Avaliação psicológica de pessoas enlutadas e intervenções psicoterapêuticas para luto
estado da arte
Palabras clave:
Luto, Transtorno de luto prolongado, Avaliação psicológica, Intervenção psicológicaResumen
O luto é uma reação normal e esperada diante de uma perda, porém, é pouco abordado na formação profissional em saúde. Há uma predominância de estudos sobre o tema no contexto internacional, o qual carece de publicações em língua portuguesa. Este artigo revisa o estado da arte atual do conhecimento sobre o tema, focando na avaliação psicológica e intervenções terapêuticas eficazes. Foram consultadas diversas bases acadêmicas, como Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Scientific Electronic Library Online e PubMed, além de livros da área. Os resultados descrevem modelos teóricos, diagnósticos prevalentes na população enlutada, como o transtorno de luto prolongado, saúde mental dos enlutados e intervenções terapêuticas. Revela-se uma escassez de estudos no contexto brasileiro, ressaltando os principais achados e limitações de pesquisa nos temas discutidos.
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Alves, T. M., Oliveira, M. C., & Lotufo-Neto, F. (2016). Diagnosis of complicated grief using the Texas Revised Inventory of Grief, Brazilian Portuguese version. Journal of Psychological and Clinical Psychiatry, 6(1), 1-11. https://doi.org/10.15406/jpcpy.2016.06.00316
American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). American Psychiatric Association.
American Psychiatric Association. (1995). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association.
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association.
Boelen, P. A. (2021). Symptoms of prolonged grief disorder as per DSM-5-TR, posttraumatic stress, and depression: latent classes and correlations with anxious and depressive avoidance. Psychiatry Research, 302, 114033. https://doi.org/10.1016/j.psychres.2021.114033
Boelen, P. A., Keijser, J., & Smid, G. (2015). Cognitive-behavioral variables mediate the impact of violent loss on post-loss psychopathology. Psychological Trauma: Theory, Research, Practice, and Policy, 7(4), 382-390. https://doi.org/10.1037/tra0000018
Boelen, P. A., Keijser, J., van den Hout, M. A., & van den Bout, J. (2007). Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 75(2), 277-284. https://doi.org/10.1037/0022-006X.75.2.277
Boelen, P. A., Eisma, M. C., Smid, G. E., Keijser, J., & Lenferink, L. I. M. (2021). Remotely delivered cognitive behavior therapy for disturbed grief during the COVID-19 crisis: challenges and opportunities. Journal of Loss and Trauma, 26(3), 211-219. https://doi.org/10.1080/15325024.2020.1793547
Boelen, P. A., Lenferink, L. I. M., Nickerson, A., & Smid, G. E. (2018). Evaluation of the factor structure, prevalence, and validity of disturbed grief in DSM-5 and ICD-11. Journal of Affective Disorders, 240, 79-87. https://doi.org/10.1016/j.jad.2018.07.041
Boelen, P., & Lenferink, L. (2019). Symptoms of prolonged grief, posttraumatic stress, and depression in recently bereaved people: symptoms profiles, predictive value, and cognitive behavioural correlates. Social Psychiatry and Psychiatric Epidemiology, 55, 765-777. https://doi.org/10.1007/s00127-019-01776-w
Boelen, P., & Lenferink, L. (2020). Comparison of six proposed diagnostic criteria sets for disturbed grief. Psychiatry Research, 285, 112786. https://doi.org/10.1016/j.psychres.2020.112786
Bolaséll, L. T., Cruz Oliveira, V. C., & Kristensen, C. H. (2021). The effects of exposure to factors related to death in mental health. Journal of Loss and Trauma, 27(4), 318-334. https://doi.org/10.1080/15325024.2021.1959854
Bolaséll, L. T., Cruz Oliveira, V. C., Frimm, V. C., Menda, C. C., Rodrigues, C. S. M., & Kristensen, C. H. (2021). “I have no words”: A qualitative study about the traumatic experience of violent death. Omega – Journal of Death and Dying, 88(3), 1-17. https://doi.org/110.1177/00302228211051532
Bolaséll, L. T., Pizón, J., Boelen, P., & Kristensen, C. H. (2023). The Traumatic Grief Inventory Self-Report (TGI-SR) as a clinical measure to identify Brazilians with prolonged grief disorder and persistent complex bereavement disorder. Trends in Psychology. https://doi.org/10.1007/s43076-023-00316-5
Bowlby, J. (1990). Apego e perda: a natureza do vínculo. Martins Fontes.
