Trajectories of prolonged grief one to six years after a natural disaster

Exploring the bereavement experiences and prevalence of prolonged grief disorder among 2023 Turkish earthquake survivors with advanced chronic disease: a mixed methods study

OBJECTIVE

While traumatic experience of a loved one's death and having a chronic disease are both risk factors for prolonged grief disorder, there are no published studies on bereavement among earthquake survivors with advanced chronic disease. The objective of this study is to explore the bereavement experiences and prevalence of prolonged grief disorder (PGD) among 2023 Türkiye earthquake survivors with advanced chronic diseases.

DESIGN/SETTING

A mixed methods design of cross-sectional survey using the Prolonged Grief Scale (PG-13) and semi-structured interviews was used to provide a detailed understanding of the grief phenomenon in the context of bereaved adults with advanced chronic disease after the earthquake in Türkiye.

PARTICIPANTS

143 participants completed the survey, and interviews were conducted with 12 bereaved survivors with advanced chronic disease.

RESULTS

Our results indicated a prevalence of PGD among bereaved adults of 23.8%. The traumatic death of first-degree relatives was associated with a higher PGD prevalence (p<0.001). PGD developed in 50% of retirees (n=6). Six themes were identified: (1) bereavement reactions, (2) coping style, (3) disrupted grieving, (4) impact of grief on chronic disease, (5) moving forward and (6) unmet needs.

CONCLUSIONS

We recommend a person-centred bereavement care that prioritises early identification and reduction of prolonged grief risk factors. We propose a framework for bereaved survivors to use in the development of an effective bereavement service model. This model may be used by mental health professionals and policymakers to respond sensitively to the values, needs and preferences of bereaved survivors who have experienced the unnatural death of a loved one.

Trajectories of children's intrusive grief and association with baseline family and child factors and long-term outcomes in young adulthood

This study reports on the description of children's distinct trajectories of intrusive grief, baseline predictors of grief trajectories, and the association of grief trajectories with mental health, substantive abuse and disordered grief six and fifteen years following baseline assessment. The study uses data on 244 parentally-bereaved children ages 8-16 at baseline. Four distinct trajectories were identified using Growth Mixture Modeling over four waves of assessment across 6 years. The trajectories were labeled high chronic grief, moderate chronic grief, grief recovery (starts high but decreases over 6 years of assessment) and grief resilience (chronic low grief). Baseline factors associated with chronic high or moderate chronic levels of grief included depression, traumatic cause of death (homicide or suicide), active inhibition of emotional expression, active coping, child age and gender. At the six-year assessment, trajectories were associated with internalizing mental health problems, higher level of traumatic grief, and aversive views of the self. At the fifteen-year assessment, trajectories were associated with intrusive grief. The results are interpreted in terms of consistency with prior evidence of children's long-term grief, theoretical processes that may account for chronic grief and implications for the development of preventive and treatment interventions.

Factors of prolonged-grief-disorder symptom trajectories for ICU bereaved family surrogates

BACKGROUND

Bereaved people experience distinct trajectories of prolonged-grief-disorder (PGD) symptoms. A few studies from outside critical care investigated limited factors of PGD-symptom trajectories without a theoretical framework. We aimed to characterize factors associated with ICU bereaved surrogates' PGD-symptom trajectories, drawing from the integrative framework of predictors for bereavement outcomes, emphasizing factors modifiable by ICU care.

METHODS

Prospective cohort study of 291 family surrogates. Multinomial logistic regression was used to determine associations of three previously identified PGD-symptom trajectories (resilient [n = 242, 83.2%] as reference group, recovery [n = 35, 12.0%], and chronic [n = 14, 4.8%]) with risk factors. Factors included intrapersonal (demographics, personal vulnerabilities), interpersonal (perceived social support), bereavement-related (patient demographics, clinical characteristics, and patient-surrogate relationship), and death-circumstance (surrogate-perceived quality of patient dying and death [QODD] in ICUs classified as high, moderate, poor-to-uncertain, and worst QODD classes) factors.

