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Social Sharing of Bereavement Experience by Chinese Bereaved Persons in Hong Kong

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Title: Social Sharing of Bereavement Experience by Chinese Bereaved Persons in Hong Kong
Language: English
Authors: Chow, Amy Y. M., Chan, Cecilia L. W., Ho, Samuel M. Y.
Source: Death Studies. Aug 2007 31(7):601-618.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 325 Chestnut Street Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420; Fax: 215-625-2940; Web site: http://www.tandf.co.uk/journals/default.html
Peer Reviewed: Y
Page Count: 18
Publication Date: 2007
Document Type: Journal Articles
Reports - Research
Descriptors: Foreign Countries, Physical Health, Siblings, Emotional Response, Grief, Coping, Mental Health, Interpersonal Relationship, Cultural Differences, Family Relationship, Sibling Relationship, Friendship, Death
Geographic Terms: Hong Kong
DOI: 10.1080/07481180701405105
ISSN: 0748-1187
Abstract: Contrary to the belief that the Chinese do not share emotionally intense experiences, findings from a cross-sectional study of 292 respondents who lost either a spouse or a parent in the previous 2 years in Hong Kong indicated that only 10% did not share their bereavement experiences with another person. The physical health and emotional state of non-sharers was found to be no different to those who shared. In addition, the Chinese are believed to limit their social sharing of personal experiences to family members only. In our study, we found that for those who shared, the persons they shared most with were their best friends, siblings, and professionals. Non-family members are clearly eligible "sharees" for Chinese people. Differences in the reactions of sharees in good and bad sharing experiences were identified. Based on these findings, implications for bereavement care for Chinese are delineated. (Contains 4 tables.)
Abstractor: Author
Number of References: 17
Entry Date: 2007
Accession Number: EJ765939
Database: ERIC
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  Value: <anid>AN0025347303;dea01aug.07;2019Apr02.05:33;v2.2.500</anid> <title id="AN0025347303-1">Social Sharing of Bereavement Experience by Chinese Bereaved Persons in Hong Kong. </title> <p>Contrary to the belief that the Chinese do not share emotionally intense experiences, findings from a cross-sectional study of 292 respondents who lost either a spouse or a parent in the previous 2 years in Hong Kong indicated that only 10% did not share their bereavement experiences with another person. The physical health and emotional state of non-sharers was found to be no different to those who shared. In addition, the Chinese are believed to limit their social sharing of personal experiences to family members only. In our study, we found that for those who shared, the persons they shared most with were their best friends, siblings, and professionals. Non-family members are clearly eligible "sharees" for Chinese people. Differences in the reactions of sharees in good and bad sharing experiences were identified. Based on these findings, implications for bereavement care for Chinese are delineated.</p> <p>When she came to the funeral of my husband, she told me to "Save the tears and follow the flow." Although I have used this statement many times in consoling bereaved persons at the funerals of their loved ones, this was the first time I appreciated how cruel the statement was to the bereaved person. I love my husband so much; how can I save the tears? Why do I have to save the tears? Save them for whom? Yet, for courtesy, I tried to wipe my tears with the tissue paper that she offered me. The tears seemed like tap water with no control and soaked the whole piece of tissue. She offered another piece to me and walked away after her second statement of "Take care." (Madam A, recalling a social sharing experience with her friend at her husband's funeral)</p> <p>Going to a funeral is a helpless experience. You see the pain of your friend and you can do nothing to ease it. Except for saying "Save the tears and follow the flow," I don't know what to say. I think the best way is to give the bereaved person some space and not to ask any more of her. (Madam B, who had no bereavement experience of any close relatives)</p> <p>"Save the tears and follow the flow" (<emph>Jie ai shun bian</emph>) is the commonly used condolence statement by Chinese people for consoling bereaved persons at a funeral. Its literal meaning denotes the cultural prescription of inhibiting grief and accepting the bereavement experience silently. Most of the time, the dialogue between the bereaved person and the consoler ends with this statement because there is a discrepancy of expectations between the two parties, as reflected in the above quotes. Thus, social sharing of the bereavement experience is ended abruptly.</p> <p>Social support is considered a buffer to protect those who are experiencing stressful life events (Cohen & Wills, [<reflink idref="bib10" id="ref1">10</reflink>]) as well as bereavement (Dimond, Lund, & Caserta, [<reflink idref="bib11" id="ref2">11</reflink>]). Before soliciting social support, social sharing of the bereavement experience (talking to others about the experience of the loss of the loved one) is a prerequisite condition so that they will know the situation and needs of the bereaved. Although some recent studies have questioned the beneficial effects of social sharing in the bereavement experience (Bonanno & Kaltman, [<reflink idref="bib1" id="ref3">1</reflink>]; Stroebe, Stroebe, Schut, Zech, & van den Bout, [<reflink idref="bib16" id="ref4">16</reflink>]), it is still invaluable to explore the phenomenon of social sharing by Chinese bereaved persons. Do Chinese bereaved persons respond according to the culturally required standard of inhibiting their sharing? Or do they have a need to share these intense emotional experiences? If so, to whom and how do they share? Are the emotional and physical conditions different for those who share and those who do not? This study, a cross-sectional survey on social sharing by Chinese bereaved persons in Hong Kong, set out to explore these questions.