the relationships among grief experience, problem-solving appraisal, and depression: an exploratory...

19
This article was downloaded by: [University of Chicago Library] On: 06 October 2014, At: 05:37 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Personal and Interpersonal Loss: International Perspectives on Stress & Coping Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/upil19 The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study Jon K. Reid a & Wayne A. Dixon a a Southeastern Oklahoma State University , Durant, Oklahoma, USA Published online: 17 Jan 2008. To cite this article: Jon K. Reid & Wayne A. Dixon (2000) The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study, Journal of Personal and Interpersonal Loss: International Perspectives on Stress & Coping, 5:1, 77-93, DOI: 10.1080/10811440008407848 To link to this article: http://dx.doi.org/10.1080/10811440008407848 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,

Upload: wayne-a

Post on 09-Feb-2017

213 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

This article was downloaded by: [University of Chicago Library]On: 06 October 2014, At: 05:37Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Journal of Personal and InterpersonalLoss: International Perspectives onStress & CopingPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/upil19

The Relationships Among GriefExperience, Problem-Solving Appraisal,and Depression: An Exploratory StudyJon K. Reid a & Wayne A. Dixon aa Southeastern Oklahoma State University , Durant, Oklahoma, USAPublished online: 17 Jan 2008.

To cite this article: Jon K. Reid & Wayne A. Dixon (2000) The Relationships Among GriefExperience, Problem-Solving Appraisal, and Depression: An Exploratory Study, Journal ofPersonal and Interpersonal Loss: International Perspectives on Stress & Coping, 5:1, 77-93, DOI:10.1080/10811440008407848

To link to this article: http://dx.doi.org/10.1080/10811440008407848

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,

Page 2: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 3: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

Journal of Personal and Interpersonal Loss, 5: 77-93, 2000 Copyright 0 2000 Taylor & Francis 1081-1443/00 812.00 +.OO

THE RELATIONSHIPS AMONG GRIEF EXPERIENCE,

EXPLORATORY STUDY PROBLEM-SOLVING APPRAISAL, AND DEPRESSION : AN

JON K. REID and WAYNE A. DIXON Southeastern Oklahoma State University, Durant, Oklahoma, USA

Research has consistently shown a relationship between problem-solving appraisal and depressive symptoms. This study expands that research includitg grief symp- tomatology as a variable. A college student sample completed the Problem-Solving inventory, the Beck Depression fnventoiy, and the Revised Grief Experience Inven- tory. Consistent with hypotheses, those individuals who had experienced the death of a close loved one within the previous Syears reported sign$cant& higher levels o f grief and depression than those who had not experienced such a loss. However, the group that had exkerienced the death of a close loved one did not report signijicantb worse problem-solving scores than the group that did not. This study also examined the relationsh$s among problem-solving appraisal, depressive symptoms, and grigf symptoms within the subsample that had experienced the loss of a close loved one within the previous 5years. Consistent with predictions, grief symptoms were associ- ated with dtpressive symptoms and sey-appraised ineffective problem solving. T h e results of this study extend the research on grief and mourning. Also, the results expand our understanding of the grief process providing preliminary evidence f o r the role of problem solving in this process.

Grief is a natural response to loss, particularly loss from bereave- ment. Bereavement refers to the state of having experienced the death of a loved one. The numerous symptoms of grief can be cate- gorized under the headings of feelings, cognitions, and behaviors.

Received 10 August 1998; accepted 11 September 1998. Funding for this project was provided through a grant from Southeastern Oklahoma

Address correspondence to Jon K. Reid, Department of Psychology and Counseling, Box State University’s Organized and Applied Research Award Program.

4021, Southeastern Oklahoma State University, Durant, OK 74701-0609, USA.

77

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 4: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

78 3. K . Reid and M.’. A . Dixon

Some of those symptoms are sadness, anger, troubling cognitions absent-mindedness, difficulty in concentration or memory, and dis- turbances of sleep and appetite (Osterweis, Solomon, & Green, 1984 ; Worden, 199 1 ).

The ongoing experience of bereavement may present itself in ways less measurable than in symptoms. Rubin (1992) found that bereaved parents continued to be influenced in a “continuing and powerful” way “for a period extending 13 years following death” (p. 195). Rubin (1992) has proposed and researched extensively a two-track model of bereavement. This model refers to the “ways of transforming the bereaved’s attachment to the deceased and estab- lishing new forms of ongoing relationships to the memories of that person” (Rubin & Schechter, 1997, p. 280). Consistent with the model, Rubin and Schechter (1997) found that, based on vignettes presented to the lay public, the lay public’s view was that “a con- tinuing relationship to the deceased was considered normative five years after death” (p. 279). In addition, complicated mourning may extend indefinitely or appear episodically (Rando, 1993). Thus, the characteristics of acute grief may present themselves in a less than linear trajectory, and the influence of the loss may con- tinue for a number of years, in ways other than in symptomatic form.