RESULTS

Most surrogates were female (59.1%), the patient's adult child (54.0%), and about (standard deviation) 49.63 (12.53) years old. As surrogate age increased, recovery-trajectory membership decreased (adjusted odds ratio [95% confidence interval] = 0.918 [0.849, 0.993]) and chronic-trajectory membership increased (1.230 [1.010, 1.498]). Being married decreased membership in the recovery (0.186 [0.047, 0.729]) trajectory. Higher anxiety symptoms 1 month post loss increased membership in recovery (1.520 [1.256, 1.840]) and chronic (2.022 [1.444, 2.831]) trajectories. Spouses were more likely and adult-child surrogates were less likely than other relationships to be in the two more profound PGD-symptom trajectories. Membership in the chronic trajectory decreased (0.779 [0.614, 0.988]) as patient age increased. The poor-to-uncertain QODD class was associated with a nearly significant increase (4.342 [0.980, 19.248]) in membership in the recovery trajectory compared to the high QODD class.

CONCLUSIONS

Membership in the PGD-symptom trajectories was associated with factors modifiable by high-quality ICU care, including anxiety symptoms at early bereavement and surrogate-perceived QODD in the ICU. Clinicians should be sensitive to the psychological needs of at-risk family surrogates, provide high-quality end-of-life care to facilitate QODD, and promptly refer bereaved surrogates who suffer anxiety symptoms and profound and/or persistent PGD-symptoms for psychological support.

Pathways between grief, depression, hopelessness, reasons for living, and suicidal ideation in bereaved individuals

BACKGROUND

Associations between comorbid depression and grief with suicidal ideation (SI) have been inconsistent. To identify at-risk individuals, it is important to determine the role of symptom severity by examining both continuous and clinical-threshold grief and depression, in addition to other factors (i.e., hopelessness, reasons for living-RFL) associated with SI.

METHODS

Participants (n = 216) bereaved by combat, accident, or suicide completed an online survey. Associations between depression, grief, SI, RFL, and hopelessness were examined by multivariable logistic regressions and structural equation modeling (SEM).

RESULTS

Across the sample, hopelessness and RFL were associated with SI while continuous measures of grief and depression were not. In contrast, clinical-threshold grief, clinical-threshold depression, hopelessness, and RFL each were associated with SI. In addition, of the grief characteristics, yearning was the most robust correlate of SI, and Survival/Coping Beliefs (SCB) was the RFL most associated with SI. SEM indicated that direct paths between grief and SI, hopelessness and SI, and RFL and SI were significant, but not between depression and SI. Instead, depression had a strong direct effect on hopelessness, and hopelessness had a direct effect on SI.

DISCUSSION

Results are consistent with previously-identified associations between SI and clinical levels of depression and grief. More nuanced findings suggest hopelessness, yearning, and SCB as additional targets for reducing risk for SI in bereaved individuals regardless of whether they meet clinical thresholds for grief or depression.

A Latent Class Analysis on Indicators of Early Prolonged Grief Disorder and Well-Being Among Dutch Adults Bereaved During the First Year of the COVID-19 Pandemic

Most studies examining prolonged grief disorder (PGD) in people bereaved during the COVID-19 pandemic are focused on psychopathology. However, mental health encompasses both absence of psychopathology and presence of well-being. This is the first study examining symptom profiles of early PGD and subjective mental well-being in 266 Dutch adults recently bereaved during the pandemic. Early PGD and well-being indicators were assessed with the Traumatic Grief Inventory-Self Report Plus and the World Health Organization-Five Well-Being Index, respectively. Latent class analysis identified four classes: low PGD/high well-being (32%), low PGD/moderate well-being (24%), moderate PGD/high well-being (23%) and high PGD/low well-being class (21%). People in the poorer mental health classes were more likely to be female, lower educated, suffering from a mental disorder, have a poor health status, closer kinship to the deceased, and higher risk of severe COVID-19. Classifying adults according to symptom profiles of negative and positive outcomes provides a more complete picture of mental health in bereaved people and offers potential intervention targets.

