中島 聡美

INTRODUCTION: Evidence provides support for the therapeutic benefits of targeting avoidance in prolonged grief. However, it is not clear whether avoidance interferes with mourning through altered resilience to stress, as measured by heart rate variability (HRV). METHODS: Thirty-five adults (30 female; mean age: 39.2 years), who had been bereaved for more than one year, participated in this prospective, observational study. At each of the initial assessments and up to six-month follow-ups, grief symptoms were assessed using the Complicated Grief Questionnaire, and a resting electrocardiogram was recorded to extract the high-frequency component of HRV (HF-HRV). To differentiate avoidance from grief itself, principal component analysis was used. RESULTS: A nonlinear cross-sectional relationship was observed between avoidance and HF-HRV (coefficient = 0.29, p = .003); the lower the avoidance, the lower the HF-HRV in the low avoidance group. Grief improved only in the low avoidance group longitudinally. The observed relationship between increased HF-HRV and decreased grief was modified by the avoidance group, such that the low-avoidance group drove this association (estimate -0.53, 95% CI -0.86, -0.21, p = .001), while the high-avoidance group did not (estimate 0.44, 95% CI -0.32, 1.20, p = .26). CONCLUSION: Despite its palliative gain, avoidance relates to the maintenance of grief longitudinally through attenuated autonomic resilience to stress.

AIM: This study aimed to examine the impact of grief and depression on reduced productivity in and outside work among bereaved family members of individuals with cancer. METHODS: We used the data from the J-HOPE-4 study, a nationwide cross-sectional survey involving the bereaved families of individuals with cancer in inpatient hospices and palliative care units across Japan. We evaluated the participants' level of grief on the Brief Grief Questionnaire, their level of depression on the Patient Health Questionnaire, and their level of productivity loss on the Work Productivity and Activity Impairment Questionnaire. RESULTS: Of the participating 902 bereaved families, 98 individuals (10.9%) corresponded to probable prolonged grief disorder (PGD) and 367 (40.7%) to possible PGD. Of the 217 individuals (24.1%) corresponded to mild depression, 89 (9.9%) to moderate depression, and 44 (4.9%) to moderate-to-severe depression. The work-related productivity losses in possible and probable PGD samples were 12.6% and 15.7%, respectively. The work-related productivity losses due to mild, moderate, and moderate-to-severe depression were 8.8%, 19.4%, and 32.5%, respectively. The productivity losses outside work in individuals with possible and probable PGD were 21.6% and 30.9%, respectively. The productivity losses in mild, moderate, and moderate-to-severe depression were 22.6%, 32.8%, and 37.0%, respectively. CONCLUSION: The impact of grief on productivity loss was comparable with that of mild to moderate depression. Both the severity of grief and depression were significantly associated with productivity losses outside work, while only depression was significantly associated with work-related productivity loss.

Abstract Introduction Light information critically influences sleep and emotion regulation. Nighttime light exposure has been suggested to disrupt sleep and predict poor health outcomes. However, little is known about how sleep changes after bereavement and how sleep changes contribute to prolonged grief. We examined the association between nighttime light exposure and sleep continuity in bereaved adults. Methods In this cross-sectional study, 30 adults who had been bereaved for at least one year, wore a wrist actigraphy for seven consecutive nights. Bedroom light intensity from bedtime to rising time (BLI, lux) and sleep continuity variables were estimated from the wrist actigraphy. We tested the association between BLI and natural log-transformed sleep continuity measures and explored factors that modify this relationship in multivariable-adjusted generalized linear models. Results Nearly 40% of participants were diagnosed with current prolonged grief disorder (PGD), even after a median of 2.5 years since the loss. The mean BLI was 3.72 lux. Overall, higher BLI was associated with lower sleep continuity, independently of psychological, physical, and sleep covariates, including total sleep time, sleep midpoint, and season. This was particularly evident for sleep fragmentation index (B = 0.076; 95% CI, 0.029–0.122; exp[B] = 1.079), indicating that every 1-unit increase in BLI was associated with a 7.9% increase in sleep fragmentation index. Moreover, the association between BLI and sleep fragmentation was more robust in participants with current PGD, those who had lost a child or spouse, and those whose loss was violent or sudden than in those without each of these characteristics. Similarly, depressive symptoms, hypnotic use, and regular alcohol drinking also modified the relationship between BLI and sleep fragmentation. Conclusion These data strengthen the evidence for nighttime light exposure and sleep fragmentation. Our findings suggest that post-loss stress and vulnerability factors interact to disrupt sleep through increased light sensitivity at night. Further research is needed to determine the role of sleep fragmentation in the maintenance of and recovery from grief. Support (if any) This work was supported by the Intramural Research Grant for Neurological and Psychiatric Disorders of NCNP (Grant numbers #3-1 and #6-1) and KAKENHI (Grant numbers #20H01774 and #23H01045).