Grief has a major impact on our society. For example, it has been estimated that more than 8 million Americans experience the death of a close family member each year (Osterweis et al., 1984). Following the death of a close family member comes a period of stress and grief Grief among college student populations is of par- ticular concern, since studies have indicated that, following a stressful life event such as the death of a loved one, there tends to be a decrease in college grade point average and an increased risk for attrition (Sarason, Johnson, & Siegel, 1978). Grief, for college students, may be complicated by the transitional status of the student facing age-appropriate developmental tasks and the reduced social support that may accompany residing away from home. An additional factor is that typical college-aged peers avail- able for support may suffer from a relative lack of experience in dealing with grief (Balk et al., 1998).

Much of the theoretical and practical literature on grief and mourning indicates that problem solving may be related to grief

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 5: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

Grief Experience and Problem Solving 79

experience (Cook & Dworkin, 1992; Figley, 1989; Parkes, Relf, & Couldrick, 1996; Rando, 1993). A number of sources have also indicated that memory loss and cognitive impairment can accom- pany bereavement (Cook & Dworkin, 1992; Osterweis et al., 1984; Sanders, 1992; Worden, 1991).

The role of problem solving in grief has not been ignored by the clinical literature. Although their research was not empirically based, Neeld (1990) and Worden (1991, 1994) identified problem solving as a key component in reconciling oneself to a bereavement-related loss. A task-based approach to understanding grief relates conceptually to a problem-solving orientation. In con- ducting grief therapy, Worden (1991) advocates assessing which of the four tasks of grief has not been completed. Task 1 addresses accepting the reality of the loss, and Task 2 addresses working through to the pain of grief. The third task of grief identified by Worden (1991) is adjusting to an environment in which the deceased is missing, and the fourth and final task of mourning involves emotionally relocating the deceased and moving on with life. As addressed later, it is the third task that appears most related clinically to this study.

Studies have also consistently shown that depressive symptoms are linked to ineffective personal problem solving. For example, in a review of the literature, Dixon, Heppner, Burnett, Anderson, and Wood (1993) found 22 studies that linked increases in depressive symptoms to decreases in effective problem solving across a variety of populations. Since the literature has consistently shown a relationship between depressive symptoms and grief symptoms, there may also be a relationship between problem solving and grief symptoms. Although the direction of this relationship is difficult to determine, it is addressed in the transactional model described subsequently. This relationship was shown by Jacobs, Kasl, Schaefer, and Ostfeld (1994), who found that those who used more problem-focused planning had a reduced risk of “psychological distress one year into follow-up” (p. 562) after their loss, however, no empirical data that we are aware of have examined whether one’s ability to solve problems of daily living is also impaired while grieving.

Moreover, Dixon et al. (1993) have recently proposed a trans- actional model of problem solving. They speculated that although

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 6: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

80 3. IT. Reid and W. A . Dixon

problem solving is an antecedent (cause) of some disorders, it is also sometimes a concomitant (temporary symptom) of these symp- toms. Thus, there may be a vicious cycle between problem solving and various disorders, including grief reactions and symptoms. Consistent with this, they found that problem solving was an ante- cedent of future depressive symptoms, as well as a concomitant of current ones.

The overall purpose of this study was to extend the research on grief and problem solving by examining the relationship between problem-solving appraisal and grief. In accord with the theoretical literature on grief and mourning and in accord with Dixon et al.’s (1993) transactional model of problem solving, it was predicted that there would be a relationship between problem-solving appraisal and grief. More specifically, it was predicted that those individuals who had experienced the death of a close loved one within the previous 5 years would report significantly higher levels of grief, depression, and ineffective problem solving than those who had not experienced such a loss.

A second purpose of this study was to examine the relationships among problem-solving appraisal, depressive symptoms, and grief symptoms within the subsample that had experienced the loss of a close loved one within the previous 5 years. We predicted that grief symptoms would be correlated with depressive symptoms and self- appraised ineffective problem solving. Also consistent with the lit- erature, we predicted that there would be a strong correlation between depressive symptoms and grief symptoms.