</p> <p>The bereavement experience is not a topic that appears frequently in daily social conversations among Chinese persons in Hong Kong, nor in discussions among academics. There are few research studies in the area of bereavement experiences among the Chinese (Chow, Chan, & Ho, [<reflink idref="bib8" id="ref5">8</reflink>]). With a better understanding of the phenomenon of social sharing by Chinese bereaved persons, appropriate bereavement care can be formulated.</p> <hd id="AN0025347303-2">Social Sharing and Bereavement in Chinese Culture</hd> <p>Social sharing of bereavement experiences is not highly valued by the Chinese when compared with Western culture. First, the excessive expression of such emotions is thought to be hazardous to health (C. L. W. Chan, [<reflink idref="bib5" id="ref6">5</reflink>]). Second, influenced by Confucian philosophy, Chinese treasure maintaining harmony in their social relationships. The expression of intense emotions in grief and bereavement seems to contradict the harmony of relationships. On the one hand, the sharer seems to lose face and is responsible for disrupting the harmony; and on the other hand, the sharee seems to be embarrassed as he or she is incapable of restoring the harmony.</p> <p>Third, as prescribed by the common condolence statement, the bereaved person has to "follow the flow." This idea is rooted in Taoism and is best represented by the well-known story of Chuang Tzu. As a leading Taoist teacher, when facing the death of his wife, Chuang Tzu sat comfortably, played a drum and sang, and showed no signs of grief. When challenged by his friend, he offered his naturalistic view of life and death. He perceived that life and death comprised the cycle of nature as the transition of four seasons and should not be over-emphasized. His teaching that individuals should accept their fate peacefully subtly affected a lot of Chinese.</p> <p>Besides the traditional philosophical view, the taboo regarding death and dying contributes another driving force that inhibits the social sharing of bereavement. There is a general tendency to avoid the topic of death, except in arguments as a curse to another person. Talking about or even thinking about death is believed to pose an invitation to evil spirits to enter one's house and one's life. To this end, a "treat pocket" is given to guests after joining a Chinese funeral. It contains a piece of small towel or tissue (for wiping the tears), a piece of candy (to induce a sense of sweetness), and a dollar coin (as the gratitude gift to the gift of condolence). Though it is similar to the birthday treat bag in the West, the bag is never welcomed and the recipient is forbidden to bring it back to his or her home. The contents are expected to be used up and the pocket thrown away (C. L. W. Chan, [<reflink idref="bib4" id="ref7">4</reflink>]).</p> <p>Aside from the promotion of harmony in relationships, Confucian philosophy also dictates the appropriate interaction of different relationships. Bond and Hwang ([<reflink idref="bib3" id="ref8">3</reflink>]) used the analogy of an onion to describe the multi layers of relationship (<emph>guanxi</emph>) and the hierarchical structure of the Chinese in social sharing. The content of sharing with casual friends, business friends, and public officials typically is limited to superficial topics, as the outer layer of the onion. Inner and deep feelings are only to be shared with those with whom they have close ties. As cited by Bond and Hwang ([<reflink idref="bib3" id="ref9">3</reflink>]), Lin ([<reflink idref="bib15" id="ref10">15</reflink>]) found that divorced Taiwan woman tended to consult their parents and siblings about their divorce, although few consulted relatives outside their immediate families or friends.</p> <hd id="AN0025347303-3">Social Sharing of the Bereavement Experience in Hong Kong</hd> <p>The majority of the population in Hong Kong is of Chinese ethnicity. At the same time, Western philosophy is influencing the people in Hong Kong because of the colonization by Britain for nearly a hundred years, as well as the sophistication of international communication networks. The concept of bereavement counseling, which originated in Western culture, was only initially offered in selected formal health care settings in Hong Kong during the mid-1990s. The first community-based bereavement counseling services center was inaugurated in the late 1990s (Chow & Chan, [<reflink idref="bib7" id="ref11">7</reflink>]). The first challenge faced by the service was the lack of a formal Chinese term of bereavement (Chow, Koo, Koo, & Lam, [<reflink idref="bib9" id="ref12">9</reflink>]). Running against the tide of inhibition of sharing the bereavement experience with non-family members among the Chinese, the center has served 1,400 families since its opening in late 1997 (F. M. Y. Chan, [<reflink idref="bib6" id="ref13">6</reflink>]). The experience of the counseling service is that Chinese bereaved persons do have the need to share their experiences and that they even seek help from professionals.</p> <hd id="AN0025347303-4">Method</hd> <p></p> <hd id="AN0025347303-5">Participants</hd> <p>The target participants for this study were bereaved persons who had lost their spouse or a parent through death. Two groups were included in this study. The first group, the clinical bereaved sample, was recruited from a community-based bereavement counseling center. All those who had been receiving individual or group bereavement counseling services between April 2001 and April 2003 were invited to participate in the study.</p> <p>The second group consisted of the general bereaved who were recruited from a cancer hospital. Those who had a family member who passed away in that hospital between January 2001 and March 2003 were invited to participate in the study. Ethical approvals were obtained from the departmental research ethics committee and the medical Institutional Review Board of the University.