Stigmatization and Receptivity to Mental Health Services Among Recently Bereaved Adults

Abstract

Severe grief symptoms, treatment receptivity, attitudes about grief, and stigmatization concerns were assessed in a community-based sample of 135 widowed participants in the Yale Bereavement Study. There was a statistically significant association between the severity of grief symptoms and reported negative reactions from friends and family members. However, more than 90% of the respondents with complicated grief, a severe grief disorder, reported that they would be relieved to know that having such a diagnosis was indicative of a recognizable psychiatric condition, and 100% reported that they would be interested in receiving treatment for their severe grief symptoms.

This research was supported in part by the following grants to Dr. Prigerson: MH56529 and MH63892 from the National Institute of Mental Health and CA106370 from the National Cancer Institute; a Soros Open Society Institute Project on Death in America Faculty Scholarship; a RAND/Hartford Interdisciplinary Geriatric Health Research Center Grant; a Fetzer Religion at the End-of-Life Grant; the Claude D. Pepper Older Americans Independence Center Grant P30AG21342 from the National Institute on Aging; and the Center for Psycho-oncology and Palliative Care Research, Dana-Farber Cancer Institute.

Notes

¹Alternative terms for complicated grief, such as prolonged grief disorder are under consideration for inclusion in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

Note. CG = complicated grief.

^a Because the expected cell number is <5, Fisher's exact test (FET) was conducted.

^b Because the expected cell number is <5, Cochran Mantel-Haenszel test was conducted.

^c Because the time to death variable is highly skewed (skewness > 2), non-parametric Wilcoxon rank sum test (W) was conducted. Wilcoxon statistic and associated p value were reported.

Note. The two groups did not differ significantly with respect to any of the attitudes and feelings about grief symptoms that were assessed.

^a Adjusted for age, gender, and education; 95% C.I. = 95% Confidence Interval.

^b Reverse-coded item.

Note. The two groups did not differ significantly with respect to assessed receptivity to treatment.

^a Adjusted for age, gender, and education; 95% C.I. = 95% Confidence Interval.

^b Odds ratio could not be computed due to 100% receptivity to treatment among individuals with complicated grief.

^a Adjusted for age, gender, and education; 95% C.I. = 95% Confidence Interval.

^b Odds ratio could not be computed due to the absence of concerns about negative reactions among individuals with complicated grief (CG).

^c Fisher's exact tests were computed due to the low number of cases reporting negative reactions from others. When there were less than 2 cases in the Complicated Grief group reporting negative reactions from others, Fisher's exact tests could not be computed.

²The assumptions for logistic regression models are (a) the true conditional probabilities are a logistic function of the independent variables, (b) no important variables are omitted, (c) no extraneous variables are included, (d) the independent variables are measured without error, (e) the observations are independent, and (f) the independent variables are not linear combinations of each other. If the Hosmer and Lemeshow (1989) goodness-of-fit test p value was less than 0.05, the insignificant covariates were removed from the model and significant confounders were added to gain a better model fit. For the model regressing “Relieved to know you had a recognizable problem?” on CG status, education was removed from the model to obtain a good fit. For the model regressing “Have your family member or friends told you that you are exaggerating or overacting with your grief?” on CG status, gender was removed to obtain a good fit.

^a Age, education, gender, and relationship to the deceased were controlled statistically.

^b Proportion of variance in Stigma Receptivity Scale subscale scores uniquely attributable to the association with grief severity scores.