A third purpose of the study was to examine which of the problem-solving inventory (PSI) factors (Problem-Solving Con- fidence, Approach-Avoidance Style, and Personal Control) is most strongly related to grief symptoms. To date, there has been a lack of attention paid to differential relations with the three factors (see Larson & Heppner, 1989). Such a focus might result in the addi- tion of more specific information to the understanding of the coping process, particularly with regard to grieving. Consistent with some past research that has shown that the Problem-Solving Confidence factor has a stronger relation to depressive symptoms than do the Approach-Avoidance Style and Personal Control factors, we predicted that this factor would also have a stronger relation to grief symptoms.

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 7: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

Grief Experience and Problem Solving 81

Method

Participants

The total sample consisted of 118 undergraduate and graduate stu- dents who were enrolled in psychology classes at a regional uni- versity. The sample included 83 female respondents, 29 male respondents, and 6 who did not report their gender. Sixty-seven of the respondents reported their ethnic background as Caucasian, 6 reported it as Native American, 3 reported it as African American, 1 reported it as Hispanic, and 20 did not report their ethnicity. The average age for the total sample was 30 years.

A subsample of 21 of the respondents had reported the death of a close loved one within the previous 5 years. As addressed pre- viously, Rubin (1992) and Rubin and Schechter (1997) found that the influence of some losses may extend for years afterward, partic- ularly the parental loss of a child. Only a portion of the bereaved in the current study had experienced child loss, since this study was an exploratory one, however, using the period of 5 years seemed reasonable and also facilitated gathering more bereaved partici- pants from this sample of convenience. The losses represented by the 2 1 bereaved participants included parent, sibling, child, and spouse. This sample included 11 female respondents, 8 male respondents, and 2 who did not report their gender. Fourteen of the respondents reported their ethnic background as Caucasian, 4 reported it as Native American, and 3 did not report their ethnicity. The average age for this subsample was 38 years, a fact influenced no doubt by the inclusion of graduate students in the sample and by the high number of returning students at this particular university.

Instrumentation

The Revised Grief Experience Inventory (RGEI) is a 22-item instru- ment measuring grief reactions along four dimensions. The RGEI is a shortened version of the Grief Experience Inventory (Sanders, Mauger, & Strong, 1985). As a result of the authors’ desire to use a Scantron format for recording responses in the current study, which limited the number of questions that could be asked, an

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 8: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

a2 3. K . Reid and W. A . Dixon

instrument shorter than the GEI was needed. In addition, rather than the dichotomous response format of the GEI, the RGEI uses a 6-point scale ranging from strongly agree to strongly disagree. Per- mission to revise the scoring to a Likert format was received from the primary author (Lev). We believed that such a revision would lend itself to ease of administration and scoring. The possibility that this might affect the reliability and validity of the RGEI was considered but not deemed a serious threat.

Reliability and validity have been reported in Lev, Munro, and McCorkle (1993). The RGEI has also been used in the following studies: Lev, Nuamah, Robinson, and McCorkle (1995) and Lev, and Owen (1996). Four factors were selected via a principal- components factor analysis, these factors accounted for 57.7% of the variance (Lev et al., 1993). Validity was established through several mechanisms : selecting items from the GEI, an instrument with validity already established; review of the proposed items by a panel of experts; correlating relationship to the deceased with intensity and direction of responses on the RGEI; and, as pre- viously indicated, conducting a principal-components factor analysis. Reliability coefficients reported on the RGEI subscales and total score ranged from .72 to .93 (Lev et al., 1993).

Subscales (and sample items) are as follows: Existential Con- cerns (e.g., “I feel lost and helpless”), Depression (e.g., “I cry easily”). Tension and Guilt (e.g., “I have feelings of guilt because I was spared and the deceased taken”), and Physical Distress (e.g., “I have frequent headaches since the death”). Higher scores on the RGEI subscales and higher total RGEI scores indicate more grief (Lev et al., 1993). Since it was assumed that some of the par- ticipants would not be recently bereaved, the response option of “not applicable” was added to the RGEI.

The Problem-Solving Inventory (Form B ) ; (Heppner, 1988a) is com- posed of 35 Likert-type items, rated on a 6-point scale ranging from strongly agree (1 ) to strongly disagree (6) that measure people’s perceptions of their personal problem-solving behaviors and atti- tudes. The inventory measures people’s appraisal of their problem- solving capacities on a global level, apart from specific problems (Heppner, 1988b). Lower scores indicate assessment of oneself as a relatively effective problem solver, whereas higher scores indicate assessment of oneself as a relatively ineffective problem solver.