Immediate and evolving emotions among directly exposed survivors 7 years after the Oklahoma City bombing

The Oklahoma City bombing in 1995 was one of the most devastating incidents of terrorism in America at that time. Existing research has not examined changes in emotional responses outside of psychopathology to disaster over time. The sample for this study consisted of adult participants randomly selected from a state registry of survivors who were directly exposed to the 1995 bombing in Oklahoma City. The Disaster Supplement to the Diagnostic Interview Schedule was used to collect participants' demographic information and qualitative details of their disaster experience, perceptions, and feelings. A total of 315 items resulted from the coding of responses pertaining to emotions (125 immediately after the disaster event, 140 in the following week, and 50 at approximately seven years postdisaster). The most common emotions in the immediate postdisaster period were shock, fear, and anxiety. In the following week, the most common were sorrow and anger. At seven years, sorrow was the most frequently expressed of all emotions. Understanding the progression of these feelings across time enhances the ability to anticipate responses at different postdisaster timeframes and to intervene in a timely manner.

Mental health burden following extreme weather events in South-east Asia: A systematic review and meta-analysis

Background

Exposure to extreme weatherly events potentially develops mental disorders among affected individuals.

Aim

To synthesize the burden of mental disorders following impact of extreme weather events in South-east Asian (SEA) countries.

Methods

Proposal was registered in PROSPERO register [CRD42023469788] and reported as per PRISMA-2020 guidelines. Studies reporting prevalence of mental health disorders following extreme weather events from SEA countries during 1990 and 2023 were searched on Embase, PubMed, and Scopus databases. Study quality was assessed using Appraisal tool for Cross-Sectional Studies. Overall pooled prevalence was computed using DerSimonian-Laird method for random-effects model and reported as 95% confidence intervals.

Results

On screening 12,046 records, we included 155 studies (2,04,474 participants) for analysis. Overall burden of mental disorders was 35.31% (95%CI: 30.42%-40.21%). In subgroup analysis, studies on cyclones, India, local residents, children and adolescents, rural settings, and community settings reported higher burden of mental disorders. Depression (28.58%; 95%CI: 24.05%-33.1%) and PTSD (29.36%; 95%CI: 26.26%-32.46%) had similar prevalence. Visiting tourists to SEA region experienced fear, fear of recurrence of tsunami, nightmares, and sense of helplessness. Mental health outcomes were relatively higher in studies conducted within 1 year of events. Heterogeneity and possibility of publication bias exists among the reported studies.

Conclusion

With the significant rise in episodes of extreme weather events in SEA region over the last three decades, mental disorders are documented in different proportions. We suggest prioritizing well-informed policies to formulate inclusive and resilient strategies on effectively identifying and treating mental health concerns among victims of extreme weather events.

How reminiscing about deceased close others together with continuing bonds relates to grief severity and personal growth: a cross-sectional study with bereaved adults

OBJECTIVES

One of the reasons why people engage in reminiscences about their past is to maintain intimacy with deceased close others. Although previous research alerts to the negative effects of reminiscence for intimacy maintenance on mental health, little is known about its relation to individuals' reactions to loss (i.e. grief severity and personal growth). In two samples, we focus on time since loss and continuing bonds, to elucidate the role of reminiscence for intimacy maintenance in grief.

METHOD

The samples comprised 111 and 198 bereaved adults. All participants rated the frequency of reminiscence for intimacy maintenance and loss-related variables, such as time since loss, continuing bonds, and grief severity. Sample 2 additionally completed measures of personal growth, loss-centrality, and their interconnectedness with the deceased.

RESULTS

Reminiscence on intimacy maintenance was positively related to grief severity. This relation was independent of time since loss and partly driven by externalized bonds. Internalized bonds mediated the relation between reminiscence for intimacy maintenance and grief severity (in sample 1) and personal growth (in sample 2).

CONCLUSION

Continuing bonds help explain why reminiscing for intimacy maintenance can be harmful in terms of grief severity but also fosters personal growth after the loss.