Importance Cognitive processing therapy (CPT) is an evidence-based treatment for posttraumatic stress disorder (PTSD). However, there is little evidence on the efficacy of CPT in East Asia. Objective To evaluate whether CPT is effective in treating PTSD among outpatients in a Japanese medical setting. Design, Setting, and Participants This randomized clinical trial used a 16-week, single-center, assessor-blinded, parallel-group superiority design to examine the efficacy of CPT in conjunction with treatment as usual (CPT-TAU) vs waiting list with TAU (WL-TAU) from April 2016 through December 2022. The trial included adult patients with PTSD at a national psychiatric referral hospital in Tokyo, Japan. Analysis was based on intention to treat and per protocol and was performed from February 1 to April 30, 2024. Interventions Participants were randomized 1:1 to CPT-TAU (n = 29), which consisted of 12 weekly individual CPT sessions, or WL-TAU (n = 31), which consisted of clinical monitoring and/or pharmacotherapy. Main Outcomes and Measures The primary outcome was the Clinician-Administered PTSD Scale (CAPS-5) score for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) at 17 weeks. Secondary outcomes included self-reported PTSD symptoms assessed by the PTSD Checklist–5 and responder status at 17 weeks. Adverse events were evaluated using the Japanese version of the Common Terminology Criteria for Adverse Events, version 4.0. Results Among 60 eligible participants (all included in the intention-to-treat analysis), mean (SD) age was 36.9 (9.9) years; 54 (90.0%) were women. The CPT-TAU group showed a mean (SE) reduction in CAPS-5 scores of 14.00 (1.92) points, with a low dropout rate (2 of 29 [6.9%]). Patients in the CPT-TAU group showed superiority in all secondary and other outcomes. The mean change difference was observed in depression (8.83; 95% CI, 6.00-11.66), suicidal ideation (6.73; 95% CI, 1.25-12.22), disability (8.16; 95% CI, 3.90-12.43), clinical global impression (0.84; 95% CI, 0.41-1.26), and loss of principal PTSD diagnosis (59.09; 95% CI, 37.19-81.00). There were no serious adverse events in the CPT-TAU group and 3 serious adverse events in the WL-TAU group during the intervention period. Conclusions and Relevance In this randomized clinical trial of CPT-TAU vs WL-TAU, CPT was superior in reducing PTSD symptoms. These results strengthen the evidence for use of CPT in East Asian populations. Trial Registration Umin.Uc.Jp/Ctr Identifier: UMIN000021670

Grief reactions to the bereavement of a close individual could involve empathy for pain, which is fundamental to social interaction. To explore whether grief symptoms interact with social relatedness to a person to whom one directs empathy to modulate the expression of empathy, we administered an empathy task to 28 bereaved adults during functional magnetic resonance imaging, in which participants were subliminally primed with facial stimuli (e.g., faces of their deceased or living relative, or a stranger), each immediately followed by a visual pain stimulus. Individuals' grief severity promoted empathy for the pain stimulus primed with the deceased's face, while it diminished the neural response to the pain stimulus primed with the face of either their living relative or a stranger in the medial frontal cortex (e.g., the right dorsal anterior cingulate cortex). Moreover, preliminary analyses showed that while the behavioral empathic response was promoted by the component of "longing" in the deceased priming condition, the neural empathic response was diminished by the component of "avoidance" in the stranger priming condition. Our results suggest an association between grief reactions to bereavement and empathy, in which grief symptoms interact with interpersonal factors to promote or diminish empathic responses to others' pain.

Abstract Grief reactions to the bereavement of a close individual could involve empathy for pain, which is fundamental to social interaction. To explore whether grief symptoms interact with social relatedness to a person to whom one directs empathy to modulate the expression of empathy, we administered an empathy task to 28 bereaved adults during functional magnetic resonance imaging, in which participants were subliminally primed with facial stimuli (e.g., faces of their deceased or living relative, or a stranger), each immediately followed by a visual pain stimulus. Individuals’ grief severity promoted empathy for the pain stimulus primed with the deceased’s face, while it diminished the neural response to the pain stimulus primed with the face of either their living relative or a stranger in the medial frontal cortex (e.g., the right dorsal anterior cingulate cortex). Moreover, preliminary analyses showed that while the behavioral empathic response was promoted by the component of “longing” in the deceased priming condition, the neural empathic response was diminished by the component of “avoidance” in the stranger priming condition. Our results suggest an association between grief reactions to bereavement and empathy, in which grief symptoms interact with interpersonal factors to promote or diminish empathic responses to others’ pain.