</p> <p>The first group consisted of 140 respondents from 302 invitations with a response rate of 46%. The second group consisted of a similar size. Of the 956 invitations, 152 completed questionnaires were received. At the same time, 46 letters were returned because of an inappropriate address. Thus, the response rate of this group was only 17% of the valid population.</p> <p>The demographic data are shown in Table 1. There were nearly three times as many female as male participants. The majority of the participants experienced spousal loss. Cancer was the major cause of death of the deceased, as one of the study sites was a cancer hospital. Other causes of death, including sudden deaths, were reported by the participants recruited from the bereavement counseling center. The means of the length of time that had elapsed between the death of the deceased and the participants completing the questionnaires were 15.04 (<emph>n</emph> = 139, <emph>SD</emph> = 7.77) and 17.43 (<emph>n</emph> = 146, <emph>SD</emph> = 7.93) months for the clinical and general bereaved samples, respectively.</p> <p>TABLE 1 Profile of the Participants</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Participants</td><td>Clinical bereaved <italic>n</italic> (%)</td><td>General bereaved <italic>n</italic> (%)</td><td>Total <italic>N</italic> (%)</td></tr></thead><tbody><tr><td>Gender</td><td /><td /><td /></tr><tr><td> Male</td><td>12 (8.6)</td><td>67 (45.0)</td><td>79 (27.3)</td></tr><tr><td> Female</td><td>128 (91.4)</td><td>82 (55.0)</td><td>210 (72.7)</td></tr><tr><td>Total</td><td>140 (100.0)</td><td>149 (100.0)</td><td>289 (100.0)</td></tr><tr><td>Age</td><td /><td /><td /></tr><tr><td> 18–24</td><td>1 (0.7)</td><td>10 (6.7)</td><td>11 (3.8)</td></tr><tr><td> 25–34</td><td>24 (17.1)</td><td>20 (13.4)</td><td>44 (15.2)</td></tr><tr><td> 35–44</td><td>41 (29.3)</td><td>44 (29.6)</td><td>85 (29.4)</td></tr><tr><td> 45–54</td><td>47 (33.6)</td><td>41 (27.5)</td><td>88 (30.5)</td></tr><tr><td> 55–64</td><td>13 (9.3)</td><td>20 (13.4)</td><td>33 (11.4)</td></tr><tr><td> > 65</td><td>14 (10.0)</td><td>14 (9.4)</td><td>28 (9.7)</td></tr><tr><td>Total</td><td>140 (100.0)</td><td>149 (100.0)</td><td>289 (100.0)</td></tr><tr><td /><td>–</td><td>–</td><td>–</td></tr><tr><td>Relationship of deceased to participant</td><td>–</td><td>–</td><td>–</td></tr><tr><td> Husband</td><td>100 (71.4)</td><td>36 (25.0)</td><td>136 (47.9)</td></tr><tr><td> Wife</td><td>12 (8.6)</td><td>24 (16.7)</td><td>36 (12.7)</td></tr><tr><td> Father</td><td>16 (11.4)</td><td>39 (27.1)</td><td>55 (19.4)</td></tr><tr><td> Mother</td><td>12 (8.6)</td><td>45 (31.2)</td><td>57 (20.0)</td></tr><tr><td>Total</td><td>140 (100.0)</td><td>144 (100.0)</td><td>284 (100.0)</td></tr><tr><td>Cause of death</td><td /><td /><td /></tr><tr><td> Cancer</td><td>70 (50.3)</td><td>147 (98.0)</td><td>217 (75.1)</td></tr><tr><td> Other chronic illnesses</td><td>9 (6.5)</td><td>1 (0.7)</td><td>10 (3.5)</td></tr><tr><td> Acute illness</td><td>31 (22.3)</td><td>2 (1.3)</td><td>33 (11.4)</td></tr><tr><td> Accidents/suicide</td><td>29 (20.9)</td><td>0 (0.0)</td><td>29 (10.0)</td></tr><tr><td>Total</td><td>139 (100.0)</td><td>150 (100.0)</td><td>289 (100.0)</td></tr></tbody></table> </ephtml> </p> <hd id="AN0025347303-6">Procedure</hd> <p>A questionnaire in Chinese, together with an invitation letter, information sheet on the research, two consent forms, and a stamped return envelope were sent to the potential participants. The invitation explained the rationale and potential contribution of the study and was signed by both the director of the organizations and the supervisor of the university. In the consent forms, besides the agreement details, a statement of "If you would like to talk to someone about your responses after filling out the questionnaire, please contact..." was added to minimize the risk of inducing stress to the participants.</p> <hd id="AN0025347303-7">Measures</hd> <p></p> <hd id="AN0025347303-8">SOCIAL SHARING OF THE BEREAVEMENT EXPERIENCE</hd> <p>Eight questions on social sharing of the bereavement experience were created for measuring the first time that participants shared (their bereavement experience), the number and relationship of persons shared with, the frequency of sharing, the perceived usefulness of sharing, and the responses of the sharee in the most impressive sharing experience, as well as the appraisal of the most impressive sharing experience.</p> <hd id="AN0025347303-9">EMOTIONAL REACTIONS</hd> <p>Anxiety and depression were two commonly identified reactions of bereaved persons. Thus, the Hospital Anxiety and Depression Scale (HADS; Leung, Wing, Kwong, Lo, & Shum, [<reflink idref="bib14" id="ref14">14</reflink>]; Zigmond & Snaith, [<reflink idref="bib17" id="ref15">17</reflink>]) was included in the questionnaire for a more specific measure of the emotional state of the respondents. The scale was used to measure mood, emotional distress, anxiety, and depression in clinical samples with symptoms of physical disease. Half of its 14 items were used to measure anxiety and half to measure depression.</p> <hd id="AN0025347303-10">HEALTH STATUS</hd> <p>Three self-invented items were introduced into the questionnaire for assessing the respondent's health status. They included a comparison of a clinic visit or hospitalization, sick leave, or days of incapacitation, and the respondent's general health condition in the 3-mo period preceding the death of the loved one compared with the 3-mo period post-mortem.</p> <hd id="AN0025347303-11">Results</hd> <p></p> <hd id="AN0025347303-12">Time of First Sharing of Bereavement Experience</hd> <p>Only around 19% of the participants shared their bereavement experience in the first few hours and 40% shared in the first day, leaving around 60% who did not share in the first day. About 10% reported that they had never shared the bereavement experience with anyone, though some of these had actually been receiving bereavement counseling. For the latter respondents, sharing in the counseling context was not considered "social" sharing. Table 2 shows the distribution of the time of first sharing for the clinical and general bereaved participants. Comparing the general bereaved sample with the clinical one, the former tended to share earlier (72.29% in the first week) than the latter (56% in the first week). The median and mode for the whole group of participants was the first week and the first month, respectively. The clinical status and the timing of first sharing were found to be significantly related. Yet, the result should be taken with caution as the return rate of general bereaved sample was much lower than that of the clinical sample.