Braz, M. S., & Franco, M. H. P. (2017). Profissionais paliativistas e suas contribuições na prevenção de Luto Complicado. Psicologia: Ciência & Profissão, 37(1), 90-105. https://doi.org/10.1590/1982-3703001702016
Buur, C., Zachariae, R., Komischke-Konnerup, K. B., Marello, M. M., Schierff, L. H., & O’Connor, M. (2024). Risk factors for prolonged grief symptoms: a systematic review and meta-analysis. Clinical Psychology Review, 107, 102375. https://doi.org/10.1016/j.cpr.2023.102375https://doi.org/10.1016/j.cpr.2023.102375
Collins, L. M., & Lanza, S. T. (2010). Latent class and latent transition analysis: with applications in the social, behavioral and health sciences. Wiley.
de Heus, A., Hengst, S., la Rie, S., Djelantik, A., Boelen, P., & Smid, G. (2017). Day patient treatment for traumatic grief: preliminary evaluation of a one-year treatment program for patients with multiple and traumatic losses. European Journal of Psychotraumatology, 8(1). https://doi.org/10.1080/20008198.2017.1375335
Djelantick, A. A. A. M., Smid, G. E., Kleber, R. J., & Boelen, P. A. (2017). Symptoms of prolonged grief, post-traumatic stress, and depression after loss in a Dutch community sample: a latent class analysis. Psychiatry Research, 247, 276-281. https://doi.org/10.1016/j.psychres.2016.11.023
Djelantick, A. A. A. M., Smid, G. E., Morz, A., Kleber, R. J., & Boelen, P. A. (2020). The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis. Journal of Affective Disorders, 15, 146-156. https://doi.org/10.1016/j.jad.2020.01.034
Djelantik, A. A. A. M. J., Bui, E., O’Connor, M., Rosner, R., Robinaugh, D. J., Simon, N. M., & Boelen, P. A. (2021). Traumatic grief research and care in the aftermath of the COVID-19 pandemic. European Journal of Psychotraumatology, 12(1), 1957272. https://doi.org/10.1080/20008198.2021.1957272
Djelantik., A. A. A. M., Robinaugh, D. J., & Boelen, P. A. (2022). The course of symptoms in the first 27 months following bereavement: alatent trajectory analysis of prolonged grief, posttraumatic stress, and depression. Psychiatry Research, 311, 114472/. https://doi.org/10.1016/j.psychres.2022.114472
Eisma, M. C., & Stroebe, M. S. (2021). Emotion regulatory strategies in complicated grief: a systematic review. Behavior Therapy, 52(1), 234-249. https://doi.org/10.1016/j.beth.2020.04.004
Eisma, M. C., Boelen, P. A., Van den Bout, J., Stroebe, W., Schut, H., Lancee, J., & Stroebe, M. (2015). Internet-based exposure and behavioral activation for complicated grief and rumination: a randomized controlled trial. Behavior Therapy, 46(6), 729-748. https://doi.org/10.1016/j. beth.2015.05.007
Franco, M. H. P. (2021). O luto no século 21: uma compreensão abrangente do fenômeno. Summus Editorial.
Freud, S. (2012). Luto e Melancolia. Cosac & Naify. (Original published in 1917).
Fukumitsu, K. O., & Kovács, M. J. (2015). O luto por suicídios: uma tarefa da posvenção. Revista Brasileira de Psicologia, 2(2), 41-47.
Hayasida, N. M. A., Assayag, R. H., Figueira, I., & Matos, M. G. (2014). Morte e luto: comptetências profissionais. Revista Brasileira de Terapias Cognitivas, 10(2), 112-121. http://dx.doi.org/10.5935/1808-5687.20140017
Heeke, C., Franzen, M., Hofmann, H., Knaevelsrud, C., & Lenferink, L. I. M. (2022). A latent class analysis on symptoms of prolonged grief, post-traumatic stress, and depression following the loss of a loved one. Frontiers in Psychiatry, 13, 878773. https://doi.org/10.3389/fpsyt.2022.878773
Heeke, C., Stammel, N., Heinrich, M., & Knaevelsrud. (2017). Conflict-related trauma and bereavement: exploring differential symptom profiles of prolonged grief and posttraumatic stress disorder. BMC Psychiatry, 17, 1-10. https://doi.org/10.1186/s12888-017-1286-2
Janoff-Bulman, R. (1992). Shattered assumptions: towards a new psychology of trauma. Free Press.
