Formal caregivers in end-of-life care routinely accompany patients into death, yet their own grief is often interpreted through individualized constructs-burnout, compassion fatigue, secondary traumatic stress-that obscure how loss is generated relationally and shaped institutionally. Drawing on Doka's concept of disenfranchized grief and Kastenbaum's concept of vicarious grief, this study examines how caregivers bear witness to loss: how they carry their own bond with the deceased while empathically engaging with the grief of families and colleagues. Sixteen Italian healthcare and social-care professionals participated in semi-structured interviews, analyzed using reflexive thematic analysis supported by ATLAS.ti. Three interconnected experiential domains were identified: the overlap between personal and professional experience; the organizational shaping of grief expression; and processes of elaboration and integration following the loss. Building on these findings, we advance a process-oriented model in which professional grief develops through sustained relational engagement, is framed by organizational norms that either enfranchise or silence it, and is subsequently integrated into professional identity through meaning-making practices. The findings shift attention from individual coping to institutional conditions that render caregiver loss shareable-including reflective supervision, brief team rituals around the moment of death, and family involvement in end-of-life decisions-as low-cost mechanisms that enfranchise grief and sustain compassionate care over time.s
Many people experience periods of severe stress or trauma in which they question and rethink their core beliefs about life. This recently conceptualized phenomenon, labeled Crisis of Belief, has been clearly theoretically specified, but has yet to be operationalized. In a series of six studies (total N = 2,739), we developed and validated a psychometric designed to measure this construct, called the Crisis of Belief Scale (COBS). Studies 1 and 2 identified items and used exploratory and confirmatory factor analysis to test the structure of the COBS. Study 3 measured COBS alongside a variety of variables to assess its convergent, discriminant, and concurrent validity. Study 4 assessed its test-retest and split-half reliability. Studies 5 and 6, assessed its known-groups validity by comparing COBS scores in a sample of people experiencing homelessness (Study 5), and people in substance abuse recovery (Study 6), to that of the general population. The results of these studies support the validity of the COBS, which provides a rigorous means of measuring COB and investigating its relationships with key variables, such as depression, anxiety, life satisfaction, posttraumatic growth, and belief change. Importantly, the results indicate that COB predicts variability in key outcomes over and above variability attributable to trauma. The COBS provides a valuable tool for researchers and practitioners to understand how COB relates to well-being outcomes and processes of belief change.
Losses that remain unaddressed can serve as a barrier to positive substance use treatment outcomes. Adults who misuse opioids face various barriers to substance use treatment and may also be navigating different forms of losses, including non-death loss. Due to the obscure nature of non-death losses, the support typically provided during a distinct loss is not made available, leading to the disenfranchisement of one's grief. Lacking social support and having a reduced capacity to cope can be harmful to the grieving and drug recovery process, contributing to an increased risk of relapse. Understanding participants' experiences of non-death loss and its impact on their well-being and drug misuse is imperative to promote recovery. Using a sample of 41 Black adults who reported opioid misuse, researchers employed reflexive thematic analysis to examine themes in participants' experiences of loss. Identified themes were: (1) pre-addiction loss, childhood trauma, (2) loss during/because of addiction, idealized adulthood, and (3) loss during remission, recovery capital, interpersonal relationships, and stability. Findings provide evidence that non-death losses affected participants' drug use, whether it was the initiation of their use, the duration of their use, or their remission or relapse. Researchers discuss implications for providers who work with people who use drugs (PWUD), who may experience adverse life events that could be framed as loss. Results of this study suggest that viewing clients' non-death losses as moments of loss can help to explore their grief and ultimately address their drug use as a coping mechanism.