</p> <p>TABLE 2 Time of Sharing, Numbers of Sharing, and Number of Persons to Share with in Clinical and General Bereaved Sample</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Variable</td><td>Clinical bereaved sample <italic>n</italic> (% within the choice)</td><td>General bereaved sample <italic>n</italic> (% within the choice)</td><td>Total bereaved sample <italic>n</italic> (% within the choice)</td><td>Cramér's <italic>V</italic></td></tr></thead><tbody><tr><td>Time of first sharing</td><td /><td /><td /><td>.233<xref ref-type="fn" rid="fn1" /> (<italic>p</italic> = .01)</td></tr><tr><td> First few hours</td><td>24 (46.2)</td><td>28 (53.8)</td><td>52 (100.0)</td><td /></tr><tr><td> The same day</td><td>18 (33.3)</td><td>36 (66.7)</td><td>54 (100.0)</td><td /></tr><tr><td> The day after</td><td>14 (48.3)</td><td>15 (51.7)</td><td>29 (100.0)</td><td /></tr><tr><td> The same week</td><td>20 (41.7)</td><td>28 (58.3)</td><td>48 (100.0)</td><td /></tr><tr><td> The same month</td><td>47 (66.2)</td><td>24 (33.8)</td><td>71 (100.0)</td><td /></tr><tr><td> Never</td><td>12 (41.4)</td><td>17 (58.6)</td><td>29 (100.0)</td><td /></tr><tr><td> Total</td><td>135 (47.7)</td><td>148 (52.3)</td><td>283 (100.0)</td><td /></tr><tr><td>No. of times of sharing</td><td /><td /><td /><td>.24<xref ref-type="fn" rid="fn2" /> (<italic>p</italic> = .01)</td></tr><tr><td> Never</td><td>9 (40.9)</td><td>13 (59.1)</td><td>22 (100.0)</td><td /></tr><tr><td> 1–2 times</td><td>17 (47.2)</td><td>19 (52.8)</td><td>36 (100.0)</td><td /></tr><tr><td> 3–4 times</td><td>26 (44.1)</td><td>33 (55.9)</td><td>59 (100.0)</td><td /></tr><tr><td> 5–6 times</td><td>10 (25.0)</td><td>30 (75.0)</td><td>40 (100.0)</td><td /></tr><tr><td> 7–10 times</td><td>19 (59.4)</td><td>13 (40.6)</td><td>32 (100.0)</td><td /></tr><tr><td> 11–20 times</td><td>19 (55.9)</td><td>15 (44.1)</td><td>34 (100.0)</td><td /></tr><tr><td> More than 20 times</td><td>37 (61.7)</td><td>23 (38.3)</td><td>60 (100.0)</td><td /></tr><tr><td> Total</td><td>137 (48.4)</td><td>146 (51.6)</td><td>283 (100.0)</td><td /></tr><tr><td>No. of persons shared with</td><td /><td /><td /><td>.15 (<italic>p</italic> = .36)</td></tr><tr><td> Nobody</td><td>7 (36.8)</td><td>12 (63.2)</td><td>19 (100.0)</td><td /></tr><tr><td> 1–2 persons</td><td>13 (46.4)</td><td>15 (53.6)</td><td>28 (100.0)</td><td /></tr><tr><td> 3–4 persons</td><td>27 (46.6)</td><td>31 (53.4)</td><td>58 (100.0)</td><td /></tr><tr><td> 5–6 persons</td><td>25 (41.0)</td><td>36 (59.0)</td><td>61 (100.0)</td><td /></tr><tr><td> 7–10 persons</td><td>26 (63.4)</td><td>15 (36.6)</td><td>41 (100.0)</td><td /></tr><tr><td> 11–20 persons</td><td>18 (52.9)</td><td>16 (47.1)</td><td>34 (100.0)</td><td /></tr><tr><td> More than 20 persons</td><td>22 (51.2)</td><td>21 (48.8)</td><td>43 (100.0)</td><td /></tr><tr><td> Total</td><td>138 (48.6)</td><td>146 (51.4)</td><td>284 (100.0)</td><td /></tr><tr><td /></tr></tbody></table> </ephtml> </p> <hd id="AN0025347303-13">Number of Times of Social Sharing</hd> <p>The clinical sample tended to share more times when compared with the general bereaved sample. The median for the clinical sample and general sample was 7–10 times and 5–6 times, respectively. About 27% of the clinical sample shared more than 20 times, and this category was also the mode of the sample. Table 2 shows the distribution of the number of times of social sharing for the two groups of participants. The status as clinical sample and the number of times of social sharing were again found to be significantly related.</p> <hd id="AN0025347303-14">Number of Persons with Whom the Bereavement Experience was Shared</hd> <p>As reflected in Table 2, the mode for the clinical and general bereaved sample was 3–4 persons and 5–6 persons, respectively. However, about 15% of the respondents shared with more than 20 persons.</p> <hd id="AN0025347303-15">With Whom to Share the Bereavement Experience</hd> <p>Among the 10 relationships listed in Table 3, participants in the clinical bereaved sample most commonly shared with professionals, best friends, and siblings. These three choices were also the top three choices for the question of most frequent sharer. For the general bereaved sample, the three most commonly identified sharers were siblings, best friends, and other family members (excluding spouses, parents, and siblings). Combining the two groups of samples, the top three were my best friend, siblings, and a friend. When they were asked to choose the one with whom they shared most, the list changed to my best friend, siblings, and professionals.</p> <p>TABLE 3 With Whom the Bereavement Experience was Shared</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td>Those the sharer chose to share the bereavement experience with</td><td>The one most frequently chosen by the sharer<xref ref-type="fn" rid="fn2" /></td></tr><tr><td>Person</td><td>Clinical <italic>n</italic> (%)</td><td>General <italic>n</italic> (%)</td><td>Total <italic>N</italic> (%)</td><td>Clinical <italic>n</italic> (%)</td><td>General <italic>n</italic> (%)</td><td>Total <italic>N</italic> (%)</td></tr></thead><tbody><tr><td>Spouse/partner</td><td>13 (9.3)</td><td>50 (33.1)</td><td>83 (28.5)</td><td>5 (3.6)</td><td>26 (17.2)</td><td>31 (10.7)</td></tr><tr><td>Parents</td><td>41 (29.3)</td><td>39 (25.8)</td><td>80 (27.5)</td><td>14 (10.0)</td><td>7 (4.6)</td><td>21 (7.2)</td></tr><tr><td>Siblings</td><td>74 (52.9)</td><td>96 (63.6)</td><td>170 (58.4)</td><td>29 (20.7)</td><td>49 (32.5)</td><td>78 (26.8)</td></tr><tr><td>Other family members</td><td>55 (39.3)</td><td>80 (53.0)</td><td>135 (46.4)</td><td>13 (9.3)</td><td>28 (18.5)</td><td>41 (14.1)</td></tr><tr><td>My best