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Background: There is a need for an interview-based measure to assess Prolonged Grief Disorder (PGD) included in the text revision of the fifth Diagnostic and Statistical Manual for Mental Disorder (DSM-5-TR) and 11th edition of the International Classification of Disease (ICD-11). We evaluated the psychometric properties of the Traumatic Grief Inventory-Clinician Administered (TGI-CA); a new interview measuring DSM-5-TR and ICD-11 PGD severity and probable caseness. Methods: In 211 Dutch and 222 German bereaved adults, the: (i) factor structure, (ii) internal consistency, (iii) test-retest reliability, (iv) measurement invariance across subgroups (e.g., differing in language), (v) prevalence of probable caseness, (vi) convergent validity, and (vii) known-groups validity were examined. Results: Confirmatory factor analyses (CFAs) showed acceptable fit for the unidimensional model for DSM-5-TR and ICD-11 PGD. Omega values indicated good internal consistency. Test-retest reliability was high. Multi-group CFAs demonstrated configural and metric invariance for DSM-5-TR and ICD-11 PGD criteria for all group-comparisons; for some we found support for scalar invariance. Rates of probable caseness for DSM-5-TR PGD were lower than ICD-11 PGD. Optimal agreement in probable caseness was reached when increasing the number of accessory symptoms for ICD-11 PGD from 1+ to 3+. Convergent and known-groups validity was demonstrated for both criteria-sets. Limitations: The TGI-CA was developed to assess PGD severity and probable caseness. Clinical diagnostic interviews for PGD are needed. Conclusions: The TGI-CA seems a reliable and valid interview for DSM-5-TR and ICD-11 PGD symptomatology. More research in larger and more diverse samples is needed to further test its psychometric properties.

Objective: The Dutch Congenital hypothyroidism (CH) Newborn Screening (NBS) algorithm for thyroidal and central congenital hypothyroidism (CH-T and CH-C, respectively) is primarily based on determination of thyroxine (T4) concentrations in dried blood spots, followed by thyroid-stimulating hormone (TSH) and thyroxine-binding globulin (TBG) measurements enabling detection of both CH-T and CH-C, with a positive predictive value (PPV) of 21%. A calculated T4/TBG ratio serves as an indirect measure for free T4. The aim of this study is to investigate whether machine learning techniques can help to improve the PPV of the algorithm without missing the positive cases that should have been detected with the current algorithm. Design & methods: NBS data and parameters of CH patients and false-positive referrals in the period 2007–2017 and of a healthy reference population were included in the study. A random forest model was trained and tested using a stratified split and improved using synthetic minority oversampling technique (SMOTE). NBS data of 4668 newborns were included, containing 458 CH-T and 82 CH-C patients, 2332 false-positive referrals and 1670 healthy newborns. Results: Variables determining identification of CH were (in order of importance) TSH, T4/TBG ratio, gestational age, TBG, T4 and age at NBS sampling. In a Receiver-Operating Characteristic (ROC) analysis on the test set, current sensitivity could be maintained, while increasing the PPV to 26%. Conclusions: Machine learning techniques have the potential to improve the PPV of the Dutch CH NBS. However, improved detection of currently missed cases is only possible with new, better predictors of especially CH-C and a better registration and inclusion of these cases in future models.

Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances and other symptoms, and has a substantial socioeconomic impact. Current biomedical and psychosocial treatments are unsatisfactory for many patients, and treatment progress has been hindered by the lack of a clear understanding of the pathogenesis of fibromyalgia. We present here a model of fibromyalgia that integrates current psychosocial and neurophysiological observations. We propose that an imbalance in emotion regulation, reflected by an overactive 'threat' system and underactive 'soothing' system, might keep the 'salience network' (also known as the midcingulo-insular network) in continuous alert mode, and this hyperactivation, in conjunction with other mechanisms, contributes to fibromyalgia. This proposed integrative model, which we term the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model, should be viewed as a working hypothesis with limited supporting evidence available. We hope, however, that this model will shed new light on existing psychosocial and biological observations, and inspire future research to address the many gaps in our knowledge about fibromyalgia, ultimately stimulating the development of novel therapeutic interventions.

To date, there have been no cohort studies of sexual harassment incidence and its relation to mental health within humanitarian field-workers. Research among numerous occupations suggests an association between workplace sexual harassment and several health complaints. This study examined the incidence and severity of sexual harassment and its association with changes in mental health in a cohort of international humanitarian aid field-workers (iHAWs). Four hundred and seventy-eight iHAWs filled in questionnaires about sexual harassment, depression, anxiety, and Post-Traumatic Stress Disorder (PTSD) as part of a larger study on health and well-being. Six percent of male and 18% of female iHAWs reported experiencing sexual harassment during their latest field assignment, with most reporting low levels of nonphysical forms of sexual harassment. Sexual harassment was predictive of negative changes in both depression and anxiety symptom severity between before and after an assignment for females; for males, it predicted negative changes in PTSD symptom severity. Sexual harassment did not predict utilization of mental healthcare services within 2 months after the end of assignment. The current findings are the first figures derived from a representative sample of iHAWs on the incidence of sexual harassment during a field assignment and show sexual harassment to be a relatively common and present issue. The findings are mostly in line with the extant literature and underscore the importance of attending to the issue of sexual harassment in the humanitarian sector.

