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Samuel J. Marwit

Bio: Samuel J. Marwit is an academic researcher from University of Missouri–St. Louis. The author has contributed to research in topics: Grief & Complicated grief. The author has an hindex of 20, co-authored 32 publications receiving 2610 citations.

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TL;DR: The psychometric validity of criteria for prolonged grief disorder (PGD) is tested to enhance the detection and care of bereaved individuals at heightened risk of persistent distress and dysfunction.
Abstract: Background: Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. Methods and Findings: A total of 291 bereaved respondents were interviewed three times, grouped as 0–6, 6–12, and 12– 24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. Conclusions: The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for the Editors’ Summary.

1,437 citations

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TL;DR: Findings suggest that anticipatory grief in dementia caregiving is "real" grief, equivalent in intensity and breadth to death-related grief.
Abstract: Purpose: Grief is an overlooked but important element of the caregiver experience. This study defines a model of caregiver grief to aid in clinical intervention and to support further research. Design and Methods: This study addressed the grief responses of 87 spouse and adultchild caregivers of patients with progressive dementia representing mild, moderate, severe, and postdeath. Questionnaire data and qualitative findings from 16 semistructured focus group interviews provide the basis for a descriptive model of anticipatory grief in dementia caregiving. Results: Significant differences emerged between spouse and adult-child caregiver groups as a whole and as a function of Clinical Dementia Rating impairment level. Caregiver grief was found to fluctuate between intellectual, affective, and existential poles depending upon current care demands and expectations. Implications: These findings suggest that anticipatory grief in dementia caregiving is “real” grief, equivalent in intensity and breadth to death-related grief.

244 citations

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TL;DR: Results suggest that caregiver grief is neither a unitary nor a static construct and that a scale such as this may be appropriate for use in supportive, clinical, and research settings.
Abstract: Purpose: The purpose of this study was to develop an empirically based, psychometrically sound instrument for the assessment of grief in caregivers of persons with Alzheimer’s disease. Design and Methods: A total of 184 statements addressing personal grief reactions were obtained from 45 adult child and 42 spouse caregivers in 16 focus groups representing early, middle, late, and postdeath stages. These were presented to a second sample of 83 adult child and 83 spouse caregivers, who rated them according to their current experience. Also administered were the Beck Depression Inventory, the Anticipatory Grief Scale, the Caregiver Strain Index, the Caregiver Well-Being Scale‐Basic Needs, and the Perceived Social Support‐Family Questionnaire. Results: Factor analysis resulted in a 50-item scale containing three factors: Personal Sacrifice Burden , Heartfelt Sadness and Longing , and Worry and Felt Isolation . Cronbach’s alpha scores ranged from .90 to .96, indicating high internal consistency reliability for each factor as well as for their combined total. Correlations of each factor with other measures provide evidence of validity, especially when assessed in the context of the caregiver grief model. Implications: Results suggest that caregiver grief is neither a unitary nor a static construct and that a scale such as this may be appropriate for use in supportive, clinical, and research settings.

148 citations

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TL;DR: The Posttraumatic Growth Inventory, Revised Grief Experience Inventory, and World Assumptions Scale were administered to 111 bereaved parents and indicate that many bereavedParents report personal growth in domains outlined by L.G. Calhoun and R. G. Tedeschi (2001).
Abstract: The Posttraumatic Growth Inventory (PTGI), Revised Grief Experience Inventory, and World Assumptions Scale were administered to 111 bereaved parents. The PTGI scores indicate that many bereaved parents report personal growth in domains outlined by L.G. Calhoun and R. G. Tedeschi (2001). Grief intensity was inversely correlated with growth scores. Self-worth was a strong predictor of growth scores, whereas assumptions about the benevolence and meaningfulness of the world were not correlated with growth.

146 citations

Journal ArticleDOI
TL;DR: The derivation of a short-form of the Marwit-Meuser Caregiver Grief Inventory (MM-CGI), an inventory designed to measure grief in caregivers of persons with progressive dementia, is described and initial reliability and validity data are presented.
Abstract: This article describes the derivation of a short-form of the Marwit-Meuser Caregiver Grief Inventory (MM-CGI), an inventory designed to measure grief in caregivers of persons with progressive dementia. It presents initial reliability and validity data and describes ways to use the inventory both clinically and scientifically. The resulting MM-CGI Short Form, presented here in its entirety, is comprised of 18 items and, like its full-form relative, is self-scoring and yields a Total Grief score and sub-scale scores measuring factors representing Personal Sacrifice Burden, Heartfelt Sadness and Longing, and Worry and Felt Isolation.

107 citations


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5,680 citations

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3,628 citations

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TL;DR: An integrated model of meaning making is presented, which distinguishes between the constructs of global and situational meaning and between "meaning-making efforts" and "meaning made," and it elaborates subconstructs within these constructs.
Abstract: Interest in meaning and meaning making in the context of stressful life events continues to grow, but research is hampered by conceptual and methodological limitations. Drawing on current theories, the author first presents an integrated model of meaning making. This model distinguishes between the constructs of global and situational meaning and between "meaning-making efforts" and "meaning made," and it elaborates subconstructs within these constructs. Using this model, the author reviews the empirical research regarding meaning in the context of adjustment to stressful events, outlining what has been established to date and evaluating the strengths and weaknesses of current empirical work. Results suggest that theory on meaning and meaning making has developed apace, but empirical research has failed to keep up with these developments, creating a significant gap between the rich but abstract theories and empirical tests of them. Given current empirical findings, some aspects of the meaning-making model appear to be well supported but others are not, and the quality of meaning-making efforts and meanings made may be at least as important as their quantity. This article concludes with specific suggestions for future research.

2,082 citations

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TL;DR: Modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders are discussed.
Abstract: Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally, grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence, some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This article focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders.

796 citations