Terminal lucidity refers to a sudden, meaningful period of clear communication shortly before death in patients who were previously confused or unresponsive. The literature describes a phenomenon with unclear contours and a form of continuum, with diverse consequences. We conducted semi-structured interviews with 22 people who had lost a close relative after an episode of terminal lucidity. Qualitative data were analyzed using the method of interpretative phenomenological analysis. Most participants reported that final interactions with their loved one provided an opportunity for closure, although nearly half experienced these exchanges as sources of painful false hope. Two primary patterns of response were observed: "shared grief," in which families and patients collectively recognize the impending death, and "hyperbolic grief," where revival postpones acceptance and renders the felling of loss more sudden and unexpected. While outcomes are generally neutral or positive, there is potential for complicated grieving processes in this context, indicating the importance of informing healthcare professionals.
In suicide prevention, gatekeepers are community members who interact with many individuals, can be trained to recognize signs of suicidality, and facilitate referral to support services. Teachers are considered natural gatekeepers who play an important role in identifying and supporting students, yet require adequate knowledge and self-efficacy beliefs to engage in suicide intervention behaviors. The aim of the current scoping review was to investigate what factors are associated with teachers' suicide literacy and self-efficacy in identifying and helping students with suicidal ideations and behaviors. Search terms were entered in Web of Science, Scopus, PubMed, and ERIC in March 2025, followed by a forward/backward search, and an updated search in April 2026. For inclusion, journal articles needed to report on factors associated with schoolteachers' suicide literacy and/or self-efficacy with quantitative data in English. Articles were excluded if they reported on non-suicidal self-injury, did not report data specifically for teachers, or presented qualitative studies/summarized data. 20 articles were included in the narrative synthesis and evaluated with the QuADS checklist. In addition to program participation and professional development, various individual (e.g., experiences with suicidality) and contextual factors (e.g., crisis intervention team at school) were examined. These provide insights for the development and refinement of future gatekeeper programs and teacher education. However, the limited number of studies examining the range of factors represents an important limitation. Future research should prioritize replication and alleviate methodological limitations, such as employing larger sample sizes and psychometrically validated instruments.
Adoption breakdown occurs when a child leaves the adoptive family home prematurely. Although only a minority of adoption placements end prematurely, breakdown has a profound impact on all involved and a period of grieving often follows the loss of a child from the family home. For adopters, loss and grief may be prolonged and complicated by the stigma surrounding breakdown, commonly interpreted as parental failure. Such perceptions can lead to feelings of isolation and shame, often intensified by professional scrutiny, blame, or involvement in child protection investigations. This qualitative study explored adoption breakdown from the perspective of adopters, examining the nature of loss and grief associated with breakdown, its psychological impact, and adopters' attempts to make sense of and reconstruct meaning following the experience. Nine online focus groups were conducted with 34 adopters who had experienced adoption breakdown in the UK system. Findings highlight the complex and psychologically significant nature of adopters' loss and grief, which was exacerbated by the silence and taboo surrounding adoption breakdown. Adoptive parents described experiencing anticipatory loss prior to formal placement breakdown, characterized by a sense of psychological absence despite the child's continued physical presence in the home. Participants also grieved the loss of the happy family life they had imagined. The study further illustrates how adopters sought to understand the breakdown and reconstruct meaning through processes of sense-making, benefit-finding, and identity change as they adapted to new forms of parenting post-breakdown. Finally, the paper discusses implications for policy and practice.
The studies examining the impact of Covid-19 restrictions on bereaved people's grief experiences largely assumed that people mostly complied with health measures. Our study explores disruptions to the measures to perform funeral and social rituals, examining in which context they took place, how they were experienced and what they allowed in the bereaved's grieving processes. A mixed-method was used to analyze data collected through self-reported questionnaires from 472 bereaved individuals in Belgium. As we hypothesized that disruptions would act as coping strategies, leading to lower levels of grief and guilt, and greater post-traumatic growth, quantitative analyses compared people who disregarded the rules to those who complied using MANCOVA. Then, a reflexive thematic analysis explored 185 open-ended responses about disruptive rituals. Overall, 40% of the participants reported having disregarded the rules, particularly when death was unbearable and unfair. These behaviors were multiple and had various meanings and emotional connotations. In general, such behaviors were driven by a need to do the right thing, which was described as an easy or difficult choice in the face of conflicting norms and values. Contradicting our hypothesis, disruptions were associated with elevated levels of grief and guilt. People who disregarded the rules showed also greater post-traumatic growth, but only if they were ultimately able to perform the desired rituals. Our findings argue that disruptions could have served as a form of self-empowerment, enabling people to resist constraints and meet their needs, those of the deceased and other bereaved, in accordance with moral and ethical principles.
