The Role of Defense Mechanisms, Personality and Demographical Factors on Complicated Grief following Death of a loved one by Cancer
Abstract
Objective: Identification of the risk factors and psychological correlates of prolonged grief disorder is vital for health promotions in relatives of persons who died of cancer. The aim of this research was to investigate the role of defense mechanisms, character dimension of personality and demographic factors on complicated grief following a loss of a family member to cancer.
Method: A number of 226 persons who had lost a family member to cancer in a cancer institute at Tehran University of Medical Science were selected through compliance sampling and completed the Inventory of complicated Grief-Revised (ICG-R), the Defense Styles Questionnaire (DSQ), the Character dimension of Temperament and Character Inventory (TCI), and the Demographical questionnaire. Data were analyzed by stepwise multiple regression analysis,using the PASW version 18.
Results: Findings revealed that neurotic defense style had a significant positive predictive role in the complicated grief; and cooperativeness, age of the deceased person, self-transcendence and mature defense style had a significant negative predictive role in complicated grief (p<0.001). R2 was 0.73 for the final model (p<.001).
Conclusion: The results revealed that two character dimensions (low cooperativeness and self-transcendence), high neurotic defense style and young age of the deceased person were involved in the psychopathological course of the complicated and prolonged grief. It was concluded that personality characteristics of the grieving persons and demographics of the deceased person should be addressed in designing tailored interventions for complicated grief.
Stroebe M, Schut H, Stroebe W. Health outcomes of bereavement. Lancet 2007; 370: 1960–1973.
Christakis N, Allison P. Mortality after the hospitalization of a spouse. N Engl J Med 2006; 354: 719–730.
Lombardo L, Lai C, Luciani M, Morelli E, Buttinelli E, Aceto P, et al. Bereavement and complicated grief: towards a definition of Prolonged Grief Disorder for DSM-5. Riv Psichiatr 2014; 49: 106-114.
Gana K, K'Delant P. The effects of temperament, character, and defense mechanisms on grief severity among the elderly. J Affect Disord 2011; 128: 128–134.
Meuser TM, Marwit SJ. An integrative model of personality, coping and appraisal for the prediction of grief involvement in adults. Omega: J Death Dying 2000; 40: 375 –393.
Robinson T, Marwit SJ. An investigation of the relationship of personality, coping, and grief involvement among bereaved mothers. Death Stud 2006; 30: 677 –696.
Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, Goodkin K, et al.. Prolonged grief disorder: psychometric validation criteria proposed for DSM-V and ICD-11. PLoS Medicine 2009; 6:1–12.
Tomarken A, Holland J, Schachter S, Vanderwerker L, Zuckerman E, Nelson C, et al. Factors of complicated grief pre-death in caregivers of cancer patients. Psychooncology 2008; 17: 105–111.
Anngela-Cole L, Busch M. Stress and grief among family caregivers of older adults with cancer: a multicultural comparison from Hawai'i. J Soc Work End Life Palliat Care 2011; 7: 318-337.
Rosenberg AR, Baker KS, Syrjala K, Wolfe J. Systematic review of psychosocial morbidities among bereaved parents of children with cancer. Pediatr Blood Cancer 2012; 58: 503-512.
Lacey J. Recognizing grief in oncology patients and their caregivers. J Support Oncol 2011; 9: 183.
Clark PG, Brethwaite DS, Gnesdiloff S. Providing support at time of death from cancer: results of a 5-year post-bereavement group study. J Soc Work End Life Palliat Care 2011; 7: 195-215.
Lai C, Luciani M, Morelli E, Galli F, Cappelluti R, Penco I, et al. Predictive role of different dimensions of burden for risk of complicated grief in caregivers of terminally ill patients. Am J Hosp Palliat Care 2014; 31: 189-193.
Cramer P. Coping and defense mechanisms: what's the difference? J Pers 1998; 66: 919-946.
Cloninger CR. The genetics and psychobiology of the seven-factor model of personality. In: Silk, K.R. (Ed.), Biology of Personality Disorders. Washington, DC: American Psychiatric Press; 1998.
Yoon SJ, Jun CS, An HY, Kang HR, Jun TY. Patterns of temperament and character in patients with posttraumatic stress disorder and their association with symptom severity. Compr Psychiatry 2009; 50: 226-321.
Richter J, Brändström S. Personality disorder diagnosis by means of the Temperament and Character Inventory. Compr Psychiatry 2009; 50: 347-352.
Ball J. Widows grief: the impact of age and mode of death. Omega: J Death Dying 1977; 7: 307–333.
Mystakidou K, Tsilika E, Parpa E, Katsouda E, Sakkas P, Galanos A, et al. Demographic and clinical predictors of preparatory grief in a sample of advanced cancer patients. Psychooncology 2006; 15: 828-833.
