Rumination following bereavement in Chinese bereaved people : a process-oriented perspective

Abstract

Rumination, a widely experienced cognitive process after the death of a close person, is expected to be linked to bereavement outcomes. However, the role of bereavement-specific rumination in bereavement adjustment remains unclear, probably due to the diversified conceptualization of rumination. Guided by a comprehensive literature review, this work proposes rumination as a process-oriented multicomponent construct. No valid measure exists for this integrative conceptualization. Moreover, findings from Western cultures may be inapplicable to the Chinese people, who embody a family-centered cultural value system. Therefore, this thesis aims to conceptualize a bereavement rumination process, develop an evidence-based and psychometrically rigorous measurement tool for the process, and investigate its role in bereavement adjustment among Chinese bereaved people.

The multilevel research objectives include describing, measuring, and exploring bereavement rumination and predicting its effect on bereavement outcomes. Thus, a multilevel inquiry involving qualitative and quantitative methods was adopted, namely, the exploratory sequential mixed method. In the first and qualitative phase, 16 bereaved people were interviewed about their bereavement-specific rumination experiences, thereby establishing the conceptualization and laying the foundation for developing a new measure. In the second and quantitative phase, 711 bereaved people completed a cross-sectional online survey, providing data for the measurement evaluation and model testing.

The qualitative phase entailed the thematic analysis of the interview transcriptions. Forty-five codes were grouped as different themes including the circumstances of occurrence, content, metacognition, and reaction. An item pool was also generated from the verbatim account to create the process-oriented multi-component measure of bereavement rumination.

The newly designed measure, Bereavement Rumination Process Scale (BRPS), and a few validated scales comprised the online survey in the quantitative phase. Split-half datasets were used to sequentially perform the exploratory factor analysis and confirmatory factor analysis. The finalized BRPS contains an 8-question section of circumstance, a seven-factor 39-item section of content, a three-factor 10-item section of metacognition, and a three-factor 8-item section of reaction. Circumstances include timing, location, companion, busy status, transit status, special days, life events, and reminders. Content includes yearning, recalling conflicts, regretting, self-comforting, seeking positivity, questioning feelings and reactions, and considering others. Metacognitions involve perceiving rumination as disturbance, connection, and assistance. Reaction comprises "let nature take its course," engagement, and disengagement. The BRPS demonstrated satisfactory internal consistency; test-retest reliability; and convergent, discriminant, and concurrent validity.

The test of the inter-component structure of bereavement rumination process using the full dataset verified the distinct mediating roles of metacognitions between content and reaction. Prevalence, risk and protective bereavement rumination patterns, content, metacognitions, and reactions were identified. Additionally, metacognition and reaction mediated the paths from content to bereavement outcomes.

This thesis advances knowledge by providing a process-oriented multicomponent conceptualization of the rumination process. It also poses new perspectives for theory development in bereavement-specific rumination by verifying the mediation model of the components in the process. The newly developed and validated measure is useful for future research and practice. Finally, this research adds the Chinese perspective to the study of bereavement and rumination.