Objective This study aimed to examine the severity of posttraumatic stress disorder (PTSD) symptoms in children of parents with cancer and to identify individual and family factors associated with these symptoms. Methods The sample consisted of 175 children (52% girls, aged M = 11.98, SD = 3.20, range = 6–20 years) from 92 families, of which 90 parents with a current or past cancer diagnosis and 71 healthy co-parents also completed questionnaires. Children reported on PTSD symptoms, trauma-related cognitions, emotion regulation difficulties, general family functioning, and family communication. Both parents reported on their own PTSD symptoms. Associations were investigated using multilevel regression. Results Twenty-seven percentage of the children showed clinically relevant PTSD symptoms. Intraclass correlations indicated that children from the same family showed little overlap in these symptoms. Multilevel analyses showed that child trauma-related cognitions and emotion regulation difficulties were related to higher levels of PTSD symptoms at the individual level. General family functioning was only related to child PTSD symptoms at the family level. Child PTSD severity was unrelated to parental PTSD symptoms and family communication at the family level when taking into account the other factors. Conclusions The current study highlights the psychological impact of parental cancer on children. Individual factors contributed more strongly to child PTSD symptoms than family factors. Trauma-related cognitions and emotion regulation difficulties might be targeted through specific psychoeducation for children and parents, family-oriented support and interventions, and evidence-based treatments for child PTSD.

Objective Knowledge about the temporal relationship between disturbed grief and symptoms of posttraumatic stress disorder (PTSD) may have important implications for clinicians working with bereaved trauma survivors. We aimed to investigate the longitudinal association between symptoms of complicated grief and PTSD in a bereaved trauma-exposed sample. Method In total, 275 bereaved survivors (M age = 19.3, SD = 4.6 years; 47.3% females) of the 2011 massacre on Utoya Island, Norway, participated in semistructured interviews 4-5 months (Time 1 [T1]), 14-15 months (Time 2 [T2]), and 30-32 months (Time 3 [T3]) posttrauma. Complicated grief was measured using the Brief Grief Questionnaire, and posttraumatic stress reactions using the University of California at Los Angeles PTSD Reaction Index. To explore associations between symptoms of complicated grief and PTSD over time, we used a random intercepts cross-lagged panel model. Results The participants had lost a close friend (n = 256) and/or a family member/partner (n = 19) in the attack. We found a strong correlation between stable individual differences in symptoms of complicated grief and PTSD across the three time-points. PTSD symptoms at T2 predicted complicated grief reactions at T3, but not vice versa. Conclusion Findings suggest that targeting PTSD symptoms among trauma-exposed bereaved may hinder later development of complicated grief. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This study investigated how children, a post-war generation without direct connection to war, relate to the commemoration of World War II (WWII). Seven group interviews were held among pupils in the Netherlands, aged 9 to 18 (n = 55) and, subsequently, questionnaires were administered to other pupils (n = 374). Results revealed that children are affected by the collective narrative of WWII, and connect to commemoration on a social and emotional level. Comprehension, tangibility, inclusiveness and a right atmosphere are key elements to appreciate a commemoration. Insights from this study may help societies practice more appealing remembrances with post-war generations.

The Traumatic Grief Inventory Self-Report (TGI-SR), which aims to assess both Persistent Complex Bereavement Disorder and Prolonged Grief Disorder, has been validated in several languages. This study sought to validate the French-Canadian version. We conducted an online survey exploring the impact of the COVID-19 pandemic on grief. With data from 728 participants, the scale demonstrated high internal consistency, correlated significantly with three other scales known to measure similar concepts, and distinguished between groups known to be different. This study supports the use of the TGI-SR French-Canadian version by clinicians and researchers to assess complications of grief.

WD40 repeat-containing proteins play a key role in many cellular functions including signal transduction, protein degradation, and apoptosis. The WD40 domain is highly conserved, and its typical structure is a β-propeller consisting of 4-8 blades which probably serves as a scaffold for protein-protein interaction. Some WD40 repeat-containing proteins form part of the corepressor complex of nuclear hormone receptors, a family of ligand-dependent transcription factors that play a central role in the regulation of gene transcription. This explains their involvement in endocrine physiology and pathology. In the present review, we first touch upon the structure of WD40 repeat-containing proteins. Next, we describe our current understanding of the role of WD40 domain containing proteins in nuclear receptor signaling e.g. as corepressor or coactivator. In the final part of this review, we focus on WD40 domain containing proteins that are associated with endocrine pathologies. These pathologies vary from isolated dysfunction of one endocrine axis, e.g., congenital isolated central hypothyroidism, to more complex congenital syndromes comprising endocrine phenotypes, such as the Triple-A syndrome.

BACKGROUND: There is increasing evidence, in transgenic mice and in vitro, that inhibitory killer cell immunoglobulin-like receptors (iKIRs) can modulate T cell responses. Furthermore, we have previously shown that iKIRs are an important determinant of T cell-mediated control of chronic virus infection and that these results are consistent with an increase in CD8+ T cell lifespan due to iKIR-ligand interactions. Here we test this prediction and investigate whether iKIRs affect T cell lifespan in humans in vivo. METHODS: We used stable isotope labelling with deuterated water to quantify memory CD8+ T cell survival in healthy individuals and patients with chronic viral infections. RESULTS: We showed that an individual's iKIR-ligand genotype is a significant determinant of CD8+ T cell lifespan: in individuals with two iKIR-ligand gene pairs, memory CD8+ T cells survived on average for 125 days, in individuals with four iKIR-ligand gene pairs then memory CD8+ T cell lifespan was doubled to 250 days. Additionally, we showed that this survival advantage is independent of iKIR expression by the T cell of interest and further that iKIR-ligand genotype altered CD8+ and CD4+ T cell immune aging phenotype. CONCLUSIONS: Together these data reveal an unexpectedly large impact of iKIR genotype on T cell survival. FUNDING: Wellcome Trust, Medical Research Council, EU Horizon 2020, EU FP7, Leukemia and Lymphoma Research, National Institute of Health Research Imperial Biomedical Research Centre, Imperial College Research Fellowship, National Institute of Health, Jefferiss Trust.

Thyroid hormones play an essential role in regulating whole-body homeostasis. Deiodinases are known to convert thyroid hormone from the prohormone thyroxine (T4) to the bioactive hormone tri-iodothyronine (T3) and convert both T4 and T3 toward their inactive metabolites 3,3’,5’-tri-iodothyronine (rT3) and 3,3’-di-iodothyronine (3,3’-T2). Deiodinases are thus important for the regulation of intracellular thyroid hormone concentrations. This is known to be crucial both during development and adult life in regulating thyroid hormone-related gene transcription. This review discusses the importance of liver deiodinases in determining serum and liver thyroid hormone concentrations, liver metabolism and liver disease.