Joaquim, R. M., Pinto, A. L. C. B., Guatimosim, R. F., de Paula, J. J., Costa. D. S., Diaz, A. P., Silva, A. G., Pinheiro, M. I., Serpa, A. L. O., Miranda, D. M., & Malloy-Diniz, L. F. (2021). Bereavement and psychological distress during COVID-19 pandemics: the impact of death experience on mental health. Current Research in Behavioral Sciences, 2, 100019. https://doi.org/10.1016/j.crbeha.2021.100019
Johannsen, M., Damholdt, M. F., Zachariae, R., Lundorff, M., Farver-Vestergaard, I., & O’Connor, M. (2019). Psychological interventions for grief in adults: a systematic review and meta-analysis of randomized controlled trials. Journal of Affective Disorders, 253, 69-86. https://doi.org/10.1016/j.jad.2019.04.065
Johnsen, I., & Dyregrov, K. (2016). “Only a friend”: The bereavement process of young adults after the loss of a close friend in an extreme terror incident: a qualitative approach. Journal of Death and Dying, 74(1), 16-34. https://doi.org/10.1177/0030222815622956
Kentish-Barnes, N., Chaize, M., Seegers, V., Legriel, S., Cariou, A., Jaber, S., Lefrant, J., Floccard, B., Renault, A., Vinatier, I., Mathonnet, A., Reuter, D., Guisset, O., Cohen-Solal, Z., Cracco, C., Seguin, A., Durand- Gasselin, J., Éon, B., … Azoulay, E. (2015). Complicated grief after death of a relative in the intensive care unit. European Respiratory Journal, 45, 1341-1352. https://doi.org/10.1183/09031936.00160014
Kersting, A., Dölemeyer, R., Steinig, J., Walter, F., Kroker, K., Baust, K., & Wagner, B. (2013). Brief internet-based intervention reduces posttraumatic stress and prolonged grief in parents after the loss of a child during pregnancy: a randomized controlled trial. Psychotherapy and Psychosomatics, 82(6), 372-381. https://doi.org/10.1159/000348713
Komischke-Konnerup, K., Vang, M. L., Lundorff, M., Elklit, A., & O’Connor, M. (2023). Do early symptoms of prolonged grief disorder lead to symptoms of posttraumatic stress disorder and depression? A longitudinal register-based study of the two first years of bereavement. Journal of Psychopathology and Clinical Science, 132(8), 996-1006. https://doi.org/10.1037/abn0000859
Komischke-Konnerup, K., Zachariae, R., Johannsen, M., Nielsen, L. D., & O’Connor, M. (2021). Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: a systematic review and meta-analysis. Journal of Affective Disorders, 4, 100140. https://doi.org/10.1016/j.jadr.2021.100140
Kovács, M. J. (2016). Curso Psicologia da Morte: educação para a morte em ação. Boletim - Academia Paulista de Psicologia, 36(91), 400-417.
Kristensen, P., Weisaeth, L., & Heir, T. (2012). Bereavement and mental health after sudden and violent losses: a review. Psychiatry, 75(1), 76-97. https://doi.org/10.1521/psyc.2012.75.1.76
Kübler-Ross, E. (2017). Sobre a morte e o morrer. WMF Martins Fontes. (Originalmente publicado em 1969)
Lenferink, L., de Keijser, J., Eisma, M., Smid, G., Boelen, P. (2020). Online cognitive–behavioural therapy for traumatically bereaved people: study protocol for a randomized waitlist-controlled trial. BMJ Open, 10, e035050. https://doi.org/10.1136/bmjopen-2019-035050
Lenferink, L., Eisma, M., Buiter, M., de Keijser, L., & Boelen, P. (2023). Online cognitive behavioral therapy for prolonged grief after traumatic loss: a randomized waitlist-controlled trial. Cognitive Behavior Therapy, 52, 502-522. https://doi.org/10.1080/16506073.2023.2225744
Lenferink, L., Nickerson, A., de Keijser, J., Smid, G., & Boelen, P. (2018). Trajectories of grief, depression and posttraumatic stress in disaster-bereaved people. Depression and Anxiety, 37(1), 35-44. https://doi.org/10.1002/da.22850
Lenferink, L., Nickerson, A., de Keijser, J., Smid, G., & Boelen, P. (2019). Reciprocal associations among symptom levels of disturbed grief, posttraumatic stress, and depression following traumatic loss: a four-wave cross-lagged study. Clinical Psychological Science, 7, 1330-1339. https://doi.org/10.1177/2167702619858288
Lichtenthal, W. G., Catarozoli, C., Masterson, M., Slivjak, E., Schofield, E., Roberts, K. E., Neimeyer, R. A., Wiener, L., Prigerson, H. G., Kissane, D., Li, Y., & Breitbart, W. (2019). An open trial of meaning-centered grief therapy: rationale and preliminary evaluation. Palliative and Supportive Care, 17(1), 2-12. https://doi.org/10.1017/S1478951518000925