friend</td><td>88 (62.9)</td><td>89 (58.9)</td><td>177 (60.8)</td><td>49 (35.0)</td><td>39 (25.8)</td><td>88 (30.2)</td></tr><tr><td>A friend</td><td>69 (49.3)</td><td>73 (48.3)</td><td>142 (48.8)</td><td>23 (16.4)</td><td>20 (13.2)</td><td>43 (14.8)</td></tr><tr><td>A neighbor</td><td>28 (20.0)</td><td>17 (11.3)</td><td>45 (15.5)</td><td>3 (2.1)</td><td>2 (1.3)</td><td>5 (1.7)</td></tr><tr><td>A colleague</td><td>29 (20.7)</td><td>53 (35.1)</td><td>82 (28.2)</td><td>3 (2.1)</td><td>9 (6.0)</td><td>12 (4.1)</td></tr><tr><td>A professional</td><td>104 (74.3)</td><td>31 (20.4)</td><td>135 (46.4)</td><td>59 (42.1)</td><td>7 (4.6)</td><td>66 (22.7)</td></tr><tr><td>A religious staff person</td><td>36 (25.7)</td><td>23 (15.2)</td><td>59 (20.3)</td><td>12 (8.6)</td><td>9 (6.0)</td><td>21 (7.2)</td></tr><tr><td /></tr></tbody></table> </ephtml> </p> <p>Contrary to the belief that the Chinese share their emotional experiences with family members only, participants in this study chose non-family members as sharees more often than family members. For further analysis, the first four relationships (spouses or partners, parents, siblings, and family members) were grouped as insiders and the remaining as outsiders. For the clinical sample, in choosing whom to share with the most, the ratio of insiders to outsiders was 1:2.44; but for the general sample, the ratio was 1:0.78.</p> <hd id="AN0025347303-16">Perceived Responses of Sharees in the Most Impressive Social Sharing Experience</hd> <p>The respondents were asked about the perceived responses of the sharees in their most impressive social sharing of their bereavement experiences. They rated the responses on a 7-point scale ranging from "totally absent" to "totally appropriate" on eight possible responses. Whereas the English word <emph>impressive</emph> has a positive connotation, in Chinese it is neutral. Thus, respondents were further asked whether this was a good, mixed, or bad experience. One hundred and sixty three (6%) respondents appraised the experience as positive, and only 4 (2%) appraised it as bad. As the negative appraisal group was so small, analysis was carried out between the positive appraisal group and the mixed/bad combined group. Details of the findings are shown in Table 4.</p> <p>TABLE 4 Independent Samples t test of Perceived Responses of the Sharees between the Positive Appraiser and Mixed or Negative Appraiser</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Perceived responses</td><td>Groups</td><td><italic>n</italic></td><td><italic>M</italic><xref ref-type="fn" rid="fn3" /></td><td><italic>SD</italic></td><td><italic>t</italic></td></tr></thead><tbody><tr><td>He/she showed care and concern</td><td>Mixed/bad</td><td>85</td><td char="." charoff="50">4.88</td><td char="." charoff="50">1.679</td><td char="." charoff="50">−6.137**</td></tr><tr><td /><td>Good</td><td>163</td><td char="." charoff="50">6.04</td><td char="." charoff="50">1.254</td><td /></tr><tr><td>He/she avoided the topic of bereavement</td><td>Mixed/bad</td><td>82</td><td char="." charoff="50">2.57</td><td char="." charoff="50">1.839</td><td char="." charoff="50">2.680**</td></tr><tr><td /><td>Good</td><td>151</td><td char="." charoff="50">1.96</td><td char="." charoff="50">1.566</td><td /></tr><tr><td>He/she escaped from you</td><td>Mixed/bad</td><td>81</td><td char="." charoff="50">1.83</td><td char="." charoff="50">1.403</td><td char="." charoff="50">2.863**</td></tr><tr><td /><td>Good</td><td>150</td><td char="." charoff="50">1.39</td><td char="." charoff="50">.925</td><td /></tr><tr><td>He/she offered an opinion to you</td><td>Mixed/Bad</td><td>86</td><td char="." charoff="50">3.98</td><td char="." charoff="50">2.136</td><td char="." charoff="50">−5.496**</td></tr><tr><td /><td>Good</td><td>153</td><td char="." charoff="50">5.31</td><td char="." charoff="50">1.574</td><td /></tr><tr><td>He/she offered relevant information to you</td><td>Mixed/bad</td><td>84</td><td char="." charoff="50">3.31</td><td char="." charoff="50">2.151</td><td char="." charoff="50">−6.029**</td></tr><tr><td /><td>Good</td><td>161</td><td char="." charoff="50">4.87</td><td char="." charoff="50">1.793</td><td /></tr><tr><td>He/she listened</td><td>Mixed/bad</td><td>89</td><td char="." charoff="50">4.52</td><td char="." charoff="50">2.018</td><td char="." charoff="50">−2.309*</td></tr><tr><td /><td>Good</td><td>152</td><td char="." charoff="50">5.10</td><td char="." charoff="50">1.808</td><td /></tr><tr><td>He/she kept a distance from you</td><td>Mixed/bad</td><td>84</td><td char="." charoff="50">2.24</td><td char="." charoff="50">1.633</td><td char="." charoff="50">2.919**</td></tr><tr><td /><td>Good</td><td>149</td><td char="." charoff="50">1.67</td><td char="." charoff="50">1.292</td><td /></tr><tr><td>He/she tried to help you to forget the bereavement experience</td><td>Mixed/bad</td><td>86</td><td char="." charoff="50">3.71</td><td char="." charoff="50">2.040</td><td char="." charoff="50">−.766</td></tr><tr><td /><td>Good</td><td>152</td><td char="." charoff="50">3.93</td><td char="." charoff="50">2.150</td><td /></tr><tr><td /></tr><tr><td /></tr></tbody></table> </ephtml> </p> <p>Significant differences were found between the two groups in the seven responses. Those who appraised the experience as positive perceived the responses of the sharees as expressing greater care and concern, as more likely to offer opinions and relevant information, and as less inclined to avoid topics, escape physically, and distance themselves. The sharees were perceived to be more willing to listen.</p> <hd id="AN0025347303-17">Emotional Reactions and Physical Health Status of Sharers andNon-Sharers</hd> <p>Those individuals who reported that they had shared their bereavement experience with nobody were identified. Together, they formed a group of non-sharers. The anxiety and depression subscale of this group was found to be slightly higher than those who had shared with someone, but the difference was not statistically significant.