Feasibility and Acceptability of a Mobile App for Prolonged Grief Disorder Symptoms

Background

Mobile apps provide a unique platform for mental health assessment and monitoring. They can provide real time, accessible data on symptoms of mental disorders that may yield rich data for detailed clinical assessment and help individuals gain insight into their current mental state. We developed one of the first apps for tracking symptoms of prolonged grief disorder.

Method

In this pilot feasibility study, we assess the feasibility and acceptability of a new mobile app mGAGE for use once a day for 3 weeks. 27 participants completed mental health assessments at t1 and t2.

Results

Adherence to the app protocol was very high with 100% for the first two weeks of use. A surprising finding was the improvement of grief symptoms at t2. Debriefing interviews revealed general qualitative categories including positive feedback, negative feedback and specific recommendations. Overall, the app was found to be feasible for use for the first two weeks and acceptable for bereaved individuals.

Conclusions

This app could provide valuable data for in depth clinical assessment, may support individuals to gain greater insight into their symptoms and may have a therapeutic effect in terms of improved grief symptoms. Implications for future studies including use in larger intervention studies are discussed.

The Role of Perceived Social Support in the Grief Experiences of More Anxious and Self-Compassionate People

Past research showed that high trait anxiety and low self-compassion, along with lack of perceived social support, have been associated with experiencing stronger grief symptoms. However, research is yet to understand if and how these factors interact among grieving individuals. Results of a cross-sectional study (N = 539) showed that perceived social support interacted differently with trait anxiety and self-compassion to shape grief experiences. Unexpectedly, perceived social support did not buffer the association between higher trait anxiety and stronger grief symptoms. Instead, participants with higher trait anxiety reported stronger symptoms only when they perceived to have less social support. In contrast, participants with higher self-compassion reported less symptoms when they perceived to have more social support. These findings show that social support can emphasize the detrimental role of anxiety and the protective role of self-compassion when people are coping with a loss. Implications and suggestions for future research are discussed.

Grief trajectories after loss in pregnancy and during the neonatal period

Distinguishing patterns of grief over time in parents with a loss in pregnancy or during the neonatal period is important for identification of parents with severe grief symptoms, who may need additional support. Our aim was to describe grief in this population and to examine variations by type of loss in a large prospective cohort. We used questionnaire data from the Danish longitudinal cohort, Life After the Loss, which contains information on parents with a loss in pregnancy (from 14 weeks) or during the neonatal period. Parents completed the Prolonged Grief-13 scale at 1, 7, and 13 months after their loss. We applied Latent Growth Mixture Modelling to identify prolonged grief trajectories and used multinomial regression models to assess factors associated with class membership. Three distinct trajectories were identified in 676 parents: resilience (73.1%), recovery (16.9%), and chronic (10%). The distribution varied by type of loss, and the chronic group were overrepresented by parents with stillbirths (16.2%) and neonatal deaths (16.1%) in contrast to parents with spontaneous abortions (8.2%) and termination of pregnancy due to fetal anomalies (6.2%). Furthermore, not having a living child or being a woman was associated with following the chronic trajectory. These results underline that, while most bereaved parents are resilient, 10% experience consistently high levels of grief symptoms during the first year after the loss. Information on type of loss, gender, and whether the parent has living children are meaningful indicators of grief class membership.

Latent trajectories of DSM-5-TR-based Prolonged Grief Disorder: findings from a data pooling project MARBLES

