1. 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 study Mai-Britt Guldin Cand.Psych. Specialist i psykoterapi, phd-studerende. m.guldin@alm.au.dk.

2. 09-05-2015 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.

3. 09-05-2015 Mai-Britt Guldin 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

4. 09-05-2015 Mai-Britt Guldin 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.

5. 09-05-2015 Mai-Britt Guldin Clinical issues What 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?

6. Mai-Britt Guldin Bereavement management Description, assessment and care A randomized controlled study Supervisors: Frede Olesen, GP, Professor, Research Director¹ Peter Vedsted, MD, Phd, Ass. Research Director¹ Anders Bonde Jensen, MD, Oncologist, Senior Researcher² Bobby Zachariae, MSc (Psych.), Professor, Research Director3 1: Research Unit for General Practice, University of Aarhus 2: Department of Oncology, Aarhus University Hospital 3: Psykooncological Research Unit. University of Aarhus.

7. Aim of 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 Guldin D. 12.5.09

8. 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 Guldin D. 12.5.09

9. Project flow chart Patient inclusion Intervention groupControl 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

10. 09-05-2015 Mai-Britt Guldin 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.

11. 09-05-2015 Mai-Britt Guldin 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.

12. 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! m.guldin@alm.au.dk