</p> <p>The extremes in the range for the number of sharers went from <emph>nobody</emph> to <emph>more than 20 persons</emph>. The former were classified as a group of <emph>non-sharers</emph>, whereas the second category was classified as <emph>extensive sharers</emph>. The non-sharers, when compared with the extensive sharers, were found to have slightly better perceived health and less anxiety and more depression, although none of the differences were statistically significant.</p> <hd id="AN0025347303-18">Discussion</hd> <p></p> <hd id="AN0025347303-19">The Myth of Death as a Forbidden Topic for the Chinese</hd> <p>In our study, 10% of respondents revealed that they had shared their bereavement experience with nobody (9% and 12% in the clinical and general samples, respectively). This claim among the clinical sample seems to be paradoxical. Social sharing of the bereavement experience is likely to be included in the counseling process, so this group of respondents may have considered themselves as informants for the counselors so as to help other bereaved family members.</p> <p>Another possible explanation is that the informants might exclude sharing with counselors in defining social sharing. Furthermore, the non-sharing rate of 10% is likely to be an under-estimate of prevalence within the general population. There is likely to be a much higher proportion of non-sharers among the non-respondents, as they did not want to disclose their bereavement experience even in the form of questionnaires.</p> <p>However, the study shows that 40% of Chinese bereaved persons had shared with somebody within the first day. The belief of death as a forbidden topic for the Chinese is not necessarily supported.</p> <hd id="AN0025347303-20">The Myth of Excessive Emotional Expression as a Threat to Health</hd> <p>In comparing the non-sharers with extensive sharers, there were no significant differences in the frequencies of clinic visits, days of sick leave, perceived general health, or anxiety and depression level. To a certain extent, we can say that there are no signs of emotional or physical health problems in the multiple sharers. At the same time, the reverse can also be true. There were no signs of emotional or physical health problems in the non-sharers. To further support the statements claimed above, two independent sample <emph>t</emph> tests were carried out to compare extensive sharers and non-sharers with the other bereaved samples (sharers who shared with fewer than 20 persons), respectively. These identified no significant differences either. We further repeated the same statistical tests on three new groups: the non-sharers, those who shared more than 20 times, and those who shared fewer than 20 times. Similarly, there were no significant differences in the emotional reactions and health status.</p> <p>Because this is a cross-sectional study, we do not know about the change before and after the social sharing. The non-significant differences in the post-sharing measurement might have different explanations. Possibly, those displaying high-level emotional reactions were more inclined to have extensive sharing and became less emotional after sharing. Their level of emotional reaction perhaps then became comparable with those less emotional non-sharers.</p> <p>Yet, the reverse might be possible: Perhaps those who were more emotional and tended to suppress and not share with others became less emotional after inhibition. On the other hand, perhaps those who shared heightened their emotional arousal, thus reaching a level comparable with that of the post-inhibition non-sharers.</p> <p>There might be another possibility of combining the scenarios mentioned above, thus canceling out the effect, with the differences then becoming non-significant. Longitudinal studies of bereavement should be adopted for a better understanding of this phenomenon.</p> <hd id="AN0025347303-21">The Myth of Social Sharing of Bereavement Experience as aFamily Affair</hd> <p>As reflected in our study, the social sharing of the bereavement experience was not restricted to family members. "My best friend", rather than family members, yielded the highest score as the choice of sharees. "Siblings" ranked second whereas "a friend" ranked third, followed by "professional". Thus, among the first four choices, "outsiders" occupied three places. In ranking the one to share the bereavement experience most, "my best friend", "siblings", and "professional" were the first three choices. Both results indicate that non-family members occupy an important role as sharees to Chinese bereaved persons in Hong Kong.</p> <p>As about half the informants were recruited from the community bereavement center, the result could be biased as those who chose to share with family members most might not be in need of a bereavement counseling service. Besides, the general bereaved sample is much underrepresented because of the low response rate. Thus, although the ratio of outsider sharee to insider sharee in this study is larger than one, we cannot generalize that bereaved persons prefer to share with outsiders rather than family members. Further studies should be carried out to verify this postulation with a more representative sample. On the other hand, we can falsify the notion that Chinese bereaved persons only share their bereavement experience with family members.</p> <p>Though it might be possible that family members are not sufficiently supportive to be sharees, bereaved persons may choose outsiders as their sharee for other reasons. The clinical experience of working with widows in Hong Kong shows that widows did not want to put additional burdens on other family members, especially their aged parents or their young children; thus they pretended to be well adjusted to their bereavement. When they felt the need to share, they would turn to someone not directly affected by the bereavement experience. Best friends, friends, and professionals then become the popular choices. This matches with the concepts of relational self among the Chinese (D. Y. F. Ho, [<reflink idref="bib12" id="ref16">12</reflink>]) as well as the interdependence in grief among Hong Kong Chinese (S. M. Y. Ho & Tsui, [<reflink idref="bib13" id="ref17">13</reflink>]).