Background: With the release of the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR), criteria for Prolonged Grief Disorder (PGD) were included. This necessitates studying grief trajectories based on these criteria.Objective: This is the first study examining latent trajectories of DSM-5-TR-based PGD symptom levels and testing whether specific risk factors (e.g. cause of death) predicted PGD trajectories.Method: We evaluated latent DSM-5-TR PGD trajectories using pooled existing data collected at 6-12, 13-24, and 25-60 months post-loss in Danish and Dutch bereaved adults (N = 398). Latent Growth Mixture Modelling (LGMM) was employed to determine the trajectories. Multinomial logistic regression analyses were used to examine which risk factors predicted class membership.Results: The four-class LGMM solution with a quadratic term was best-fitting the data. This solution represented four trajectories: High stable PGD (6%), High PGD quick recovery (10%), High PGD slow recovery (35%), and Low PGD symptoms (49%). Participants with a higher educational level were more likely to be assigned to the Low PGD symptoms trajectory compared to High stable PGD and High PGD slow recovery trajectories. Unnatural causes of death increased the likelihood of being in the High stable PGD and High PGD slow recovery trajectories compared to the Low PGD symptoms trajectory.Conclusions: Consistent with prior research, the Low PGD symptoms trajectory was the most common. A significant minority experienced high and stable levels of PGD within five years after the loss. About one-third of participants experienced high acute grief levels that decreased slowly; how slow decreasing symptoms relate to an individual's functioning requires further attention. This study demonstrates that a significant minority of bereaved people develop acute PGD symptomatology that does not diminish within five years post-loss, emphasizing the need for early screening for PGD to prevent long-lasting complaints.

Comorbid Prolonged Grief, PTSD, and Depression Trajectories for Bereaved Family Surrogates

Importance

Family surrogates of patients who die in an intensive care unit (ICU) are at risk of cooccurring prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depressive disorder during bereavement, but symptom trajectories are often explored individually.

Objectives

To simultaneously examine and determine co-occurrence of PGD, PTSD, and depressive symptom trajectories.

Design, Setting, and Participants

This cohort study was conducted in ICUs of 2 Taiwanese medical centers from January 2018 to March 2020, with follow-up through July 2022. Participants included surrogates responsible for decision-making who provided data 6 to 24 months after the death of their loved one. Data were analyzed from August to December 2022.

Main Outcomes and Measures

PGD was assessed with the 11 grief symptom items of the PG-13; PTSD, the Impact of Event Scale-Revised; and depressive symptoms, the depression subscale of the Hospital Anxiety and Depression Scale at 6, 13, 18, and 24 months after the death. Latent growth mixture modeling was conducted to identify distinct trajectories, and joint latent class analysis was used to assess joint patterns of trajectories.

Results

A total of 303 participants were included, with most younger than 56 years (207 participants [68.3%]), female (177 participants [58.4%]), and married (228 participants [75.2%]), and their relationship with the patient was mostly spouse (88 participants [29.0%]) or adult child (166 participants [54.8%]). Three trajectories were identified each for PGD, PTSD, and depressive symptoms. A resilience trajectory was predominant across PGD (253 participants [83.5%]), PTSD (250 participants [82.5%]), and depressive (200 participants [66.0%]) symptoms. Second most common was a recovery trajectory identified for PGD (36 participants [11.9%]) and PTSD (41 participants [13.5%]) symptoms, while for depressive symptoms, a moderate trajectory (72 participants [23.8%]) signified persistent moderate distress. A chronic trajectory characterized by persistently high distress was identified for PGD (14 participants [4.6%]) and depressive (31 participants [10.2%]) symptoms, whereas a unique delayed-onset trajectory (12 participants [4.0%]) was identified for PTSD symptoms. Most family surrogates (228 participants [75.2%]) experienced cooccurring PGD, PTSD, and depressive symptom trajectories, but multiple patterns were discordant. Symptom trajectories cooccurred in joint patterns: resilient (247 participants [81.5%]), recovered (43 participants [14.1%]), and distressed (14 participants [4.5%]). These patterns were characterized by high conditional probabilities for the resilience (PGD, 0.999; PTSD, 0.999; depressive, 0.804), recovery (PGD, 0.854; PTSD, 0.890; depressive, 0.588), and chronic (PGD, 0.921; PTSD, 0.789; depressive, 0.980) symptom trajectories.

Conclusions and Relevance

In this cohort study, grief-related psychological symptoms evolved in complex ways during ICU bereavement, as characterized by heterogeneous trajectories. Some ICU bereaved surrogates experienced persistent elevated PGD, PTSD, and depressive symptoms individually or conjointly, underscoring the importance of early screening to identify this population at high risk of comorbid psychological distress trajectories.