Lundorff, M., Bonanno, G., Johannsen, M., & O’Connor, M. (2020). Are there gender differences in prolonged grief trajectories? A registry-sampled cohort study. Journal of Psychiatric Research, 129, 168-175. https://doi.org/10.1016/j.jpsychires.2020.06.030
Lundorff, M., Holmgren, H., Zachariae, R., Farver-Vestergaard, I., & O’Connor, M. (2017). Prevalence of prolonged grief disorder in adult bereavement: a systematic review and meta-analysis. Journal of Affective Disorders, 212(1), 138-149. http://dx.doi.org/10.1016/j.jad.2017.01.030
MacCallum, F., & Bryant, R. A. (2013). A Cognitive Attachment Model of prolonged grief: Integrating attachments, memory, and identity. Clinical Psychology Review, 33, 713-727. http://dx.doi.org/10.1016/j.cpr.2013.05.001
Nam, I. (2017). Restoration-focused coping reduces complicated grief among older adults: a randomized controlled study. European Journal of Psychiatry, 31(3), 93-98. http://dx.doi.org/10.1016/j.ejpsy.2017.07.002
Neimeyer, R. A. (2000). Searching for the meaning of meaning: grief therapy and the process of reconstruction. Death Studies, 24(6), 541-558. https://doi.org/10.1080/07481180050121480
Neimeyer, R. A. (2019). Meaning reconstruction in bereavement: development of a research program. Death Studies, 43(2), 79-91. https://doi.org/10.1080/07481187.2018.1456620
Neimeyer, R. A., & Burke, L. A. (2017). What makes grief complicated? Risk factors for complicated grief. In K. Doka & A. Tucci (Eds.), Living with grief: when grief is complicated (pp. 73-93). Hospice Foundation of America.
Neimeyer, R., & Lee, S. A. (2021). Circumstances of the death and associated risk factors for severity and impairment of COVID-19 grief. Death Studies, 46(1), 34-42. https://doi.org/10.1080/07481187.2021.1896459
Nickerson, A., Liddell, B., Maccallum, F., Steel, Z., Silove, D., & Bryant, A. (2014). Posttraumatic stress disorder and prolonged grief in refugees exposed to trauma and loss. BMC Psychiatry, 14(106), 1-11. https://doi.org/10.1186/1471-244X-14-106
Nielsen, M. K., Carlsen, A. H., Neergaard, M. A., Bidstrup, P. E., & Guldin, M.-B. (2019). Looking beyond the mean in grief trajectories: a prospective, population-based cohort study. Social Science & Medicine, 232, 460-469. https://doi.org/10.1016/j.socscimed.2018.10.007
Parkes, C. M. (1998). Luto: estudos sobre a perda na vida. Summus.
Prigerson, H. G., Boelen, P. A., Xu, J., Smith, K., & Maciejewski, P. (2021). Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale. World Psychiatry, 20, 96-106. https://doi.org/10.1002/wps.20823
Prigerson, H., Horowitz, M., Jacobs, S., Parkes, C., Aslan, M., Goodkin, K., Raphael, B., Marwit, S., Wortman, C., Neimeyer, R., Bonanno, G., Kissiane, D., Boelen, P., Maercker, A., Litz, B. T., Johnson, J. G., First, M. B., & Maciejewski, P. (2009). Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11. Plos Med, 6(8). https://dx.doi.org/10.1371/journal.pmed.100012
Reitsma, L., Boelen, P. A., de Keijser, J., & Lenferink, L. (2021). Online treatment of persistent complex bereavement disorder, posttraumatic stress disorder, and depression symptoms in people who lost loved ones during the COVID-19 pandemic: study protocol for a randomized controlled trial and a controlled trial. European Journal of Psychotraumatology, 12(1), 1987687. https://doi.org/10.1080/20008198.2021.1987687
Reitsma, L., Boelen, P. A., de Keijser, J., & Lenferink, L. (2023). Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: a randomized controlled trial. Behaviour Research and Therapy, 163, 104286. https://doi.org/10.1016/j.brat.2023.104286
Rosner, R., Comtesse, H., Vogel, A., & Doering, B. K. (2021). Prevalence of prolonged grief disorder. Journal of Affective Disorders, 287, 301-207. https://doi.org/10.1016/j.jad.2021.03.058
Rosner, R., Pfoh, G., Kotoučová, M., & Hagl, M. (2014). Efficacy of an outpatient treatment for prolonged grief disorder: a randomized controlled clinical trial. Journal of Affective Disorders, 167, 56–63. https://doi.org/10.1016/j.jad.2014.05.035
Santos, G. C. B. F. (2017). Intervenção do profissional de saúde mental em situações de perda e luto no Brasil. Revista M, 2(3), 116-137. https://doi.org/10.9789/2525-3050.2017.v2i3.116-137
Shear, M. K., Frank, E., Houck, P. R., & Reynolds III, C. F. (2005). Treatment of complicated grief. JAMA, 293, 2601-2608.