Background Dispositional compassion is regarded as a facet of Agreeableness, an emotional driver of prosociality, and a primary marker of adjustment. We examined changes in dispositional compassion in Syrian young adults resettling in the Netherlands, as well as the role of migration-related and demographic variables in this change. Methods We analyzed data from a 4-wave (T1-T4), 13-month longitudinal study ( N = 168; T1 Mage = 28.1 years, 70% male) using Latent Growth Curve Modelling (LGCM) in Mplus. Results Bivariate correlations indicated moderate test-retest correlations across the four waves of dispositional compassion and several correlations with the migration-related and demographic variables. A LGCM indicated a high initial level and small linear decrease in compassion over the four waves. Except for a link between pre-migration adversity and the intercept, the migration-related and demographic variables were not related to either the intercept of the slope of dispositional compassion. Conclusion Results suggest that high levels of dispositional compassion may be common for Syrian young adults with refugee backgrounds, but on average, slowly decreases over time. The cross-sectional associations between migration-related and demographic variables and dispositional compassion in the absence of a prospective one emphasize the importance of longitudinal research for understanding trajectories of adjustment.

Currently, thyroid hormone status is predominantly determined by the measurement of serum thyroid-stimulating hormone and free thyroxine. Although it is assumed that serum thyroid hormone (TH) concentrations within the reference range represent euthyroidism, it is unknown whether this reflects euthyroidism in all tissues (e.g. brain, muscle, bone and liver). To date, no serum marker has been established for clinical use that represents TH status within tissues accurately. However, several biomarkers have been investigated and innovative techniques have been used to unravel new biomarkers. This review provides an overview of proposed serum biomarkers that reflect tissue TH status in humans. Furthermore, we discuss the feasibility of these serum markers in clinical practice.

Pierpont syndrome is a rare disorder characterized mainly by global developmental delay, unusual facial features, altered fat distribution in the limbs and hearing loss. A specific mutation (p.Tyr446Cys) in TBL1XR1, encoding a WD40 repeat-containing protein, which is a component of the SMRT/NCoR (silencing mediator retinoid and thyroid hormone receptors/nuclear receptor corepressors), has been reported as the genetic cause of Pierpont syndrome. Here, we used CRISPR-cas9 technology to generate a mutant mouse with the Y446C mutation in Tbl1xr1, which is also present in Pierpont syndrome. Several aspects of the phenotype were studied in the mutant mice: growth, body composition, hearing, motor behavior, thyroid hormone state and lipid and glucose metabolism. The mutant mice (Tbl1xr1Y446C/Y446C) displayed delayed growth, altered body composition with increased relative lean mass and impaired hearing. Expression of several genes involved in fatty acid metabolism differed in white adipose tissue, but not in liver or muscle of mutant mice compared to wild-type mice (Tbl1xr1+/+). No difference in thyroid hormone plasma concentrations was observed. Tbl1xr1Y446C/Y446C mice can be used as a model for distinct features of Pierpont syndrome, which will enable future studies on the pathogenic mechanisms underlying the various phenotypic characteristics.

Sjögren’s syndrome (SS) is a disease with autoimmune features that affects mainly women and compromises the health-related quality of Life (HRQoL); it is important to evaluate illness experience for a better understanding of the life situation of the patient. The aim of the study was to summarize the individual life experiences and determine the impact of HRQoL and oral health-related quality of life (OHRQoL) and their correlation with health self-assessment in women with SS. The life experiences evaluation employed a concept mapping design to structure qualitative content obtained from semi-structured interviews. Hierarchical cluster analysis was used to analyze the patient’s experiences. EQ-5D-5L and OHIP-14Sp were used. The correlation between appreciation of the general health status and OHIP-14 was evaluated. The experience classification by patients were analyzed and a dendrogram was obtained, identifying 10 clusters of disease experiences of SS, being limitations, pain and difficulties, coping and attitudes towards treatment the most common. Pain/discomfort in EQ-5D-5L and physical pain and psychological discomfort in OHIP-14 were the most affected dimensions in the patients. The results support the theoretical perspective that the experience of illness is relevant to describing the main difficulties of patients with SS and how it affects their quality of life.

More recently, the prolonged grief disorder (PGD) has been recognized as a mental health disorder following bereavement, which is distinct from depression and PTSD. However, the number and proposed symptom items vary across the ICD-11 and the DSM-5-TR criteria for PG. The Traumatic Grief Inventory-Self Report Plus (TGI-SR+), which is an updated version of the TGI-SR, is currently the only robust instrument that assesses PG according to the ICD-11 and DSM-5-TR criteria. For research and clinical use among French-speaking countries, the forward-backward procedure was applied to translate the TGI-SR+ into French language. Exploratory factor analysis and parallel analysis converged towards a two-dimensional structure for the TGI-SR+, representing adaptation difficulties and traumatic separation distress. However, items mapping onto ICD-11 and DSM-5-TR criteria for PG represented a one-dimensional structure. Findings based on item response theory method provided strong evidence for discriminative characteristics of the items. The internal reliability was excellent for the TGI-SR+ (McDonald's ω = 0.97) and ICD-11 and DSM-5-TR criteria for PGD (McDonald's ω = 0.95). We also demonstrated a very high temporal stability for the TGI-SR+ total score (ICC =.91, p < 0.0001) and ICD-11 PGD and DSM-5-TR PGD (ICC = 0.90, and ICC = 0.88, ps < 0.0001, respectively). The concurrent validity of the instrument was also demonstrated, such that the TGI-SR+ total score and all combinations were positively and significantly associated with the levels of depression, anxiety and post-traumatic stress symptoms. However, the effect sizes were moderate. We conclude that for research and clinical use among French bereaved populations, the TGI-SR+ is a sound tool with very good psychometric properties.