Prolonged grief disorder prevalence in adults 65 years and over: a systematic review

BACKGROUND

Prolonged grief disorder (PGD) is a recently recognised mental health disorder with an estimated prevalence of 10% in the bereaved adult population. This review aims to appraise and summarise evidence relating to PGD in older adults (≥65 years), a growing population group, most likely to experience bereavement and often assumed to cope well.

METHOD

Literature from Medline, PsycINFO, CINAHL, Cochrane Library and Web of Science was searched. Epidemiological and non-epidemiological studies including data on frequency of PGD in older adults bereaved by mainly natural causes were included and a descriptive analysis undertaken.

RESULTS

From 2059 records, three epidemiological and six non-epidemiological studies were included. Most studies had good internal but not external validity. Conditional prevalence for PGD ranged between 3.2% and 48.8%. Heterogeneity in sample characteristics and study methodology contributed to this variability resulting in a descriptive analysis. The prevalence rate of 9.1% by Kersting et al was the best available estimate for PGD in older adults for western countries. The small number of epidemiological studies and the use of varying PGD-constructs which did not match International Classification of Diseases 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were the main limiting factors.

CONCLUSION

This first review on PGD prevalence in older adults suggests that, despite studies' methodological short comings, a similar proportion of older adults experience PGD as the general bereaved adult population (1:10). With older adults forming the largest subgroup among the bereaved, health and social care systems need to adapt their provision of care to address the specific needs of older adults.

Looking back and moving forward: dimensions of coping flexibility divergently predict long-term bereavement outcomes

BACKGROUND AND OBJECTIVES

Bereavement is a serious public health concern. Some people suffer prolonged and debilitating functional impairment after the death of a loved one. Evidence suggests that flexibility in coping approaches predicts resilience after stressful life events, but its long-term effects after the unique experience of bereavement are unknown. Which strategies of coping flexibility predict better-or worse-adjustment over time for bereaved people and at what times?

DESIGN AND METHODS

The present study used path analyses to investigate longitudinal effects of forward-focus and loss-focus coping strategies on symptoms of persistent complex bereavement disorder (PCBD), depression, and posttraumatic stress disorder in a spousally bereaved adult sample (N = 248) at three time-points after the loss (∼3 months, ∼14 months, and ∼25 months).

RESULTS

Forward-focus coping demonstrated adaptive utility overall, with sooner effects on PCBD than on depression. By contrast, loss-focus coping demonstrated a delayed-onset, maladaptive pattern.

CONCLUSIONS

The findings contribute to the coping flexibility literature by suggesting that the adaptiveness or maladaptiveness of different coping strategies may depend on the context that requires coping. In particular, forward-focus coping may be substantially more advantageous than loss-focus coping in the context of bereavement. Implications, limitations, and future research directions are discussed.

A consideration of the increased risk of schizophrenia due to prenatal maternal stress, and the possible role of microglia

Schizophrenia is caused by interaction of a combination of genetic and environmental factors. Of the latter, prenatal exposure to maternal stress is reportedly associated with elevated disease risk. The main orchestrators of inflammatory processes within the brain are microglia, and aberrant microglial activation/function has been proposed to contribute to the aetiology of schizophrenia. Here, we evaluate the epidemiological and preclinical evidence connecting prenatal stress to schizophrenia risk, and consider the possible mediating role of microglia in the prenatal stress-schizophrenia relationship. Epidemiological findings are rather consistent in supporting the association, albeit they are mitigated by effects of sex and gestational timing, while the evidence for microglial activation is more variable. Rodent models of prenatal stress generally report lasting effects on offspring neurobiology. However, many uncertainties remain as to the mechanisms underlying the influence of maternal stress on the developing foetal brain. Future studies should aim to characterise the exact processes mediating this aspect of schizophrenia risk, as well as focussing on how prenatal stress may interact with other risk factors.

Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial

OBJECTIVE

This randomized-waitlist controlled trial is the first study examining short-term effects of a self-guided online grief-specific cognitive behavioral therapy (CBT) in reducing early persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression symptoms in adults bereaved during the COVID-19 pandemic.

METHOD

Sixty-five Dutch adults, bereaved at least three months earlier during the pandemic, with clinically-relevant PCBD, PTSD, and/or depression symptoms, were allocated to a treatment (n = 32) or waitlist condition (n = 33). Telephone interviews were conducted to assess PCBD, PTSD, and depression symptoms (using validated instruments) at baseline, post-treatment, and post-waiting period. Participants received an eight-week self-guided online grief-specific CBT including exposure, cognitive restructuring, and behavioral activation assignments. Analyses of covariance were performed.

RESULTS

Intention-to-treat analyses indicated that people in the intervention condition showed significantly lower PCBD (d = 0.90), PTSD (d = 0.71), and depression (d = 0.57) symptom-levels post-treatment relative to waitlist controls post-waiting, while taking baseline symptom-levels and use of professional psychological co-intervention into account.

CONCLUSIONS

The online CBT proved to be an effective intervention, reducing PCBD, PTSD, and depression symptoms. Pending replication of these findings, early online interventions may be widely implemented in practice to improve treatments for distressed bereaved people.

The relationship between social acknowledgment and prolonged grief symptoms: a multiple mediation effect of beliefs about the goodness and controllability of grief-related emotions

Background: Social acknowledgment is a protective factor for survivors of trauma. However, the role of social acknowledgment in association with prolonged grief symptoms has not yet been established.Objectives: The current study aims to explore the relationship between social acknowledgment and prolonged grief via two beliefs foundational to how people think about grief-related emotions (1) goodness (i.e. whether emotions are desirable, useful, or unwanted and harmful), and (2) controllability (i.e. whether emotions are regulated according to our will or involuntary, arising of their own accord). These effects were explored in two different cultural samples of bereaved people.Methods: One hundred and fifty-four German-speaking and two hundred and sixty-two Chinese bereaved people who lost their loved ones completed questionnaires assessing social acknowledgment, beliefs about the goodness and controllability of grief-related emotions, and prolonged grief symptoms.Results: Correlation analyses showed that social acknowledgment was positively linked with stronger beliefs about the goodness and controllability of grief-related emotions and negatively related to prolonged grief symptoms. Beliefs about the goodness and controllability of grief-related emotions correlated negatively with prolonged grief symptoms. Multiple mediation analyses suggested that beliefs about the controllability and goodness of grief-related emotions mediated the link between social acknowledgment and prolonged grief symptoms. Cultural groups did not moderate the above model.Conclusion: Social acknowledgment may be related to bereavement adjustment consequences via the roles of beliefs about the goodness and controllability of grief-related emotions. These effects seem to be consistent cross-culturally.

Grief trajectories among bereaved parents after the 2011 Utøya terror attack: A qualitative analysis

This study took a qualitative approach to explore terror-bereaved parents' long-term experiences with grief. Data were drawn from a larger, longitudinal study, and interviews with 10 bereaved parents were selected based on their reported change in scores on Inventory of Complicated Grief (ICG) over a period of 6.5 years, including the five parents with the largest change (group 1) and the five parents with the least change (group 2). Reflexive thematic analysis of the interview transcripts resulted in four main themes: "I felt completely lost and helpless, like I was stuck in a whirlwind" and "I have been fighting to get back to my everyday life", which both groups contributed to. Participants in group 1 contributed to the theme "I have found a way to a new life," while participants in group 2 contributed to the theme "I cannot seem to find a way to a new life." Findings suggest that sense of control, acceptance, and social support enhanced experienced coping following terror-related bereavement, while comorbid mental health problems, difficulties with acceptance, and repetitive thoughts about the death was experienced as contributing to long-term struggles following terror-related bereavement.

The course of symptoms in the first 27 months following bereavement: A latent trajectory analysis of prolonged grief, posttraumatic stress, and depression

BACKGROUND

Much remains unknown about the course of grief in the early months following bereavement, including the prevalence and timing of a recovery trajectory, whether specific symptoms mark a failure to recover, and the co-occurrence of chronic prolonged grief (PG), posttraumatic stress (PTS) and depression symptoms.