</p> <hd id="AN0025347303-22">Implications for Bereavement Care</hd> <p></p> <hd id="AN0025347303-23">From Informal Family Support to Formal Community Service</hd> <p>When facing the painful experience of losing a loved one through death, informal family support can be a safety net for some people; yet others may want to share with non-family members. This strongly supports the importance of establishing a community bereavement support center.</p> <hd id="AN0025347303-24">From Universal Need of Expression to Optimal Level of Sharing</hd> <p>Emotional expression has for decades been perceived to be an essential element of grief work. On the other hand, the Chinese promote inhibition, as reflected by the commonly used condolence statement. Bonanno and colleagues (Bonanno, Wortman, & Nesse, [<reflink idref="bib2" id="ref18">2</reflink>]) have suggested the possible co-existence of enhancement and suppression of emotional expression as the optimal solution to the controversy regarding the beneficial effect of social sharing of bereavement experience. The concept seems to be paradoxical, yet it matches well with the Chinese Yin–Yang model of duality and reciprocity. Yin and Yang, though opposite in polarities, coexist and mutually construct one another. This idea of co-existence is one of the possible explanations for the findings in our study. Yet, as we have suggested, more rigorous research methodology has to be used in future studies to verify as well as to tap the mechanism by which sharing has psychological benefits or drawbacks for the bereaved.</p> <hd id="AN0025347303-25">From Immediate Response to Optimal Timing</hd> <p>Because only about 40% of the respondents shared their bereavement experience on the first day, it seems that a greater portion of bereaved persons chose not to share on the first day. Possibly, they were numbed and needed time to assimilate the bereavement experience, and they preferred to do it internally. Those who offer bereavement care should be aware that the rejection of help on the first day of bereavement does not necessarily reflect the real needs of the bereaved persons. Some bereaved persons reported that they felt embarrassed to go back to someone whose offer of help they had previously turned down. Thus, the optimal timing for intervention should be explored.</p> <hd id="AN0025347303-26">From Passive Listening to Interactive Communication</hd> <p>The results in the perceived reactions of the sharees in the most impressive social sharing experience of bereavement can give insights on what can be done for bereaved persons. Physically escaping, distancing, and avoiding the topic of the deceased were more commonly cited in the bad or mixed social sharing experiences. Thus, giving bereaved persons space to grieve on their own might not be seen as a supportive act. The impact of these three reactions on those bereaved persons who did not share is uncertain, as the sample size is too small to differentiate. Yet the impact on the general bereaved population is definitely negative. Besides the reminders of don'ts, the findings in this study also suggest some dos. Listening, showing care and concern, providing relevant information, and offering opinion are also perceived as components of a good social sharing experience.</p> <hd id="AN0025347303-27">Conclusion</hd> <p>Because of language and philosophical differences, the picture of the Chinese bereavement experience is veiled. This study is a first attempt to remove the shroud providing a glimpse of a selected aspect of social sharing in the bereavement experiences of the Chinese. As the participants of this study are from Hong Kong, where East meets West, the respondents might be integrating both cultural traditions. Further research should be undertaken in other Chinese populations in Mainland China, Taiwan, and in other Western countries for a better understanding of Chinese bereaved persons. This study, as one of the first to explore the Chinese bereavement experience, has indicated the need for further research. For example, longitudinal studies would enable a wider data collection and would provide a more diversified sample pool.</p> <p>However, the present study has explored and clarified some long-standing perceptions of social sharing among the Chinese. Importantly, bereavement care from non-family members is perceived to be equally as important as care from family members, whereas the offers of listening, care and concern, and relevant information are suggested as meaningful options to those who want to care for the bereaved, rather than merely saying "Jie ai shun bian."</p> <hd id="AN0025347303-28">Acknowledgments</hd> <p>Part of this article was presented in poster form at the 27th Annual Association for Death Education and Counseling (ADEC) conference, March 31–April 3, 2005, in Albuquerque, New Mexico. The article received the ADEC 2005 Cross-Cultural Award. In addition, the work described in this article was substantially supported by a grant from the Research Grants Council (RGC) of the Hong Kong Special Administrative Region, China (Project No. HKU 7110/01H). We express our sincere gratitude to ADEC, RGC, Jessie and Thomas Tam Centre (JTTC), the Society for the Promotion of Hospice Care, and Nam Long Hospital of Hospital Authority for the support and assistance given to this study.</p> <ref id="AN0025347303-29"> <title> References </title> <blist> <bibl id="bib1" idref="ref3" type="bt">1</bibl> <bibtext> Bonanno, G. A. & Kaltman, S. (1999). Toward an integrative perspective on bereavement. Psychological Bulletin, 125, 760–776.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref18" type="bt">2</bibl> <bibtext> Bonanno, G. A., Wortman, C. B., & Nesse, R. M. (2004). Prospective patterns of resilience and maladjustment during widowhood. 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(2004). Society for the promotion of hospice care in Hong Kong. The Forum, 30 (3), 5.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref11" type="bt">7</bibl> <bibtext> Chow, A. Y. M. & Chan, C. L. W. (2006). Bereavement care in Hong Kong: Past, present, and future. In C. L. W.Chan & A. Y. M., Chow (Eds.), Death, dying and bereavement: A Hong Kong Chinese experience (pp. 253–260). Hong Kong: Hong Kong University Press.