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 9: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

Grief Experience and Problem Solving 83

Although PSI scores have been found to correlate significantly with observational ratings of problem-solving skill (Heppner, 1988b), the PSI measures an individual’s global self-appraisal of his or her problem-solving ability rather than the individual’s actual ability (Heppner, 1988b).

Factor analysis has revealed that the PSI is composed of three factors : Problem-Solving Confidence ( 1 1 items), Approach- Avoidance Style (16 items), and Personal Control (5 items). Problem-Solving Confidence “refers to self-assurance while engag- ing in problem-solving activities” (Heppner, 1988b, p. 1). A sample item from this subscale is “I have the ability to solve most problems even though initially no solution is immediately appar- ent” (p. 8). Approach-Avoidance Style refers to “a general tendency of individuals to approach or avoid problem-solving activities” (Heppner, 1988b, p. 2) . A sample item is “When I have a problem, I think up as many possible ways to handle it as I can until I can’t come up with any more ideas” (p. 8. ) Personal Control “indicates the extent to which individuals believe that they are in control of their emotions and behavior while solving prob- lems” (Heppner, 1988b, p. 2). A sample item is “Even though I work on a problem, sometimes I feel like I am groping or wander- ing, and am not getting down to the real issue” (p. 9).

The PSI appears to be relatively internally consistent and stable, with Cronbach alpha coefficients ranging from .72 to .90 and test- retest coefficients ranging from .83 to .89 over a 2-week period (Heppner, 1988b). In addition, the PSI has received sizable research support suggestive of its validity in discerning differences across problem-solving styles, attitudes, and behaviors (see Heppner, 1988b). For example, validity estimates suggest that the PSI measures constructs that are (a) amenable to change through problem-solving training; (b) related to a wide variety of cognitive, affective, and behavioral variables; and (c) unrelated to social desirability or intelligence (see Heppner, 198813).

The Beck Depression Inventory (BDI) ; Beck, Ward, Mendelson, Mock, & Erbaugh, 196 1 ) is a 2 1 -item, nonspecific scale that assess- es a person’s depressive symptomatology during the previous week. The BDI is commonly used to measure depressive symptoms by surveying several areas, including feeling states, relationships with others, physical indices of depression (e.g., loss of appetite, change

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 10: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

84 3. X. Reid and W . A . Dixon

in amount of sleep needed, change in body weight), performance on daily tasks, and outlook toward the future. Estimates of reli- ability and validity (psychiatric criterion measures) have been found to be .78 and . 7 7 within a university population (Oliver & Burkham, 1979).

Procedure

The participants were asked to complete the three instruments (in the following order: RGEI, PSI, BDI), followed by several demo- graphic questions. The instruments were completed in January and in May. Participation was strictly voluntary, no inducements were offered for participation. Participants were solicited from the courses of three professors.

Results

To test our first predictions that those individuals who had experi- enced the death of a close loved one within the previous 5 years would report significantly higher levels of grief, depression, and ineffective problem solving than those who had not experienced such a loss, we conducted a series of independent t tests. Consistent with predictions, the group (n = 21) that had experienced the death of a close loved one reported significantly higher mean grief scores (A4 = 57.62) than the group (n = 97) that had not (M = 46.34), t ( 1 , 116) = 4.34, p < .05. Likewise, the group that had reported the death of a close loved one reported significantly higher mean depression scores ( M = 12.00) than the group that had not (A1 = 5.94), t ( 1 , 116) = 12.64, p < .0005. However, the group that had experienced the death of a close loved one did not report significantly worse problem-solving scores ( M = 84.95) than the group that had not ( M = 85.04), t ( 1, 116) = 0.00, p < .98.

To test our second set of predictions, that there would be signifi- cant relationships among problem-solving appraisal, depressive symptoms, and grief symptoms within the subsample that had experienced the loss of a close loved one within the last 5 years, we conducted a series of zero-order intercorrelation analyses. (See Table 1) . Consistent with predictions, there was a strong corre- lation between grief symptoms and problem-solving appraisal,

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 11: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

TABLE

1 Z

ero-

Ord

er C

orre

latio

ns B

etw

een

Var

iabl

es a

nd T

heir

Mea

ns a

nd S

tand

ard

Dev

iatio

ns fo

r th

e Sa

mpl

e of

2 1

Tha

t Had

E

xper

ienc

ed th

e D

eath

of

a L

oved

One

With

in t

he P

revi

ous

5 Y

ears

Var

iabl

e 1

2 3

4 5

6 7

8 9

10

1.R

GE

I exi

sten

tial c

once

rns

2.R

GE

I de

pres

sion

3.R

GEI

ten

sion

and

gui

lt 4.