Thyroid hormone increases energy expenditure. Its action is mediated by TR, nuclear receptors present in peripheral tissues and in the central nervous system, particularly in hypothalamic neurons. Here, we address the importance of thyroid hormone signaling in neurons, in general for the regulation of energy expenditure.We generated mice devoid of functional TR in neurons using the Cre/LoxP system. In hypothalamus, which is the center for metabolic regulation, mutations were present in 20% to 42% of the neurons.Phenotyping was performed under physiological conditions that trigger adaptive thermogenesis: cold and high-fat diet (HFD) feeding. Mutant mice displayed impaired thermogenic potential in brown and inguinal white adipose tissues and were more prone to diet-induced obesity. They showed a decreased energy expenditure on chow diet and gained more weight on HFD. This higher sensitivity to obesity disappeared at thermoneutrality. Concomitantly, the AMPK pathway was activated in the ventromedial hypothalamus of the mutants as compared with the controls. In agreement, sympathetic nervous system (SNS) output, visualized by tyrosine hydroxylase expression, was lower in the brown adipose tissue of the mutants. In contrast, absence of TR signaling in the mutants did not affect their ability to respond to cold exposure.This study provides the first genetic evidence that thyroid hormone signaling exerts a significant influence in neurons to stimulate energy expenditure in some physiological context of adaptive thermogenesis. TR function in neurons to limit weight gain in response to HFD and this effect is associated with a potentiation of SNS output.

Common symptoms of overt hypothyroidism are non-specific and include fatigue, lethargy, and dry skin. Although the diagnosis is considered to be straightforward, no single symptom can be used to identify patients with overt hypothyroidism, while many patients with subclinical hypothyroidism are asymptomatic. A large population-based study on the spectrum of symptoms in subclinical hypothyroidism showed similar rates of thyroid disease-related symptoms compared with euthyroid subjects, while the TSH concentration had no impact on symptom score. Together, these findings make it challenging to attribute symptoms to their underlying cause. This is also true in the case of unexplained persistent symptoms in levothyroxine-treated patients. Although generally considered a life-long replacement therapy, successful thyroid hormone discontinuation resulting in euthyroidism has been reported in approximately one third of patients. Thus, we overtreat patients with (subclinical) hypothyroidism, highlighting the importance of reliable diagnostic criteria. The diagnostic process, including the implementation of robust TSH and FT4 reference intervals, is especially challenging in specific situations including aging, pregnancy, non-thyroidal illness, and central hypothyroidism. There is a clear need for improved adherence to current guidelines from scientific societies and for willingness to manage symptoms without a clear pathological correlate, especially in the case of mild TSH elevations. This review will highlight recent literature on this topic and offers some practice points.

Variation exists in how people respond to the loss of a loved one. For most people, grief reactions will naturally decrease over time. Yet, approximately 10% of people bereaved by a natural cause (Lundorff et al., 2017) and 50% of the people bereaved by an unnatural cause (Djelantik et al., 2020) develops intense and disabling grief symptoms associated with significant distress interfering with daily functioning. These grief symptoms are referred to as prolonged grief disorder (PGD) in the DSM-5-TR (APA, 2022). PGD is characterized by persistent yearning/longing for the deceased, and preoccupation with thoughts or memories of the deceased for at least twelve months after the death of a loved one. Due to the potential traumatic characteristics of losses during the COVID-19 pandemic, it is expected that PGD prevalence will be high (Kokou-Kpolou et al., 2020). In line with this expectation, preliminary results demonstrated that (acute) PG is high in people bereaved during the COVID-19 pandemic (Breen et al., 2022), compared to people bereaved before the COVID-19 pandemic (Downar et al., 2022; Eisma & Tamminga, 2020). To date, most studies evaluating grief levels in people bereaved during the COVID-19 pandemic have focused on the presence or absence of psychopathology. However, mental health not only encompasses less psychopathology, but also increased well-being. The dual-continua model of mental health by Keyes (2005) holds that psychopathology and well-being are related, yet distinct dimensions. Accordingly, the absence of psychopathology does not imply the presence of well-being and vice versa. This is why focusing only on the presence or absence of psychopathology gives an overly one-sided picture of mental health. In addition, psychological disorders have often been studied dichotomously (i.e., absent or present) by reporting on prevalence rates or have been studied using symptom-level means. Consequently, individual differences in psychological responses are not taken into account, while research suggests that there are considerable differences in psychological responses between individuals (e.g., Boelen et al., 2019; Djelantik et al., 2018; Eisma et al., 2019; Nielsen et al., 2019). A statistical method that can be used to identify subgroups of people that vary in response patterns is latent class analysis (LCA). LCA classifies people into unobserved subgroups (i.e., latent classes) based on similar response patterns. So far, one prior LCA study identified latent classes of bereaved people based on both negative (i.e., PGD symptoms) and positive (i.e., post-traumatic growth (PTG)) psychological outcomes (Zhou et al., 2018). They found three latent classes: one class characterized by low/moderate PGD and low/moderate PTG, a second class characterized by low/moderate PGD and high PTG, and a third class characterized by moderate/high PGD and high PTG. To our understanding, no studies have yet been conducted examining classes of bereaved people in terms of indicators of PGD and well-being. However, it is likely that latent classes of bereaved people can be identified based on differences in their endorsement of different indicators of PGD and well-being. Accordingly, the first aim of our study is to examine if, among Dutch people who lost a loved one during the COVID-19 pandemic, heterogeneous latent classes can be identified that differ in terms of the endorsement of these indicators. The second aim of our study is to examine correlates (i.e., socio-demographic, pandemic-related, health-related, and trauma exposure characteristics) of class membership.