This research paper explores the concept of "motherless mothering" among Black women, highlighting the unique challenges faced by those who have lost their mothers prior to becoming mothers themselves. Notably, nearly 40% of Black children experience the death of a parent by age 20, with maternal loss representing a significant portion of these cases. Grounded in the understanding that parental death disproportionately affects Black individuals, this study explores the emotional, psychological, and social consequences faced by Black women navigating the transition to motherhood without a maternal figure. Qualitative data were collected through a questionnaire, resulting in three key findings: participants' experiences with feelings of abandonment, entrapped grief, and discussing the lack of supportive services for motherless mothers. To address these issues, this paper introduces the Parent-Parental Loss (PPL) framework, a new model developed by the study's first author to elucidate and support the unique experiences of motherless mothers. By investigating the intersections of grief, motherhood, and communal structures, and applying the PPL framework, this study seeks to advance understanding of Black women's lived experiences as motherless mothers.
Obsessive-compulsive personality traits, as described in the DSM, include preoccupation with details, perfectionism, workaholism, over-conscientiousness, hoarding tendencies, reluctance to delegate, a miserly spending style, rigidity, and stubbornness. These traits are also known to be closely associated with emotional suppression, resistance to change, and an excessive need for control. Grief involves navigating intense emotions, restructuring the future, and adapting to changes in interpersonal roles and responsibilities. In this context, the present study aimed to test a theoretical model examining the relationships between obsessive-compulsive personality traits and negative grief-related cognitions, avoidance, a sense of unrealness, and prolonged grief disorder symptoms. The sample consisted of 486 adult participants who had lost loved ones in the last five years. Participants completed a survey battery consisting of the Pathological Obsessive-Compulsive Personality Scale, the Prolonged Grief Disorder Scale, the Grief Cognitions Questionnaire, the Depressive and Anxious Avoidance in Prolonged Grief Questionnaire, and the Experienced Unrealness Scale. Structural equation modeling tested the fit of the hypothesized theoretical model. The results supported the model, in which obsessive-compulsive personality traits were directly associated with anxious avoidance, negative grief-related cognitions, and a sense of unrealness, each of which was, in turn, associated with increased prolonged grief. All paths in the model were statistically significant. Findings suggest that higher levels of obsessive-compulsive personality traits are associated with increased avoidance of grief reminders, more negative grief-related cognitions, and difficulty in facing the reality of the loss, which are in turn associated with higher levels of prolonged grief.
This qualitative study examines the experiences of educational teams following the death of their school principal during military reserve service in the "Iron Swords" war. The principal, who was a central leadership figure, left behind an emotional, structural, and organizational void. Based on semi-structured interviews with 40 teachers and educators, this study sought to understand the processes of collective grief and systemic coping within an educational institution operating under a national state of emergency. Data analysis yielded three findings: First, the staff experienced multi-dimensional organizational trauma alongside double grief-personal and national. Second, a gap was identified in the institutional response, where the absence of formal support led to disenfranchized grief among the staff, as their loss did not receive sufficient recognition and legitimacy from the system. Third, the study demonstrated how collective resilience develops "from the bottom up," through the creation of informal emotional communities and staff-led commemoration initiatives that address the need for creating renewed meaning. The findings emphasize the need for institutional recognition and the development of trauma-informed policies for educational teams and organizations dealing with leadership loss during a collective crisis. The study's contribution to the literature on loss and trauma lies in framing the institutional failure as a malfunction of grief leadership, which creates disenfranchized grief within an environment of organizational trauma. Furthermore, the study provides guidelines for developing psychological first aid (PFA) protocols and support for educational authorities and crisis management bodies.