RG

EI p

hysi

cal distress

5.R

GE

I 6.

BD

I 7.

PSI

%PS

I pro

blem

-sol

ving

conf

iden

ce

9.PS

I ap

proa

ch-a

void

ance

styl

e 1O

.PSI

per

sona

l con

trol

M

SD

.84*

* .4

3 .7

6**

.91*

* -

.45*

.w**

.95*

* -

.58*

.6

3*

-

.94**

14.2

9 19

.19

9.10

15

.05

57.6

2 8.

88

8.47

4.

38

7.69

26

.11

.87*

* .8

7**

.45*

.8

5**

.91*

* -

12.0

0 12

.21

.63*

* .60*

.I2

.56*

.5

9*

.67*

* -

84.9

5 23

.56

.72*

* .5

5*

.06

.50*

.5

8*

.69*

* .8

4**

24.0

5 9.

80

.42

.45*

.I

3 .4

2 .44*

.50*

.9

4**

.63*

~

44.5

2 12

.19

.52*

.6

5*

.14

.63*

.60*

.58*

.7

9**

.46*

.75*

* ~

16.3

8 4.

93

Noh

RG

EI =

Rev

ised

Gri

ef E

xper

ienc

e In

vent

ory;

BD

I = B

eck

Dep

ress

ion

Inve

ntm

y; P

SI =

Pro

blem

-Sol

ving

Inv

ento

ry. H

ighe

r scores o

n th

e R

GE

I an

d R

GE

I su

hsca

lcs i

ndic

ate

mor

e gr

ief,

whe

reas

hig

her scores

on th

e B

DI

and

PSI

indi

cate

hig

her l

eveh

of d

cpra

sion

and

inef

fect

ive

pmbl

cm solving, r

cspe

ctiv

ely.

* p

< .0

5. **

p <

.W1.

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 12: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

86 J . X. Reid and W. A . Dixon

r = .59, p < .004, as well as a strong correlation between grief symptoms and depressive symptoms, r = .91, p < .001. Consistent with past research, there was also a strong correlation between problem-solving appraisal and depressive symptoms, r = .67, p < .0009. Furthermore, there were several strong correlations between the subscales of the RGEI and depressive symptoms and ineffective problem-solving appraisal. The RGEI Existential Con- cerns subscale correlated .63 with the PSI (I, < .002) and .87 (p < .0001) with the BDI. The RGEI Depression subscale corre- lated .60 with the PSI (I, < .002) and .87 (I, < .0001) with the BDI. The RGEI Tension and Guilt subscale correlated .13 with the PSI (I, < .59) and .45 (I, < .05) with the BDI. The RGEI Physical Distress subscale correlated .56 with the PSI (I, < .008) and .85 (I, < .0001) with the BDI.

To test our third set of predictions and examine which of the PSI factors (Problem-Solving Confidence, Approach-Avoidance Style, and Personal Control) was most strongly related to grief symptoms, we conducted a series of intercorrelation analyses among the PSI factors and the RGEI and BDI. Consistent with predictions, all of the PSI factors were strongly correlated with the RGEI and BDI. Next, to investigate which aspect of self-appraised problem solving was most strongly associated with grief symptoms, we conducted a simultaneous multiple regression analysis. Results of this analysis indicated that only the Problem-Solving Confidence subscale accounted for a significant portion of unique variance. F(1, 18) = 9.98, p < .005. Approach-Avoidance Style did not account for a significant portion of unique variance. F( 1, 18) = 1.00, p < .33, nor did Personal Control, F(1, 18) = 4.37, p < .06.

Discuss ion

The overall purpose of this study was to extend research on grief and problem solving by examining the relationships among problem-solving appraisal, depressive symptoms, and grief symp- toms. Consistent with our hypotheses, those individuals who had experienced the death of a close loved one within the previous 5

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 13: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

Grief Experience and Problem solving 87

years reported higher levels of grief and depression than those who had not experienced such a loss. However, the group that had experienced the death of a close loved one did not report signifi- cantly worse problem-solving scores than the group that had not experienced such a loss. This finding is difficult to interpret and may be due to several factors, including the small sample size of bereaved individuals, the mean age differences between the groups, the range of bereavement encompassing 5 years since the loss, and the variety of types of losses represented in the sample of 21 participants.