Most people who are confronted with the death of a loved adjust without needing professional help. A significant minority of people confronted with loss develops symptoms of prolonged grief disorder (PGD), sometimes accompanied by bereavement-related post-traumatic stress disorder (PTSD) and depression. PGD is newly included in the psychiatric classification systems of the ICD-11 and DSM-5-TR. In Ukraine, many people are currently facing losses, in circumstances that may render them vulnerable to develop PGD and associated symptoms. In this article, we address “healthy” grief and discuss the nature, assessment, risk factors, and treatment of “unhealthy” grief, now referred to PGD. We also introduce a cognitive behavioural theory that helps to understand problematic psychological processes involved in the persistence and maintenance of PGD and that offers a clear framework for the application of all kinds of cognitive behavioural interventions and other treatment interventions that can be used to alleviate the pain of people with PGD. Examples of these interventions are described. Attention is paid to how the situation of war affects the development and treatment of PGD.

The death of a loved one is one of the most common potentially traumatic life events (Benjet et al., 2016; Stroebe & Schut, 2007). Around 10% of bereaved people after a natural death (e.g., old age) and 50% after an unnatural death (e.g. traffic accident) develops disabling and persisting grief symptoms that interfere with daily functioning (Djelantik et al., 2020; Lundorff et al., 2017), including prolonged grief disorder (PGD). Yet, relatively little is known about the development of grief over time. Latent trajectory studies can be used to examine differences in the course of grief symptoms over time. Latent trajectory studies are an extension of current research, which is dominated by examining means of symptom-levels or the presence/absence of a psychological disorder. Criteria for PGD were recently included in the text-revision of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR; American Psychological Association [APA], 2022). Therefore, it is important to study PGD trajectories according to the latest DSM-5-TR criteria. Thus far, only one study has examined latent trajectories of PGD symptom-levels based on DSM-5-TR criteria in bereaved people (Pociunaite et al., preprint). In this study, four PGD DSM-5-TR trajectories were identified including 1) a High stable PGD trajectory (i.e., with PGD symptom-levels continuously higher than the cut-off score for PGD, 2) a High PGD quick recovery trajectory (i.e., with initially high PGD levels, which decrease quickly), 3) a High PGD slow recovery trajectory (i.e., characterized by initially high PGD levels that decrease slowly), and 4) a Low PGD symptoms trajectory (i.e., marked by PGD levels continuously below the cut-off for PGD). To our understanding, the current study is the first to examine latent trajectories of PGD DSM-5-TR symptom-levels in people bereaved during the COVID-19 pandemic. Due to the presumed high risk for PGD in people who lost a loved one during this pandemic (Reitsma et al., 2023), it is highly relevant to investigate how grief develops over time in this specific population. Accordingly, the first aim of our study is to identify trajectories of PGD DSM-5-TR symptom-levels in a sample of Dutch adults who lost a loved one during the first eight months of the COVID-19 pandemic. Our second aim is to identify predictors (i.e., socio-demographic, loss-related, health-related, and trauma exposure characteristics) associated with the different trajectories.

Objectives Hormone measurements using automated immunoassays (IAs) can be affected by the sample matrix. Liquid chromatography tandem-mass spectrometry (LC-MS/MS) is less affected by these matrix effects. In clinical laboratories, testosterone, cortisol and, free thyroxine (FT4) are often measured using IAs. Renal failure alters serum composition in blood samples from people undergoing hemodialysis (HDp) and have, therefore, a complex serum constitution compared to healthy controls (HC). The goal of this study was to investigate the accuracy of testosterone, cortisol, and FT4 measurements in samples of HDp and to get more insight in the interfering factors. Methods Thirty serum samples from HDp and HC were collected to measure testosterone, cortisol, and FT4 using a well standardized isotope dilution (ID)-LC-MS/MS method and 5 commercially available automated IAs (Alinity, Atellica, Cobas, Lumipulse, UniCel DXI). Method comparisons between LC-MS/MS and IAs were performed using both HDp and HC samples. Results Average bias from the LC-MS/MS was for testosterone, cortisol, and FT4 immunoassays respectively up to 92, 7–47 and 16–27% more in HDp than in HC samples and was IA dependent. FT4 IA results were falsely decreased in HDp samples, whereas cortisol and testosterone concentrations in females were predominantly falsely increased. Correlation coefficients between LC-MS/MS and IA results were lower in HDp compared to HC samples. Conclusions Several IAs for testosterone (in women), cortisol, and FT4 are less reliable in the altered serum matrix of samples of HDp than in HC. Medical and laboratory specialists should be aware of these pitfalls in this specific population.

Around 10% of bereaved youths experience symptoms of prolonged grief disorder (PGD). Recently, PGD was included in the two main classification systems for mental disorders: the ICD-11 and DSM-5-TR. Assessing PGD symptoms in youth is currently hindered by the lack of instruments for ICD-11 and DSM-5-TR criteria. To fill this gap, we developed an instrument to assess PGD symptoms in children and adolescents, the Traumatic Grief Inventory – Kids – Clinician-Administered (TGI-K-CA), based on input of grief experts and bereaved children. Five experts rated the items on alignment with DSM-TR and ICD-11 PGD symptoms and comprehensibility. The adjusted items were then presented to seventeen bereaved youths (Mdnage = 13.0 years, range = 8–17 years). Using the Three-Step Test Interview (TSTI), children were asked to verbalize their thoughts while answering the items. Issues raised by experts were mostly related to alignment with the DSM-5-TR/ICD-11 symptom, ambiguous formulation of the items, or low comprehensibility for children and adolescents. Items raising fundamental issues according to experts were adjusted. The TSTI showed that children encountered relatively few problems with the items. Frequently reported problems with some of the items (e.g. regarding comprehensibility) led to final adjustments. With input from grief experts and bereaved youths, an instrument to assess PGD symptoms as defined in DSM-5-TR and ICD-11 in bereaved youths was finalized. Further quantitative research is currently undertaken to evaluate the instrument’s psychometric qualities. Children with symptoms of Prolonged Grief Disorder (PGD) experience a debilitating longing for and/or preoccupation with a deceased loved one.Assessment of PGD in youth is hindered by the lack of an instrument.With the involvement of grief experts and bereaved youth, the current study developed an instrument that can be used in bereaved children and adolescents. Children with symptoms of Prolonged Grief Disorder (PGD) experience a debilitating longing for and/or preoccupation with a deceased loved one. Assessment of PGD in youth is hindered by the lack of an instrument. With the involvement of grief experts and bereaved youth, the current study developed an instrument that can be used in bereaved children and adolescents.

