessed its psychometric properties. The scale can evaluate the bereavement risk factors of FCs in clinical palliative care.

While caring for seriously ill children is a rewarding experience, pediatric healthcare providers may experience sadness and emotional distress when their patient dies. These feelings, particularly when not addressed, can lead to negative health and occupational outcomes. Remembrance practices can provide a safe space for staff to process their grief. This study explored pediatric healthcare providers’ perceptions of an annual Pediatric Remembrance Ceremony (PRC) and a quarterly program, Good Grief and Chocolate at Noon (GGCN), to learn what components of the programs were considered meaningful and the personal impact on those who attended. The programs pivoted to a virtual platform during the COVID-19 pandemic, and the study also assessed providers’ perspectives of attending the programs virtually.

A 19 multiple choice survey instrument was designed, reviewed, piloted, revised, and re-piloted by an interdisciplinary bereavement committee prior to administration. The survey included 2 open-ended questions, inviting additional insights into personal impact and future directions for remembrance programs. The survey was administered on an encrypted online platform.

Components of the PRC respondents most valued included the opportunity for staff to choose a name of a patient they cared for and to light a candle for that patient as their name is read. Those who participated in GGCN found story sharing helpful, along with having a speaker address a topic around loss and grief during the second half of the session. Both programs provided reflection, solidarity, and memorialization. Most respondents prefer having both in-person and virtual options.

Healthcare providers are affected by the death of the children they care for and value opportunities provided to join colleagues in remembering their patients. The findings underscore the value of remembrance programs in supporting bereaved staff.

Prolonged grief is a chronic and debilitating condition that affects millions of persons worldwide. The aim of this study was to use a qualitative approach to better understand how relatives with prolonged grief disorder perceive what does or not help them and whether they were able to make recommendations.

Participants were all relatives of deceased patients admitted to 26 palliative care units involved in the FamiLife study; relatives were included if diagnosed with prolonged grief symptoms (i.e., Inventory Complicated Grief (ICG) questionnaire with a cut-off >25), and volunteered to participate. Semi-directed telephone interviews were conducted by psychologists between 6 and 12 months after the patient’s death. The interviews were open-ended, without a pre-established grid, then transcribed and analyzed using a thematic approach.

Overall, 199/608 (32.7%) relatives were diagnosed with prolonged grief symptoms, i.e., with an ICG score >25, and 39/199 (20%) agreed to be interviewed. The analysis yielded 4 themes: (1) the experience of mourning: intense sadness and guilt (reported by 35/39 participants, 90%); (2) aggravating factors (38/39, 97%): feeling unprepared for death and loneliness, presence of interpersonal barriers to adjustment, external elements hindering the mourning progress; (3) facilitating factors (39/39, 100%): having inner strength or forcing oneself to get better, availability of social and emotional support; and (4) the suggestions grieving relatives had to alleviate the grief burden (36/39, 92%). The analysis enabled to identify 5 suggestions for relieving the grief burden: improving communication, developing education about death and grief, maintaining contact, offering psychological support, and choosing the right time for the palliative care team to contact the relatives.

This study revealed how bereaved relatives experienced the help provided by the healthcare teams, their representations, and what could be improved. These findings could be used to design intervention studies.