The second purpose of this study was to examine the relation- ships among problem-solving appraisal, depressive symptoms, and grief symptoms within the subsample that had experienced the loss of a close loved one within the last 5 years. Consistent with predic- tions, there were significant correlations between all of the vari- ables. More specifically, grief symptoms were associated with depressive symptoms and self-appraised ineffective problem solving, Likewise, depressive symptoms were also associated with self-appraised ineffective problem solving.

The third purpose of this study was to examine which of the PSI factors (Problem-Solving Confidence, Approach-Avoidance Style, and Personal Control) is most strongly related to grief symptoms. All of the PSI factors were strongly correlated with grief symptoms. Higher grief symptoms were associated with the Problem-Solving Confidence factor. The more grief symptoms participants reported, the less self-assurance they reported while engaging in problem- solving activities. Higher grief symptoms were also associated with the Approach-Avoidance Style factor. The more grief symptoms reported, the more individuals tended to report avoiding problem- solving activities. Finally, grief symptoms were strongly correlated with the Personal Control factor. The more grief symptoms report- ed, the more individuals reported losing control of their emotions and behavior while solving problems. In agreement with predic- tions, the Problem-Solving Confidence factor was the strongest pre- dictor of grief symptoms. This is consistent with past research showing that the Problem-Solving Confidence factor has a stronger relation to depressive symptoms (Dixon et al., 1993), hopelessness, and suicide ideation (Dixon, Heppner, & Anderson, 1991) than do the Approach-Avoidance Style and Personal Control factors.

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 14: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

88 3. IT. Reid and W. A . Dixon

The results of this study have some important theoretical impli- cations. For example, consistent with the literature on grief and mourning, and consistent with Dixon et al.’s (1993) transactional model of problem solving, the results indicate that grief symptoms are associated with self-appraised ineffective problem solving. Past research has linked self-appraised ineffective problem solving to a host of psychological problems such as hopelessness and suicide ide- ation (Dixon, Heppner & Rudd, 1994). Perhaps, through their impact on problem solving, grief symptoms make an individual vulnerable to other psychological concerns such as hopelessness and suicide. Of course, alternative interpretations of the data are possible. For example, it is always possible that those who appraise themselves as more effective in regard to problem solving are able to make a more timely progression with the grief associated with their particular type of loss. However, regardless of which interpre- tation of the data is correct, the present results underscore the importance of problem solving in the grieving process.

There are also several clinical implications from the results of this study. Because grief symptoms are associated with reductions in perceived problem-solving effectiveness, grief therapy may need to focus on problem-solving training. As introduced earlier, Worden’s (1991, 1994) task-based approach to understanding grief relates conceptually to a problem-solving orientation. It is the third task that appears most related clinically to this study. If the client appears to be having difficulty with the third task, then “problem- solving is a major part of grief therapy-the patient is taught to overcome his or her helplessness by trying out new skills, developing new roles and, in general, is encouraged to get back to living” (Worden, 1991, p. 82). An additional intervention for addressing the third task was presented in a workshop on grief of children and influence of parents’ grief on children, in which Worden (1994) advocated that spousally bereaved men, who may be disinclined to take part in a support group focused on emotional expression, may be inclined to attend a support group focusing on skill development as it relates to single parenting. In addition, in the support groups described by Neeld (1990), a “project manage- ment” tool, in the form of a worksheet, is used; this involves turning the ideas for solving a problem into a structured project (e.g., writing down purpose, goals, and time line for the project).

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 15: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

Grief ExFerience and Problem Salving 89

Problem-solving interventions may be especially useful as a pre- ventive measure following loss and may lower a person’s chances of becoming hopeless and at risk for suicide. Note also that problem- solving appraisal does not overlap completely with the acquisition of problem-solving skills. In other words, individuals may appraise themselves as more effective in solving problems than they really are, or they may be more effective in problem solving than they appraise themselves to be. Because of this, for some clients) recei- ving training in problem-solving skills may be helpful; for others, concentrating more on the appraisal aspect may be more helpful ; and, for still others, focusing on both skills and appraisal may be necessary.