Cognitive processing therapy (CPT) is one of the most widely tested evidence-based treatments for posttraumatic stress disorder (PTSD). However, most studies on CPT have been conducted in Western cultural settings. This open-label, single-arm trial investigated the feasibility, acceptability, and preliminary efficacy of CPT for treating Japanese patients with PTSD. A total of 25 outpatients underwent 12 CPT sessions. The primary outcome was the assessment of PTSD symptoms using the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV); secondary outcomes included the assessment of subjective PTSD severity, depressive and anxiety symptoms, trauma-related cognitions, and subjective quality of life. All outcomes were evaluated at pretreatment (i.e., baseline), posttreatment, and 6- and 12-month follow-ups. On average, participants attended 13 sessions of CPT (SD = 1.38), with a completion rate of 96.0%. One serious adverse event (hospitalization) occurred. Significant within-subjects standardized mean differences in CAPS-IV scores were found from baseline to treatment completion, g = -2.28, 95% CI [-3.00, -1.56]; 6-month follow-up, g = -2.95, 95% CI [-3.79, -2.12]; and 12-month follow-up, g = -2.15, 95% CI [-2.89, -1.41]. Moderate-to-large effects, gs = -0.77 to -2.45, were found on secondary outcomes. These findings support the feasibility, acceptability, and preliminary efficacy of CPT in a Japanese clinical setting.

OBJECTIVE: No prior studies have used a single sample of bereaved families of cancer patients to compare multiple scales for assessing Complicated Grief. Here, we compare the two measures. METHODS: We sent a questionnaire to the bereaved families of cancer patients who had died at 71 palliative care units nationwide. RESULTS: The analysis included 3173 returned questionnaires. Prevalence of Complicated Grief was 7.8% by Brief Grief Questionnaire (with a cutoff score of 8) and 15.5% for Inventory of Complicated Grief (with a cutoff score of 26). The Spearman's correlation coefficient between the Brief Grief Questionnaire and the Inventory of Complicated Grief was 0.79, and a ceiling effect was seen for the distribution of the Brief Grief Questionnaire scores. Although 6.4% of respondents scored both 8 or higher on the Brief Grief Questionnaire and 26 or higher on the Inventory of Complicated Grief, only 1.4% scored both 8 or higher on the Brief Grief Questionnaire and <26 on the Inventory of Complicated Grief. In contrast, 9.1% scored <8 on the Brief Grief Questionnaire but 26 or higher on the Inventory of Complicated Grief. CONCLUSION: The prevalence of Complicated Grief was estimated to be higher by the Inventory of Complicated Grief than by the Brief Grief Questionnaire in this sample. Patients with severe Complicated Grief might be difficult to discriminate their intensity of grief by the Brief Grief Questionnaire. Once the diagnostic criteria of Complicated Grief are established, further research, such as optimization of cutoff points and calculations of sensitivity and specificity, will be necessary.

This commentary discussed the psychological issues related to bereavement in the wake of the COVID-19 pandemic. Specifically, we addressed two aspects in the context of Japanese culture. The first relates to the psychological distress of members of the bereaved family who could not visit their loved ones who had COVID-19 before or after their death. The second relates to the bereavement experience of those who were unable to be with their loved ones when the end came, even though they did not have COVID-19, because of restrictions on visiting hospitals. We seek to focus on the need for a support system for bereaved families to help them through the grieving process, and discuss end-of-life care in such circumstances, and in the post-COVID-19 era, as in current day Japan.

【背景・目的】性暴力被害者が被害後の急性期に被害による心身への影響や司法手続きおよび支援に関する情報を得ることは，被害後のストレスを軽減し，被害者を適切な治療や支援に繋げやすくすると考えられる．しかし，被害後急性期の被害者に総合的な支援情報を提供する媒体は少なく，その有用性について評価されたものはない．そこで，急性期性暴力被害者のための情報提供用ハンドブック（以下，冊子）を作成し，性暴力被害者の支援者または治療者（以下，支援・治療者）を対象に本冊子の有用性について評価を行った． 【方法】先行研究や性暴力被害者への聞き取りを基に冊子原案を作成し，多職種の専門家，被害当事者（29名）に意見を求めて原案を修正し冊子を作成した．本冊子の有用性を評価するため，産婦人科医療機関や支援機関に所属する性暴力被害者の支援・治療者（186名）を対象に自記式アンケート調査を行った．本調査では，調査協力者へ先に本冊子を配布し冊子を使用してもらい，3カ月後に本冊子の有用性についての自記式調査票を配布し回答を得た．本研究の実施にあたり，国立精神・神経医療研究センター倫理委員会の承認を得た． 【結果】対象者のうち104名（回収率55.9%）から回答を得た．回答者は，女性が95.2%であり，平均年齢は54.1±13.1歳であった．調査期間に被害者に本冊子を使用した者は18.3%であった．冊子全体の評価では，支援者および被害者・家族にとって「役に立った」という回答は80%以上あり，「理解しやすかった」という回答は70%以上であった．調査期間中に支援・治療を経験した者では，そうでない者と比べ「治療・支援が円滑に行えた」という評価が高い一方，「時間の負担」が増したとする意見が多かった． 【考察】本冊子は，支援者の視点から被害者に情報提供をする上で有用であるという評価を得た．今後は性暴力被害者から評価を得て本冊子の内容を検討することが課題である．