Shear, M. K., Wang, Y., Skritskaya, N., Duan, N., Mauro, C., & Ghesquiere, A. (2014). Treatment of complicated grief in elderly persons: a randomized clinical trial. JAMA Psychiatry, 71(11), 1287-95. https://doi.org/10.1001/jamapsychiatry.2014.1242
Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., Reynolds, C., Lebowitz, B., Sung, S., Ghesquiere, A., Gorscak, B., Clayton, P., Ito, M., Nakajima, S., Konishi, T., Melhem, N., Meert, K., Schiff, M., O’Connor, M.-F., First, M., Sareen, J., … Keshaviah, A (2011). Complicated grief and related bereavement issues for DSM-5. Depress Anxiety, 28(2), 103-117. https://doi.org/10.1002/da.20780
Silva, A. C. O., & Nardi, A. E. (2010). Luto pela morte de um filho: utilização de um protocolo de terapia cognitivo-comportamental. Revista de Psiquiatria do Rio Grande do Sul, 32(3), 113-116. https://doi.org/10.1590/S0101-81082010000300008
Silva, A. C. O., & Nardi, A. E. (2011a). Terapia cognitivo-comportamental para luto pela morte súbita de cônjuge. Revista de Psiquiatria Clínica, 38(5), 213-215. https://doi.org/10.1590/S0101-60832011000500010
Silva, A. C. O., & Nardi, A. E. (2011b). Terapia cognitivista-comportamental para perda gestacional: resultados da utilização de um protocolo terapêutico para luto. Revista de Psiquiatria Clínica, 38(3), 122-4. https://doi.org/10.1590/S0101-60832011000300007
Souza, L. G., Santos, A. A., Carneiro, T. V., Santos, V. R., &b Lopez, F. N. (2023). Profissionais de saúde e educação para a morte: um estudo do ensino superior brasileiro. Revista de Saúde em Redes, 9(2), 1-16. https://doi.org/10.18310/2446-4813.2023v9n2.4009
Stroebe, M. S., & Schut, H. (2021). Bereavement in times of COVID-19: a review and theoretical framework. Omega, 82(3), 500-522. https://doi.org/10.1177/0030222820966928
Stroebe, M., & Schut, H. (1999). The dual process model of bereavement: rationale and description. Death Studies, 23(3), 197-224. https://doi.org/10.1080/074811899201046
Stroebe, M., Schut, H., & Stroebe, P. W. (2007). Health outcomes of bereavement. The Lancet, 370(9603), 1960-1937. https://doi.org/10.1016/S0140-6736(07)61816-9
Treml, J., Brahler, E., & Kersting, A. (2022). Prevalence, factor structure and correlated of DSM-5-TR criteria for prolonged grief disorder. Frontiers in Psychiatry, 13, 880380. https://doi.org/10.3389/fpsyt.2022.880380
Wagner, B., Knaevelsrud, C., & Maercker, A. (2006). Internet-based cognitive- behavioral therapy for complicated grief: a randomized controlled trial. Death Studies, 30(5), 429-53. https://doi.org/10.1080/07481180600614385
Worden, J. (2013). Aconselhamento e terapia do luto. Roca.
World Health Organization (1993). International statistical classification of diseases and related health problems (10th ed).
World Health Organization (2022). International statistical classification of diseases and related health problems (11th ed).
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Derechos de autor 2026 Laura Teixeira Bolaséll, Alice Einloft Brunnet, Christian Haag Kristensen
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
