Forskningsenheden for Almen Praksis A A R H U S U N I V E R S I T E T Afdeling for Almen Medicin How can we organize bereavement care? An.

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,

[email protected]

.

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.

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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

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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.

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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

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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.

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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!

[email protected]