Guldin MB, O'Connor M, Sokolowski I, Jensen AB, Vedsted P. Identifying bereaved subjects at risk of complicated grief: Predictive value of questionnaire items in a cohort study. BMC Palliat Care 2011; 10: 9.
Sjolander C, Hedberg B, Ahlstrom G. Striving to be prepared for the painful: Management strategies following a family member's diagnosis of advanced cancer. BMC Nurs 2011;10: 18.
Lichtenthal WG, Nilsson M, Kissane DW, Breitbart W, Kacel E, Jones EC, et al. Underutilization of mental health services among bereaved caregivers with prolonged grief disorder. Psychiatr Serv 2011; 62: 1225-1229.
Prigerson HG, Maciejewski PK, Reynolds CF, Bierhals AJ, Newsom JT, Fasiczka A, et al. Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res 1995; 59: 65-79.
Jacobs S, Prigerson H: Psychotherapy of traumatic grief: A review of evidence for psychotherapeutic treatments. Death Stud 2000; 24: 479-495.
O’Connor M, Lasgaard M, Shevlin M, Guldin MB. A confirmatory factor analysis of combined models of the Harvard Trauma Questionnaire and the Inventory of Complicated Grief-Revised: are we measuring complicated grief or posttraumatic stress? J Anxiety Disord 2010; 24: 672-679.
Simon NM, Pollack MH, Fischmann D, Perlman CA, Muriel AC, et al. Complicated grief and its correlates in patients with bipolar disorder. J Clin Psychiatry 2005; 66: 1105–1110.
Ghaffari-Nejad A, Ahmadi-Mousavi M, Gandomkar M, Reihani-Kermani H. The prevalence of complicated grief among Bam earthquake survivors in Iran. Arch Iran Med 2007; 10: 525-528.
Prigerson HG. Measuring complicated grief. Retrieved January 28, 2004 from The Complicated Grief. Available from: http://www.psych/cgrief/measure_CG.htm. 2004.
Andrews G, Singh M, Bond M. The defense Style Questionnaire. Journal Nervous Mental Disorder1993; 181: 246 –256.
Heidarinasab L, Shaeeri MR. Factor analysis of Defense Mechanisms Inventory (DSQ-40) in Iranian Non clinical sample. Journal of psychological New Research 2011; 6: 77-97.
Cloninger CR, Przybeck TR, Svrakic DM, Wetzel RD. The temperament and character inventory (TCI): a guide to its development and use. St.Louis, Missouri: Center for Psychobiology of Personality Washington University; 1994.
Gana K, Trouillet R. Structure invariance of the Temperament and Character Inventory (TCI). Personality and Individual Differences 2003; 35: 1483–1495.
Gourion D, Pe´lissolo A, Le´pine JP. Test–retest reliability of the Temperament and Character Inventory in patients with opiate dependence. Psychiatry Res 2003; 118: 81–88.
Kaviani H, Poornaseh M. validation and standardization of The Temperament and Character Inventory (TCI) in Iranian population. Medical college Journal of Tehran University of medical science 2005; 63: 89-98.
Cohen J, Cohen P, West SG, Aiken LS. Applied multiple regression/correlation analysis for the behavioral sciences, 3rd Ed. Mahwah, NJ: Lawrence Erlbaum Associates; 2003.
Watson DC. Predicting psychiatric symptomatology with the Defense Style Questionnaire-40. International Journal of Stress Management 2002; 9: 275–287.
Mancini AD, Bonanno GA. Predictors and parameters of resilience to loss: toward an individual differences model. J Pers 2009; 77: 1805–1832.
deCinque N, Monterosso L, Dadd G, Sidhu R, Lucas R. Bereavement support for families following the death of a child from cancer: Practice characteristics of Australian and New Zealand paediatric oncology units. J Paediatr Child Health 2004; 40: 131-135.
Mitchell AM, Kim Y, Prigerson HG, Mortimer-Stephens M. Complicated grief in survivors of suicide. Crisis 2004; 25: 12-18.
Mulder RT, Joyce PR, Sullivan PF, Bulik CM, Carter FA. The relationship among three models of personality psychopathology: DSM-III- R personality disorder, TCI scores and DSQ defenses. Psychol Med 1999; 29: 943-951.
Cloninger CR. Feeling Good. The Science of Well-Being. New York: Oxford University Press, Inc; 2004.
Joyce PR, McKenzie JM, Carter JD, Rae AM, Luty SE, Frampton CMA, et al. Temperament, character and personality disorders as predictors of response to interpersonal psychotherapy and cognitive- behavioural therapy for depression. Br J Psychiatry 2007; 190: 503–508.
Chiu YW, Huang CT, Yin SM, Huang YC, Chien CH, Chuang HY. Determinants of complicated grief in caregivers who cared for terminal cancer patients. Support Care Cancer 2010; 18: 1321-1327.
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Issue | Vol 10 No 2 (2015) | |
Section | Original Article(s) | |
Keywords | ||
Cancer Character Demographic Grief Personality |
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