While this hierarchy of metaphors allows a thorough examination of the factors that may impact the course of bereavement in diverse populations, it can be tailored to help understand grief and bereavement in diverse Aboriginal populations (Figure 2). Future research, nevertheless, is needed to examine bereavement among Aboriginal populations,

including the development of theoretical models that best explains CG as an outcome of bereavement. Figure 1. Squamish Nation welcome figure in Vancouver, British Columbia. The figure represents strength, and the importance of carrying on Aboriginal teachings and traditions. Figure 2. Metaphorical model of healing in Aboriginal populations. Inhibitors,research,lifescience,medical Adapted from ref 42: Kirmayer Inhibitors,research,lifescience,medical LJ. The cultural diversity of healing: meaning, metaphor and mechanism. Br Med Bull. 2004;69:33-48. Copyright © Oxford University Press

2004 Future directions Such studies must include full partnership with Aboriginal communities to help identify risk factors for CG, understand the role of culture among these communities, as well as identify Inhibitors,research,lifescience,medical interventions to reduce poor health outcomes such as suicidal behavior. In Manitoba, Canada, the Swampy Cree Suicide Prevention Team has been established to lead such research.43 The team is comprised of international experts, researchers, and community members, and aims to advance the understanding of effective Inhibitors,research,lifescience,medical suicide-prevention strategies for First Nations people. Guidance from community members is an essential component of this research team, and is a necessary element of future research in the area of CG. Given the paucity of research examining the dimensions of complicated grief in Aboriginal populations, more research is required. This research must consider the role of culture, intergenerational trauma, and traditional Inhibitors,research,lifescience,medical healing practices in order to address this important public health issue. Acknowledgments DNA Damage inhibitor Preparation of this article was supported by research grants from the Canadian Institutes of Health

Research (Dr Bolton #102682) and Manitoba Health Research Council (Dr Bolton), a Manitoba Health Research Council Chair Award (Dr Sareen), a CIHR/PHAC Applied Public Health Chair Award (Dr Martens), a SSHRC Joseph-Armand Bombardier Canada Doctoral Scholarship (Ms Spiwak), Phosphatidylinositol diacylglycerol-lyase and a Canadian Institutes of Health Research New Investigator Award (Dr Bolton #113589; Dr Elias # 80503).
The loss of a child is recognized as a very difficult life experience, which can often cause complicated grief (CG) reactions that risk negatively affecting psychological and physical well-being.1,2 In a population-based sample, bereaved individuals who had lost a child showed the highest prevalence of CG.3 Perinatal loss is a relatively common occurrence which, in this article, refers to the death of an infant due to miscarriage, stillbirth, and neonatal death.