In psychotherapy, sudden gains depict large and stable reductions in symptoms between two consecutive treatment sessions (Tang & DeRubeis, 1999). A recent meta-analysis showed that on average about one third of patients experience sudden gains, and patients with sudden gains had better treatment outcomes at post-intervention and follow-up than patients without sudden gains (Shalom & Aderka, 2020). The effects of sudden gains in treatments for children and adolescents are comparable to those in treatments for adults but have so far been investigated in fewer studies (Shalom & Aderka, 2020). No study to date investigated sudden gains in the treatment of prolonged grief disorder (PGD), a new diagnosis in ICD-11 and DSM-5-TR. It is therefore the aim of the study to examine if 1) sudden gains occur during two different treatment programs for children and adolescents with PGD symptoms, 2) whether sudden gains are related to treatment outcome, and 3) if the occurrence of sudden gains is related to the content of the session prior to the gain.

The disappearance of a significant person is an ambiguous loss due to the persistent uncertainty about the whereabouts of the person. Measures specifically capturing the psychological consequences of ambiguous loss are lacking. Therefore, this study aimed to develop the Ambiguous Loss Inventory Plus (ALI+) and evaluated its suitability for use with relatives of missing persons.

In this liviing systematic review, prevalence rates and correlates of positive and negative psychological effects of bereavement due to COVID-19 are examined

It has been posited that an excessive intolerance for uncertainty (IU) may contribute to the anxious and rigid characteristics common in individuals with eating disorders (ED). Individuals with elevated IU appraise stimuli quicker as uncertain, experience distress when faced with uncertainty and display an excessive tendency to avoid uncertainty. Elevated levels of IU are found across the EDs, corroborating IU as a transdiagnostic factor. IU is associated to more severe ED pathology but also to broader psychological outcomes such as social-emotional and executive functioning difficulties. Experimental and IU intervention studies are lacking. IU is relevant for adults and adolescents, although research in adolescents is minimal. We propose that IU may be implicated in the development of EDs as well as function as an important maintenance factor. The last decade has seen a surge in IU research in ED, particularly in Anorexia Nervosa (AN) and an updated review on IU in ED is timely. In this scoping review we will review all the published IU literature in the ED field (up to 31st August 2023) in order to present a clinical framework for IU in ED. Our protocol will be drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols, which will be revised by the research team. We will discuss clinical implications and recommendations for future research.

Road traffic accidents (RTAs) are the leading cause of death worldwide for young people aged 5-29 years (WHO, 2022). Parents of children who died in RTAs are at risk for psychological problems after the loss (Bolton et al., 2013). It is estimated that around 78-90% of parents who suddenly lost their child to an accident may develop prolonged grief disorder (PGD) (Choi & Cho, 2020; Dyregrov et al., 2003). PGD symptoms are characterized by intense yearning for, and a preoccupation with, the deceased, that endure for at least twelve months after the death. Furthermore, about 50% of parents that lost their child to an accident develops clinically-relevant symptoms of posttraumatic stress disorder (PTSD) after the loss (Choi & Cho, 2020; Dyregrov et al., 2003). While PGD is distinct from PTSD (e.g., Lenferink et al., 2021; O’Connor et al., 2010), studies have found that they often co-occur (Komischke-Konnerup et al., 2021). One limitation of these studies is that they use prevalence rates or symptom-level means. Mean-based analyses may not fully capture the unique subgroups that may exist within a population. Important individual differences in psychological problems after a loss may therefore be missed. Using a person-centered approach, such as a latent class analysis, the current study focuses on the identification of subgroups among bereaved parents with similar patterns of symptoms PGD and PTSD. Furthermore, factors that are associated with the different subgroups will be examined.

Two correlational survey studies were conducted among adult samples (Ns = 205; 697) to test the effects on general life satisfaction of attachment to three close others: mother, father, and romantic partner. Results showed that attachment to mother and father also matter in adulthood, in that they are associated with adult life satisfaction. Secure attachments to mother and father were positively associated with life satisfaction, and anxious and avoidant attachments to mother and father were negatively associated with life satisfaction. Moreover, attachment to the romantic partner was also related to life satisfaction, so that secure attachment was positively related to life satisfaction, and anxious and avoidant attachments were negatively related to the outcome variable. Importantly, attachment to mother and father were still significant predictors of life satisfaction when effects of attachment to the current romantic partner were controlled for. The effects of parental attachments on life satisfaction were not mediated by attachment to the romantic partner. Theoretical and applied implications of the findings are discussed.

