Depression and Complicated Grief, and Associated Factors, of Bereaved Family Members of Patients Who Died of Malignant Pleural Mesothelioma in Japan

Our plain-English summary of Depression and Complicated Grief, and Associated Factors, of Bereaved Family Members of Patients Who Died of Malignant Pleural Mesothelioma in Japan, by Y. Nagamatsu, Y. Sakyo, E. Barroga, et al (Journal of Clinical Medicine, 2022).

The study

• Authors: Y. Nagamatsu, Y. Sakyo, E. Barroga, R. Koni, Y. Natori, M. Miyashita
• Journal: Journal of Clinical Medicine
• Published: 2022;11(12)
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: we investigated the prevalence and associated factors of depression and complicated grief (CG) among bereaved family members of malignant pleural mesothelioma (MPM) patients in Japan.

Methods: Bereaved family members of MPM patients (n = 72) were surveyed. The Japanese version of the Patient Health Questionnaire-9 (PHQ-9) and the Japanese version of the Brief Grief Questionnaire (BGQ) were used to assess depression and complicated grief (CG), respectively. Socio-economic factors, anger toward asbestos, care satisfaction, achievement of good death, and quality of end-of-life care were assessed in relation to depression and CG.

Results: In the family members of MPM patients, the frequencies of depression and CG were 19.4% and 15.3%, respectively. The bereaved family members who were not compensated by the asbestos-related health-damage relief system (p = 0.018) and who felt the financial impacts of the patient's MPM on the family (p = 0.006) had a higher likelihood of depression. The bereaved family members who were not satisfied with the care given when the patient became critical (p = 0.034), who were not compensated by the asbestos-related health-damage relief system (p = 0.020), who felt the financial impact of the patient's MPM on the family (p = 0.016), and whose deceased relative underwent surgery (p = 0.030) had a higher likelihood of CG.

Conclusions: For bereaved family members of MPM patients, routine screening for depression and CG and the provision of grief care are suggested. In addition, for family members of MPM patients, financial support, including the promotion of the asbestos-related health-damage relief system, and improved care for patients who undergo surgery and when patients become critical, are recommended.

In plain English

This cross-sectional survey studied relatives in Japan whose family member had died of malignant pleural mesothelioma (MPM). A mesothelioma and asbestos victims' association mailed questionnaires to 109 eligible family members in November 2016, and 72 were analyzed. Most respondents (72.2%) were spouses. Depression was measured with the PHQ-9 questionnaire. Complicated grief (intense, long-lasting grief that impairs daily life) was measured with the Brief Grief Questionnaire. Of the 72 family members, 19.4% screened as having moderate to severe depression, 15.3% as having complicated grief, and 2.8% as having both. Relatives who felt a financial impact from the patient's illness had higher odds of both depression and complicated grief, and so did relatives not compensated by the asbestos-related health-damage relief system. Complicated grief was also associated with the patient having had surgery and with dissatisfaction with care when the patient became critical. The authors recommended routine screening, grief care and financial support. They noted several limitations: a small convenience sample of advocacy-group members, possible recall bias, and self-reported answers without clinical interviews.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional questionnaire survey (part of a larger study of bereaved family members of MPM patients)
• Who was studied: Bereaved family members of patients diagnosed with malignant pleural mesothelioma after 2008, reached through the Japan Association of Mesothelioma and Asbestos-Related Disease Victims and their Families. Questionnaires went to 109 people in November 2016 and 74 were returned by March 2017. Two respondents bereaved within the past six months were excluded, leaving 72 for analysis. 72.2% were spouses and 79.2% were women. Of the deceased patients, 81.9% were men.
• Exposure: The study examined bereavement after a relative's death from MPM, and the factors linked to depression and complicated grief. These included compensation received, financial impact, satisfaction with care, treatments, place of death and anger toward asbestos. The families reported the patients' source of asbestos exposure: occupation 49 (68.1%), neighboring factory 17 (23.6%), school 1 (1.4%), family 1 (1.4%), unknown 4. No fiber types were reported.
• Main results:
  • Among the 72 bereaved family members, 19.4% screened as having moderate to severe depression.
  • Among the 72 bereaved family members, 15.3% had complicated grief and 56.9% probable complicated grief; 72.2% were categorized as possible complicated grief.
  • Two family members (2.8%) had both depression and complicated grief.
  • Depression: family members whose family was financially impacted by the patient's MPM had an odds ratio of 2.569 (95% CI 1.316 to 5.015, p = 0.006).
  • Depression: family members not compensated by the asbestos-related health-damage relief system had an odds ratio of 7.334 (95% CI 1.401 to 38.374, p = 0.018).
  • Complicated grief: financial impact on the family was associated with an odds ratio of 3.278 (95% CI 1.250 to 8.596, p = 0.016).
  • Complicated grief: lack of compensation from the asbestos-related health-damage relief system was associated with an odds ratio of 19.210 (95% CI 1.609 to 229.392, p = 0.020).
  • Complicated grief: the patient having received surgery was associated with an odds ratio of 11.301 (95% CI 1.256 to 101.649, p = 0.030).
  • Complicated grief: not being satisfied with the care given when the patient became critical was associated with an odds ratio of 13.626 (95% CI 1.213 to 153.009, p = 0.034).
  • The depression score (PHQ-9) was correlated with the grief score (BGQ) (r = 0.481), but not with the good-death or end-of-life care scores.
• The authors' conclusion: The authors concluded that routine screening for depression and complicated grief, and grief care, are recommended for bereaved family members. They suggested financial support (including promotion of the asbestos-related health-damage relief system) and improved care, especially for patients undergoing surgery and when patients become critical.
• Limitations the authors state:
  • Small convenience sample.
  • Participants were members of an advocacy group, so results may not represent all bereaved family members of MPM patients.
  • Possible recall bias, because the mean time since bereavement was 45 months.
  • Cross-sectional design and self-reported data, with no clinical interviews.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

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