Although the present study involved bereaved individuals, a study of those diagnosed with cancer sheds light on the relationship between problem-solving effectiveness and responsiveness to cancer treatment. Sobel and Worden (1982) reported that “the high dis- tressed patient was an individual who: ( 1 ) used fewer coping stra- tegies; (2) employed less effective strategies; (3) had significantly more problems or concerns; and (4) achieved poor resolutions when attempting to solve critical illness-related concerns.” (p. 6). This led the research team to a problem-solving orientation for an intervention. Indeed, they reported that “at-risk cancer patients who received the cognitive-behavioral intervention had a steady decrease in distress scores and manifested significantly lower dis- tress scores, than the control group” (pp. 6-7). Once again, this study involved cancer patients rather than the bereaved, but it warrants consideration and application to assisting the bereaved. Consistent with the needs of the participants in this sample, any of the preceding interventions could be used in individual counseling through a university counseling center, as well as through support groups or group counseling offered in the university setting. In the classroom, a problem-solving orientation along with skill develop- ment could be included in a variety of psychology courses and courses in other disciplines) such as human development, family studies, and education.

Certainly, neither the results of this study nor the sources con- sulted assert that problem solving is the key to grief resolution; rather, it is a key element among other important components of successful grief resolution, some of which are less tangible. Attig

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 16: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

90 3. X. Reid and M‘. A . Dixon

(1996) draws our attention to less tangible aspects of grief, as he conceptualizes grief as a process of relearning the world after the death of a loved one. This perspective involves not only the facing and resolving of problems but, even more important, the facing of the mysteries of life and death (such as finiteness, change, and uncertainty), which may not be so easily resolved as problems of daily living may be. As grief progresses, we “seek to place the death and our lives in a context of belief that enables us to renew hope and to find consolation, peace and meaning as we go on living” (Attig, 1996, p. 14).

Although the results of this study support most of our predic- tions, various considerations limit the generalizability of our con- clusions. Particularly, two concerns stand out: One is the small sample size of bereaved individuafs, and the other is that the study involved only college students, a group that may be different from the general population in a number of ways. Thus, these findings must be interpreted cautiously. A replication of this study with a larger sample size of more recently bereaved individuals from the general population is warranted. In addition, a revised order of presentation of instruments is recommended. The Revised Grief Experience Inventory could be presented after the Problem- Solving Inventory and the Beck Depression Inventory, so as not to artifically influence the responses of the bereaved on those instruments by causing them to reexperience potentially uncom- fortable thoughts or feelings. Nonetheless, the results of this study extend the research on grief and mourning and provide evidence for the role of problem solving in the grief process. Our results suggest several implications for therapeutic interventions that merit examination.

References

Attig, T. (1996). How we grieve: Relearning the world. Oxford, England: Oxford University Press.

Balk, D. E., Lampe, S., Sharpe, B., Schwinn, S., Holen, K., Cook, L., & Dubois, R, 111. (1998). TAT results in a longitudinal study of bereaved college stu- dents. Death Studies, 22, 3-21.

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 17: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

Grief Experience and Problem Salving 91

Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychia ty , 4, 561-571.

Cook, A. S., & Dworkin, D. S. (1992). Helping the bereaved: Therapeutic interventions f o r children, adolescents, and adults., New York: Basic Books.

Dixon, W. A., Heppner, P. P., & Anderson, W. P. (1991). Problem-solving appraisal, stress, hopelessness, and suicide ideation in a college population. Journal of Counseling Psychology, 38, 5 1-56.

Dixon, W. A., Heppner, P. P., Burnett, J. W., Anderson, W. P., & Wood, P. K. (1993). Distinguishing among antecedents, concomitants, and consequences of problem-solving appraisal and depressive symptoms. Journal of Counseling Psy-

Dixon, W. A., Heppner, P. P., & Rudd, M. D. (1994). Problem-solving appraisal hopelessness, and suicide ideation : Evidence for a mediational model. Journal of Counseling Psychology, 41, 91-98.

Elliott, T. R., & Marmarosh, C. L. (1994). Problem-solving appraisal, health complaints, and health-related expectancies. Journal of Counseling and Develop- ment, 72, 531-537.

chology, 40, 357-364.

Figley, C. R. (1989). Helping traumatized fami l ies . San Francisco: Jossey-Bass. Heppner, P. P. (1988a). The problem-solving inventory (Form B). Palo Alto, CA:

Consulting Psychologist’s Press. Heppner, P. P. (198813). T h e Problem-Solving Inventoy M a n u a l . Palo Alto, CA: Con-

sulting Psychologists Press. Heppner, P. P., Witty, T., & Dixon, W. A. (1996). T h e Problem-Solving Inventory:

A review of the literature. Manuscript submitted for publication. Jacobs, S., Kasl, S., Schaefer, C., & Ostfeld, A. (1994). Conscious and uncon-

scious coping with loss. Psychosomatic Medicine, 56, 557-563. Larson, L. M., & Heppner, P. P. (1989). Problem-solving appraisal in an alco-

holic population. Journal of Counseling Psychology, 36, 73-78. Lev, E., Munro, B. A., & McCorkle, R. (1993). A shortened version of an instru-

ment measuring bereavement. rnternatio~ul Journal of Xu&g Studies, 30, 2 13- 226.