To date, assessment of Prolonged Grief Disorder (PGD) symptoms in youth is hindered by the lack of a measurement instrument for PGD symptoms according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR; APA, 2022) and the International Classification of Diseases, 11th Revision (ICD-11; WHO, 2018). In the current study, a clinician-administered interview to measure PGD symptoms in children and adolescents (8 through 18 years old) will be validated. References American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. https://doi.org/10.1176/appi.books.9780890425787 World Health Organization. (2018). ICD-11: Prolonged grief disorder. Retrieved from https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1183832314

Previous research has found that grief-specific cognitive behavioral therapy (CBT) reduces symptoms of prolonged grief disorder (PGD), but also symptoms of bereavement-related posttraumatic stress disorder (PTSD) and depression as secondary outcomes. To our knowledge, changes in symptoms of PGD, PTSD, and depression during treatment with CBT in a naturalistic clinical setting have not been investigated for elderly bereaved adults. The primary purpose of this study is to investigate the change of these symptoms in elderly bereaved adults treated in a naturalistic clinic. A secondary aim is to investigate changes in theoretically proposed core mechanisms (i.e., avoidance, negative loss-related cognitions, and experiencing unrealness about the loss) and their correlations with changes in symptoms of PGD, PTSD, and depression. Only a few recent studies have investigated the relationships between changes in negative loss-related cognitions and avoidance and change in PGD. However, the third core mechanism (unrealness) is still unexplored. The same holds true for the relationship between the three core mechanisms and bereavement-related PTSD and depression. The present study will evaluate competing hypotheses about the specificity of theoretically proposed core mechanisms and their relationships with symptoms of PGD, PTSD, and depression.

Bereaved youths are at risk of developing posttraumatic stress (PTS), but there are large individual differences in presentation and severity of PTS symptoms among bereaved youths. The study sought to identify subgroups based on the distribution of self-rated loss-related PTS symptoms in a sample of 264 bereaved youths (aged 7–18). Based on latent class analysis, we identified three subgroups: no disturbance (37.9%), intermediate disturbance (39.0%) and pervasive disturbance (23.1%). Subgroups differed in PTS severity and symptom configuration. Specifically, avoidance was relatively more pronounced in bereaved youth with no and intermediate PTS disturbance, whereas emotional numbing was relatively more pronounced in bereaved youth with intermediate and pervasive PTS disturbance. Associations between subgroup membership, emotional stability and demographic and loss-related variables were also examined. Multinomial logistic regression indicated that youths in the pervasive disturbance subgroup reported lower emotional stability than youths in the no disturbance subgroup. Other variables were unrelated to subgroup membership. The study highlights the importance of considering the heterogeneity in PTS symptomatology in the diagnoses and treatment of loss-related traumatic stress in bereaved youth. Moreover, it underscores the need for further research on possible risk and protective factors involved in the maintenance and development of this traumatic stress.

Background and objectives: Evidence shows that the centrality of a loss-event maintains emotional distress following loss. Aims of the current study were to examine (i) if subgroups of bereaved people can be distinguished based on their endorsement of different manifestations of loss-centrality, (ii) if subgroup membership was associated with socio-demographic and loss-related variables, and (iii) the linkage of subgroup membership with symptom-levels of prolonged grief (PG), posttraumatic stress (PTS), and depression assessed concurrently and 6 months later. Methods: Three-hundred ninety-eight bereaved people completed the 7-item Centrality of Event Scale, with their loss as anchor-event and completed symptom-measures concurrently and 6 months later. Latent profile analysis (LPA) was used to identity profiles of loss-centrality. Results: LPA revealed a three-profile solution representing low, average, and high centrality classes, respectively. The death of a partner and younger age increased the likelihood of membership of classes evidencing stronger centrality. Membership of the low centrality class was associated with lower concurrent PG, PTS, and depression; membership of the high centrality class predicted elevated PG 6 months later, beyond baseline PG. Conclusions: Subgroups of loss-centrality were distinguished by increasing endorsement of all (rather than some) manifestations of loss-centrality. Clinical implications are discussed.

Maternal anxiety and depression symptomatology are risk factors for the development of children's internalizing and externalizing behavior problems. However, it is still unclear whether chronic and transient symptoms relate differently to child behavior. The aim of this prospective longitudinal study (N = 193) was to investigate the associations between anxiety and depression symptomatology in a community sample across the first 12.5 years of parenthood, and children's internalizing and externalizing problems. Maternal anxiety and depression were measured at the child's age of 3, 6, and 12 months, and 2.5, 4, 6, 8, 10 and 12.5 years. At 12.5 years of age, both mothers and children reported on children's internalizing and externalizing problems. Trait-state occasion modeling was used to disentangle the chronic (trait) part of maternal symptomatology from the transient (occasion-specific) part. On average, 66.6% of the variance in maternal anxiety and depression symptomatology could be explained by the chronic trait factor. For both anxiety and depression, the chronic variance in maternal symptomatology was related to mother-reported internalizing, but not externalizing, problems of the child. Also, for child-reported internalizing problems, a significant association with maternal anxiety and depression symptomatology emerged. Only the occasion-specific part of maternal depression symptomatology at the child's age of 12.5 years was marginally related to mother-reported internalizing problems. Given that chronic subclinical symptomatology seems to be associated with child internalizing problems, prevention and treatment of maternal anxiety and depression symptomatology might be worthwhile regardless of the degree of severity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

In a significant minority of people, involuntarily job loss can result in symptoms of job loss-related complicated grief (JLCG). The present cognitive-behavioral framework is introduced to explain the underlying processes that may lead to the development and maintenance of JLCG symptoms. Three core processes play a central role, namely (1) negative cognitions related to the job loss and misinterpretation of one's grief reactions; (2) anxious and depressive avoidance strategies to cope with the job loss and its consequences; and (3) insufficient integration of the job loss into the autobiographical memory. These core processes are assumed to interact and reinforce each other, leading to JLCG symptoms. The three core processes can be influenced by certain risk factors, including circumstances surrounding the loss, personality traits, and characteristics of the social environment. JLCG symptoms can lead to additional psychological and practical problems, such as anxiety and depressive symptoms, lower employability, and reduced likelihood of re-employment. This paper explains and illustrates the three core processes with vignettes. Implications of the model for preventive measures and psychological interventions are introduced. It concludes with suggestions for future research on JLCG symptoms.