Children of parents with addiction often develop a strong dependency on the family system, assuming various maladaptive roles to maintain a fragile sense of balance. While such adaptations may provide short-term coping mechanisms, they can significantly disrupt identity development and the formation of a stable sense of self. This qualitative study aimed to explore the lived experiences of adult women raised in families affected by parental substance use in a Hungarian sample, with a particular focus on how these early environments shape identity and self-concept in adulthood. Participants were recruited through social media platforms and the mailing lists of Hungarian ACA (Adult Children of Alcoholics) groups. Semi-structured interviews were conducted with a purposive sample of 15 participants, and Interpretative Phenomenological Analysis (IPA) was applied to identify recurring patterns. Three master themes emerged: Main Theme 1: "I Pretended Nothing Was Wrong", Main Theme 2: "The Question of the Right to Exist", and Main Theme 3: "The 'Homeless' Inner Child". These findings highlight the long-term psychological impact of growing up in addiction-affected households, including difficulties with self-acceptance, boundary-setting, and autonomy. The study underscores the therapeutic potential of approaches addressing the "inner child" to process unresolved losses-summarised as the loss of childhood-and to strengthen self-identity. By deepening understanding of these processes, the findings may inform targeted interventions for young children and adult children of parents with addiction.
This study examined the longitudinal relationship between post-traumatic stress disorder (PTSD), nonacceptance of negative emotions, and anxiety, with a focus on the mediating role of nonacceptance of negative emotions. A total of 405 Korean adults completed online questionnaires at three time points between October 2018 and August 2020. Results showed that latent growth modeling revealed significant linear growth for nonacceptance of negative emotions and anxiety, whereas PTSD remained stable over time. Next, baseline PTSD significantly predicted initial nonacceptance of negative emotions (beta = .406, S.E. = .010, p <.001) but did not predict its longitudinal change (beta = .063, S.E. = .004, p >.05). Finally, Sobel tests indicated that initial nonacceptance of negative emotions significantly mediated the relationship between PTSD and anxiety over time (z = 5.668, p < .001), but not between PTSD and initial anxiety (z = 1.54, p > .05). These results suggest that the structural relationship among the three variables was not significant from the perspective of concurrent effects. From a longitudinal perspective, however, PTSD increases initial nonacceptance of negative emotions, which in turn contributes to greater anxiety over time. These findings underscore the importance of addressing initial nonacceptance of negative emotions in interventions intended to alleviate the long-term impact of PTSD on anxiety.
This study aimed to examine the role of core belief disruption, intrusive rumination, and deliberate rumination in posttraumatic growth (PTG) among suicide-loss survivors and individuals who were exposed to a suicide attempt by a parent, sibling, romantic partner, relative, or friend. Participants were university students studying in Ayd & imath;n, T & uuml;rkiye; 138 were suicide-loss survivors (68 women; M = 20.8, SD = 2.1) and 198 were exposed to a suicide attempt (128 women; M = 21.05, SD = 2.2). Data were collected using the Core Beliefs Inventory, the Event-Related Rumination Inventory, and the Posttraumatic Growth Inventory. The findings indicated that core belief disruption and deliberate rumination were positively associated with PTG in both groups. In contrast, intrusive rumination was negatively associated with PTG among suicide-loss survivors but was not significantly associated with PTG among attempt-exposed individuals. Mediation analyses showed that both intrusive and deliberate rumination mediated the relationship between core belief disruption and PTG among suicide-loss survivors. However, among individuals exposed to a suicide attempt, only deliberate rumination functioned as a mediator. These findings suggest that intrusive and deliberate rumination may be differentially associated with PTG and that the pattern of associations may differ between suicide-loss survivors and individuals exposed to a suicide attempt involving a parent, sibling, romantic partner, relative, or friend. Overall, the results indicate the relevance of targeting ruminative processes in clinical interventions aimed at meaning reconstruction and suggest the need for longitudinal research to clarify the temporal dynamics of rumination and core belief disruption.
