The Research On The Relationship Between Grief And Stress-related Growth

1 BackgroundChina’s aging population is characterized by a large proportion of elderly women.It is estimated that,by 2050,elderly widows will account for more than 80%of the widowed elderly.The loss of ones’spouse,as a major negative event,may pose a negative impact on the quality of life of older women.Urban elderly widows should receive more attention from researchers with the growing number of urban empty-nest elderly in the wake of the growth of the only child and the increase of inter-regional mobility.Research focus on the elderly has been shifted from the negative impact of aging,stress,disease and other factors to stress-related growth that enjoys attention of positive psychology and public health improvement strategy in recent times.Related studies conducted on college students,patients with chronic diseases and cancer patients found that positive psychological changes were observed in the process of coping with stress after experiencing negative events.There is strong evidence abroad that psychological growth can significantly relieve negative emotions and enhance positive emotions.In addition,it indicated that,some survivors experienced positive changes in their own lives during the bereavement process,such as closer family relationships and newly-taken.However,studies on stress-related growth is still at the preliminary stage in China now.In the future,a comprehensive research system needs to be formed concerning the research object,method,measurement tools and content.According to Hogan bereavement experience theory,stress-related growth,an important part of the process of bereavement and mourning can occur at any stage and it is most noticeable in the process of extreme grief.Personal growth is the result of profound reflection on the bereaved as they are consumed by despair and emptiness.The search for meaning and purposes makes them less critical,more caring,more tolerant and more compassionate.At present,there is no empirical evidence about the mechanism for bereavement that catalyzes personal growth in the process of mourning.The influence of traditional culture leads to a lack of theoretical and empirical research on grief counseling in China,especially assessment tools for grief and the characteristics of crowd-based grief.Literature review suggests that few reports on the process of psychological and social adaptation of bereaved groups.2 ObjectiveThis study aimed to evaluate the reliability and validity of the Chinese version of Stress-related Growth Scale-Short Form(SRGS-SF)and the Texas Revised Inventory of Grief-Present Scale(TRIG-Present)in the bereaved adults,and to provide a reliable measurement tool to assess the psychological growth and grief of bereaved groups.Based on Hogan’s theory of bereavement experience,we explored the mechanism of psychological growth in the process of mourning,and to explore the intermediary role of meaning in life in the relationship between grief and stress-related growth of elderly widowed women in Guangzhou.Thus it offers reference to community activities which aim to promote active aging of widowed elderly and to enhance their quality of life.3 Methods3.1 Cross-cultural adaption of the assessment toolThe original version of SRGS-SF and TRIG-Present were translated through Brislin model(forward translation,back translation,culture adaption and pilot study).Responses from 201 and 460 bereaved Chinese adults were collected through an online survey to assess the psychometric properties of the Chinese version of SRGS-SF and TRIG-Present,respectively.The data was collected in two separate phases.In the first phase,subjects completed the general information,bereavement data,and the Chinese version of SRGS-SF.In the second phase,the general information,bereavement data questionnaire,the Chinese version of TRIG-Present,and short Chinese Version of the Center for Epidemiologic Studies Depression Scale(CES-D-9)were used.Factor analysis,content analysis,internal consistency test,and retest reliability were conducted to test the psychometric properties of the Chinese version of SRGS-SF and TRIG-Present.3.2 Cross-sectional studyIn the empirical research of the stress-related growth in widowed elderly women,the inclusion criteria of the subjects:permanent residents of Guangzhou urban area(registered permanent residents or Chinese citizens living in Guangzhou for more than6 months);widowed;women aged 60 or older;the ones who were able to read independently or complete the required questionnaire with the help of researchers.Exclusion criteria:severe somatic diseases with definite diagnosis(including advanced cancer,decompensation of cardio-hepatic renal function);persons in hospital;the ones or their family members who do not agree to participate in this study.By means of the convenient sampling method,101 widowed elderly women in Guangzhou were surveyed with the self-made questionnaire of general situation and bereavement data,meaning in life scale for the elderly,the Chinese version of the TRIG-Present,and the Chinese version of the SRGS-SF.4 Results4.1 Reliability and validity test of the Chinese version of SRGS-SF in the bereaved.The Chinese version of SRGS-SF involved 15 items.Two factors(interpersonal and intra-interpersonal growth)were obtained that accounted for 53.80%of the total variance.The confirmatory factor analysis showed that the two-factor model had good fit(χ~2/df=1.58,CFI=0.939,TLI=0.928,RMSEA=0.075,SRMR=0.051).Both the item level of Content Validity Index(I-CVI)and scale level of Content Validity Index(S-CVI)were equal to 1.00.The Cronbach’s alpha coefficient of the total scale and each dimension ranged from 0.84 to 0.92,and the retest reliability coefficient(ICC)was between 0.82 and 0.83.4.2 Reliability and validity test of the Chinese version of TRIG-Present in the bereavedThe Chinese version of TRIG-Present had a single-dimension structure with 13items.The internal consistency coefficient of the scale was 0.957,indicating that the scale had good internal consistency reliability.Both I-CVI and S-CVI reached 1.00,indicating that the scale had good content validity.The TRIG-Present score could distinguish the grief intensity of the deceased caused by the expected death from accidental death(expected death vs.accidental death=43.72 vs.38.69,t=3.56,P<0.01),indicating that the scale had good discrimination validity.The total score of TRIG-Present presented moderate positive correlation with the total score of depression scale and negative symptom dimension(r=0.569,0.607,respectively,P<0.01),and weak negative correlation with positive symptom dimension(r=-0.228,P<0.01),showing that the scale had good convergence validity.4.3 Relationship between grief and stress-related growth in elderly widowed women in Guangzhou:the mediation effect of meaning in lifeFor the surveyed elderly widowed women in Guangzhou,their average score of grief was 26.86±12.75;the average score of meaning in life was 27.08±5.54;and the average score of stress-related growth was 16.40±6.12.The structural equation model fitted the data well(χ~2/df=0.156,TLI=1.0,CFI=1.0,RMSEA=0 and SRMR=0.01).The path analysis showed that grief had a significant positive impact on meaning in life(β=0.216,P<0.05),but posed little impact on the stress-related growth(β=0.108,P>0.05).The meaning in life had a significant positive impact on quality of life(β=0.692,P<0.05).Meaning in life played a complete mediating role in the relationship between grief and stress-related growth(β=0.15,95%confidence interval was[0.027,0.304]).5 Conclusions5.1 The Chinese version of the SRGS-SF has good reliability and validity,it can be used to measure the psychological growth of the bereaved group.5.2 The Chinese version of the TRIG-Present has good reliability and validity,and easy of application,which thus can be used to evaluate the grief of the bereaved.5.3 The elderly widowed women in Guangzhou have relatively low grief level,relatively strong sense of meaning in life,and medium level of stress-related growth.They obtain the stress-related growth by finding the meaning in life following spouse bereavement.Therefore,it is advisable for communities to focus on the mourning adaptation process of the widowed elderly women.Activities for adjusted awareness,the grasp of meaning of suffering and improved self-value reflection should be carried out to promote their sense of life meaning and psychological growth.