Funerals have long been of interest to social scientists. Previous sociological work has examined the relationship between individuality, belief and tradition within funeral services, founded on the assumption that public rituals have psycho-social benefit for organisers and attendees. With the introduction of direct cremation to the UK, and the impact of the COVID-19 pandemic on funeral service attendance in 2020 and 2021, critique of this assumption is now needed. Drawing on interviews with recently bereaved people who organised a direct cremation in late 2017, this article illustrates how compromise, control and consistency are key drivers for not having a funeral service. The article argues that a declining importance in the fate of the body and a move towards ‘invite-only’ commemorative events represents a waning need for social support offered by a public, communal funeral service. In turn, this indicates a sequestration, or privatisation, of the contemporary funeral.

BACKGROUND: Violently bereaved individuals are at increased risk of developing severe and comorbid disorders. Comorbidity may increase psychiatric symptom severity and suicide risk and decrease psychosocial functioning compared with having one disorder. We aimed to identify subgroups of individuals with similar symptom patterns, describe prevalence rates and overall levels of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) per class, and explore associations between class membership and personal and homicide related variables.METHODS: We investigated the comorbidity of symptoms of PGD, PTSD, MDD, and GAD in a sample of 923 treatment-seeking homicidally bereaved individuals by deploying latent class analysis.RESULTS: Three subgroups were identified: (i) a moderate distress, low depression class (12.4%), (ii) a high distress, moderate depression class (42.7%), and (iii) a high distress and high depression class (45.0%). Prevalence rates and total scores of the questionnaires followed the pattern of iii ≥ ii ≥ i (ps ≤ .001). Being female and having experienced prior life stress distinguished between all classes (ps ≤ .05).LIMITATIONS: The data-driven analytic approach and reliance on self-reported routine outcome monitoring data limit the generalizability and validity of the study. Strengths include the large sample size and the inclusion of four measures in a treatment-seeking, violently bereaved sample.CONCLUSIONS: Classes were most clearly distinguishable based on symptom severity, indicating high comorbidity following bereavement by homicide. This argues for an integrated treatment that targets different complaints simultaneously rather than successively.

The present study aimed to examine whether day-level engagement in non-work activities can mitigate the adverse outcomes of job loss. Based on Jahoda's latent deprivation model, we hypothesized that engaging in such activities (e.g., meeting others) can fulfil five basic needs (e.g., need for time structure) and that fulfilment of these needs mitigates the negative consequences of job loss. A diary study was conducted on five consecutive days among 236 participants who had involuntarily lost their job, yielding 1046 daily measures of the time spent on activities, the evaluation of these activities, and emotional distress. Multilevel regression analyses showed that time spent on daily activities was associated with the degree of fulfilment of the basic needs and emotional distress, yet the effect sizes were small. Perceived utility of these daily activities showed more solid effect sizes with the basic needs and emotional distress. However, the mediation effect of the basic needs regarding the association between activities and emotional distress could not be confirmed. The present results suggest that, in addition to stimulating individuals who experience job loss-related emotional distress to undertake certain activities, the evaluation of these activities should also be taken into account in tailor-made interventions and preventive measures.

Background: The gut is a target organ of thyroid hormone (TH) that exerts its action via the nuclear thyroid hormone receptor α1 (TRα1) expressed in intestinal epithelial cells. THs are partially metabolized via hepatic sulfation and glucuronidation, resulting in the production of conjugated iodothyronines. Gut microbiota play an important role in peripheral TH metabolism as they produce and secrete enzymes with deconjugation activity (β-glucuronidase and sulfatase), via which TH can re-enter the enterohepatic circulation. Summary: Intestinal epithelium homeostasis (the finely tuned balance between cell proliferation and differentiation) is controlled by the crosstalk between triiodothyronine and TRα1 and the presence of specific TH transporters and TH-activating and -inactivating enzymes. Patients and experimental murine models with a dominant-negative mutation in the TRα exhibit gross abnormalities in the morphology of the intestinal epithelium and suffer from severe symptoms of a dysfunctional gastrointestinal tract. Over the past decade, gut microbiota has been identified as an essential factor in health and disease, depending on its compositional and functional profile. This has led to a renewed interest in the so-called gut-thyroid axis. Disruption of gut microbial homeostasis (dysbiosis) is associated with autoimmune thyroid disease (AITD), including Hashimoto's thyroiditis, Graves' disease, and Graves' orbitopathy. These studies reviewed here provide new insights into the gut microbiota roles in thyroid disease pathogenesis and may be an initial step toward microbiota-based therapies in AITD. However, it should be noted that cause-effect mechanisms remain to be proven, for which prospective cohort studies, randomized clinical trials, and experimental studies are needed. Conclusion: This review aims at providing a comprehensive insight into the interplay between TH metabolism and gut homeostasis.

This is the pre-registration of a study researching moral injury among Dutch treatment-seeking military veterans. This study will be the first study to examine the prevalence of morally injurious experiences and moral injury among treatment-seeking veterans in the Netherlands. We will translate (from English to Dutch) and psychometrically evaluate two self-report questionnaires for moral injury, the Moral Injury Events Scale (MIES) and the Expressions of Moral Injury Scale – Military version (EMIS-M). These questionnaires will be part of two separate substudies: [1] The MIES study The MIES will be administered at the Department of Social Work at the Netherlands Veterans Institute, where veterans will be asked to fill out the MIES during the intake procedure. [2] The EMIS study The EMIS-M will be administered at four mental health institutions with specialized departments for the treatment of veterans (ARQ Centrum’45, Sinai Centrum, GGZ Drenthe, and Reinier van Arkel). The EMIS-M will de added to the ROM test battery, and will be used in conjunction with other questionnaires (such as the PCL-5, BSI, etc.) to asses the predictive value of moral injury for general psychopathology, family functioning and physical and social functioning.

The primary aim of the TALE-study is to evaluate the psychometric properties of the Traumatic Grief Inventory - Clinical Administered (TGI-CA). The TGI-CA is an interview that is developed to tap pathological grief criteria (proposed for inclusion) in DSM-5 and ICD-11. The following publications are linked to this project: https://doi.org/10.3389/fpsyt.2022.878773