An empirical examination of the stage theory of grief
An empirical examination of the stage theory of grief
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DOI：
10.1001/jama.297.7.716
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发表时间：
2007-02-21
影响因子：
120.7
通讯作者：
Prigerson, Holly G.
中科院分区：
文献类型：
--
作者：
Maciejewski, Paul K.;Zhang, Baohui;Prigerson, Holly G.
背景悲伤的阶段理论仍然是一个被广泛接受的丧亲调整模型，仍然在医学院教授，受到医生的拥护，并在不同的背景下应用。目的考察5种悲伤指标丧失后的相对大小和变化规律，以验证其与悲伤阶段理论的一致性。设计、设置和参与者纵向队列研究(耶鲁大学丧亲研究)收集了2000年1月至2003年1月期间康涅狄格州233名失去亲人的数据。主要结果衡量5个项目，评估不信任、渴望、愤怒、抑郁和对死亡的接受，从1个月到24个月。结果与阶段理论相反，不信任不是最初的、占主导地位的悲伤指标。接受是最常被认可的项目，渴望是失恋后1至24个月的主要负面悲痛指标。在考虑了心理反应起伏的模型中，一旦重新衡量，怀疑从最初的高点下降到损失后1个月，渴望在损失后4个月达到峰值，愤怒在损失后5个月达到峰值，抑郁在损失后6个月达到峰值。在整个研究观察期间，接受度都有所增加。5个悲痛指标在悲痛阶段论预测的序列(不相信、向往、愤怒、抑郁和接受)中达到各自的最大值。结论识别自然原因死亡后的正常悲痛阶段有助于理解普通人如何在认知和情感上处理失去家庭成员的问题。考虑到负面悲伤指标都在丢失后大约6个月内达到峰值，那些在丢失后6个月后这些指标得分较高的人可能会从进一步的评估中受益。
Context The stage theory of grief remains a widely accepted model of bereavement adjustment still taught in medical schools, espoused by physicians, and applied in diverse contexts. Nevertheless, the stage theory of grief has previously not been tested empirically.Objective To examine the relative magnitudes and patterns of change over time post-loss of 5 grief indicators for consistency with the stage theory of grief. Design, Setting, and Participants Longitudinal cohort study (Yale Bereavement Study) of 233 bereaved individuals living in Connecticut, with data collected between January 2000 and January 2003.Main Outcome Measures Five rater-administered items assessing disbelief, yearning, anger, depression, and acceptance of the death from 1 to 24 months postloss.Results Counter to stage theory, disbelief was not the initial, dominant grief indicator. Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from 1 to 24 months postloss. In models that take into account the rise and fall of psychological responses, once rescaled, disbelief decreased from an initial high at 1 month postloss, yearning peaked at 4 months postloss, anger peaked at 5 months postloss, and depression peaked at 6 months postloss. Acceptance increased throughout the study observation period. The 5 grief indicators achieved their respective maximum values in the sequence (disbelief, yearning, anger, depression, and acceptance) predicted by the stage theory of grief.Conclusions Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member. Given that the negative grief indicators all peak within approximately 6 months postloss, those who score high on these indicators beyond 6 months postloss might benefit from further evaluation.