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref5" type="bt">8</bibl> <bibtext> Chow, A. Y. M., Chan, C. L. W., & Ho, S. M. Y. (2003, November 19–21). An update on bereavement research in Hong Kong. Paper presented at the 10th Hong Kong International Cancer Congress, Hong Kong SAR, China.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref12" type="bt">9</bibl> <bibtext> Chow, A. Y. M., Koo, B. W. S., Koo, E. W. K., & Lam, A. Y. Y. (2000). Turning grief into good separation: Bereavement services in Hong Kong. In R.Fielding & L. W. C.Chan (Eds.), Psychosocial oncology & palliative care in Hong Kong: The first decade (pp. 233–254). Hong Kong: Hong Kong University Press.</bibtext> </blist> <blist> <bibtext> Cohen, S. & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357.</bibtext> </blist> <blist> <bibtext> Dimond, M., Lund, D. A., & Caserta, M. S. (1987). The role of social support in the first two years of bereavement in an elderly sample. Gerontologist, 27, 599–604.</bibtext> </blist> <blist> <bibtext> Ho, D. Y. F. (1995). Selfhood and identity in Confucianism, Taoism, Buddhism, and Hinduism: Contrasts with the west. Journal-for-the-Theory-of-Social-Behaviour, 25, 115–134.</bibtext> </blist> <blist> <bibtext> Ho, S. M. Y. & Tsui, Y. K. Y. (2002). Interdependence in death and grief among Hong Kong Chinese. Newsletter of Hong Kong Society of Palliative Medicine, 2002(1), 1–4.</bibtext> </blist> <blist> <bibtext> Leung, C. M., Wing, Y. K., Kwong, P. 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Acta Psychiatrica Scandinavica, 67, 361–370.</bibtext> </blist> </ref> <ref id="AN0025347303-30"> <title> Footnotes </title> <blist> <bibtext> **<emph>p</emph> ≤ .01.</bibtext> </blist> <blist> <bibtext> <sups> <emph>a</emph> </sups>Some respondents chose more than one category, thus the total sum is greater than 100%.</bibtext> </blist> <blist> <bibtext> <sups> <emph>a</emph> </sups> The perceived response is measured on a 7-point scale. The higher the score, the more frequent the perceived responses.</bibtext> </blist> <blist> <bibtext> *<emph>p</emph> < .05. **<emph>p</emph> < .01.</bibtext> </blist> </ref> <aug> <p>By AmyY. M. Chow; CeciliaL. W. Chan and SamuelM. Y. Ho</p> <p>Reported by Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib11" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib16" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib15" firstref="ref10"></nolink> <nolink nlid="nl5" bibid="bib14" firstref="ref14"></nolink> <nolink nlid="nl6" bibid="bib17" firstref="ref15"></nolink> <nolink nlid="nl7" bibid="bib12" firstref="ref16"></nolink> <nolink nlid="nl8" bibid="bib13" firstref="ref17"></nolink>
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  Data: Social Sharing of Bereavement Experience by Chinese Bereaved Persons in Hong Kong
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  Data: <searchLink fieldCode="SO" term="%22Death+Studies%22"><i>Death Studies</i></searchLink>. Aug 2007 31(7):601-618.
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  Label: DOI
  Group: ID
  Data: 10.1080/07481180701405105
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0748-1187
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Contrary to the belief that the Chinese do not share emotionally intense experiences, findings from a cross-sectional study of 292 respondents who lost either a spouse or a parent in the previous 2 years in Hong Kong indicated that only 10% did not share their bereavement experiences with another person. The physical health and emotional state of non-sharers was found to be no different to those who shared. In addition, the Chinese are believed to limit their social sharing of personal experiences to family members only. In our study, we found that for those who shared, the persons they shared most with were their best friends, siblings, and professionals. Non-family members are clearly eligible "sharees" for Chinese people. Differences in the reactions of sharees in good and bad sharing experiences were identified. Based on these findings, implications for bereavement care for Chinese are delineated. (Contains 4 tables.)
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: Author
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 17
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2007
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ765939
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ765939
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/07481180701405105
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 18
        StartPage: 601
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Physical Health
        Type: general
      – SubjectFull: Siblings
        Type: general
      – SubjectFull: Emotional Response
        Type: general
      – SubjectFull: Grief
        Type: general
      – SubjectFull: Coping
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Interpersonal Relationship
        Type: general
      – SubjectFull: Cultural Differences
        Type: general
      – SubjectFull: Family Relationship
        Type: general
      – SubjectFull: Sibling Relationship
        Type: general
      – SubjectFull: Friendship
        Type: general
      – SubjectFull: Death
        Type: general
      – SubjectFull: Hong Kong
        Type: general
    Titles:
      – TitleFull: Social Sharing of Bereavement Experience by Chinese Bereaved Persons in Hong Kong
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Chow, Amy Y. M.
      – PersonEntity:
          Name:
            NameFull: Chan, Cecilia L. W.
      – PersonEntity:
          Name:
            NameFull: Ho, Samuel M. Y.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 08
              Type: published
              Y: 2007
          Identifiers:
            – Type: issn-print
              Value: 0748-1187
          Numbering:
            – Type: volume
              Value: 31
            – Type: issue
              Value: 7
          Titles:
            – TitleFull: Death Studies
              Type: main
ResultId 1