Lev, E., Nuamah, I. F., Robinson, L., & McCorkle, R. (1995). Smoking behav- iors, grief and bereaved family members’ health status and psychological dis- tress. j o u r n a l of Smoking-Related Disorders, 6, 99--108.

Lev, E. L., & Owen, S. V. (1996). A measure of self-care self-efficacy. Research in Nursing and Health, 19, 421429.

Neeld, E. H. (1990). Seven choices: Taking the steps to new l$e after losing someone you love. New York: Dell.

Oliver, J. M., & Burkham, R. (1979). Depression in university students as mea- sured in random samples: Duration, relation to calendar time, prevalence, and demographic correlates. Journal of Abnormal Psychology, 88, 667-670.

Osterweis, M., Solomon, F., & Green, M. (1984). Bereavement: Reactions, conse- quences, and care. Washington, DC : National Academy of Sciences.

Parkes, C. M., Relf, M., & Couldrick, A. (1996). Counselling in terminal care and bereavement. Leicester, England : British Psychological Society.

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 18: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

92 3. X . Reid and W. A . Dixon

Rando, T. .4. (19%). T h e treatment of complicattd mourning. Champaign, IL: Research Press.

Rubin, S. S. (1992). Adult child loss and the two-track model of bereavement. Omega, 24, 183-202.

Rubin, S. S., & Schechter, N. (1997). Exploring the social construction of bereavement : Perceptions of adjustment and recovery in bereaved men. Amer- icanJourna1 of Orthopychiaty, 67, 279-289.

Sanders. C. hf. (1992). Surviuing grief . . . and learning to live again. New York: Wiley.

Sanders, C . M. hlauger, P. A., & Strong, P. N. (1985). T h e Grief Experience Inuen- 107)’. Blowing Rock, NC: Center for the Study of Separation and Loss.

Sarason, I. G., Johnson, J. H., & Siegel, 1. M. (1978). Assessing the impact of life changes: Development of the Life Experiences Survey. Journal of Consulting and Clinical Psychology, 46, 932-946.

Sobel, H. J., & Worden, J. W. (1982). Practitioner’s manual: Helping cancer patients cope : A problem-solving intervention program f o r health care professionals. New York: BhlA Audio Cassettes/Guilford.

Worden, J. W. (1991 1). Grief counseling and grief therapy: A handbook f o r the mental health prac.titioner (2nd ed.). New York: Springer.

Worden, J. W. (1994). Grief and bereavement: Cliniral interventions. Topeka, KS: Menninger Clinic.

Jon K. Reid, is an associate professor in the Department of Psychology and Counseling at Southeastern Oklahoma State University and a grief therapist certified by the Association for Death Education and Coun- seling (ADEC). In addition to being a member of ADEC, he is a member of the American Psychological Association and the American Counseling Association. He maintains a part-time counseling and con- sulting practice in Sherman, Texas. His research interests include road- side death memorials, the Barbadian death system, and teacher attitudes toward coping with grief in the classroom. A native Texan, he received his PhD in family studies from ‘Texas Woman’s University in Denton, Texas. He has been published in Conlemporary Family Therapy; Illness, C r i J t r , and Loss : the Kentuckv Counseling dssociation Journal; Family Therapy: The Journal o f the Caltfornia Graduate School of Family Psychologv: and Psy- thology in the Sihools.

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4

Page 19: The Relationships Among Grief Experience, Problem-Solving Appraisal, and Depression: An Exploratory Study

Grief Experience and Problem Solving 93

Wayne A. Dixon, is an assistant professor in the Department of Psy- chology and Counseling at Southeastern Oklahama State University. A native of New York, he received his PhD from the University of Missouri-Columbia and has done extensive research in problem solving, depression, and suicidality. He has been published numerous times in the Journal of Counseling Psychology, as well as the Journal of Counseling and Development and Psychology in the Schools. He is also a member of the American Psychological Association.

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 0

5:37

06

Oct

ober

201

4