METHODS

Two hundred fifty-nine participants completed PG, PTS and depression questionnaires up to eleven times every six weeks during the two years post-bereavement. We used Latent Class Growth Mixture Modeling (LCGMM) to identify subgroups of bereaved individuals sharing similar trajectories for each disorder. We used repeated measures ANOVA to evaluate differences in individual symptoms between trajectories. Finally, we investigated to what extent chronic trajectories of these three disorders co-occurred.

RESULTS

Three trajectories of PG symptoms emerged: resilient (66.4%), chronic (25.1%) and acute recovery (8.4%). The overall severity and symptom profile of the acute recovery group were indistinguishable from that of the chronic group through 6 months post-bereavement, followed by reduction in PG from 6 to 18 months post-bereavement. Chronic PTS in the first-year post-bereavement tended to co-occur with chronic PG and/or chronic depression.

CONCLUSIONS

Twenty five percent of those with initial elevations in grief recovered in the period of 6 to 12 months post-bereavement. These findings highlight the clinical importance of severe grief in the initial months following loss, but also suggests caution in diagnosing a grief disorder within the first-year post-bereavement.

Predictors of Prolonged Grief Disorder in a German Representative Population Sample: Unexpectedness of Bereavement Contributes to Grief Severity and Prolonged Grief Disorder

Most people adapt to bereavement over time. For a minority, the grief persists and may lead to a prolonged grief disorder (PGD). Identifying grievers at risk of PGD may enable specific prevention measures. The present study examined the extent to which the subjective unexpectedness of the death predicted grief outcomes above and beyond known sociodemographic and objective loss-related variables in a sample drawn from a population-representative investigation. In our sample (n = 2,531), 811 participants (M _age 55.1 ± 17.8 years, 59.2% women) had experienced the loss of a significant person six or more months ago. Participants provided demographic and loss-related information, perceptions of the unexpectedness of the death and completed the Prolonged Grief Disorder-13 + 9 (PG-13 + 9). The PG-13 + 9 was used to determine PGD caseness. A binary logistic regression investigated predictors of PGD caseness, and a linear regression predictors of grief severity. ANCOVAs compared PGD symptoms between the groups who had experienced an "expected" vs. "unexpected" loss, while controlling for the relationship to the deceased and time since loss. The loss of a child (OR = 23.66; 95%CI, 6.03-68.28), or a partner (OR = 5.32; 95%CI, 1.79-15.83), the time since loss (OR = 0.99; 95%CI, 0.99-1.00) and the unexpectedness of the death (OR = 3.58; 95%CI, 1.70-7.69) were significant predictors of PGD caseness (Nagelkerke's R² = 0.25) and grief severity. Participants who had experienced the loss as unexpected (vs. expected) reported higher scores on all PGD symptoms. Unexpectedness of the death emerged as significant risk factor for PGD, even after controlling for demographic and other loss-related variables. While our findings replicate previous research on the importance of the relationship to the deceased as a risk factor for PGD, they also highlight the importance of assessing the subjective unexpectedness of a death and may help to identify risk groups who can profit from preventive interventions.

Grief: Aetiology, Symptoms and Management

Grief is a process provoked as a response to different losses, such as death, loss of job, relationship breakdown, some unexpected life events and changes, etc. The experiences of loss and bereavement are very individual. Even though loss is expected, the person feels traumatized, especially if death is provoked by violence, natural disasters, or war. This pandemic, like other disasters (wars, tsunami, earthquakes, floods, etc.) has provoked intensive reactions of grief, reactions that could persist for years. The core symptoms of grief are described in the ICD-11 and DSM-5 manuals. The term "complicated grief" in the medical sense refers to a superimposed process that alters grief and modifies its course for the worse. Prolonged grief disorder (PGD) is characterized by normal grief symptoms, but these are symptoms that remain too intense for too long of a period. This article is a review of the manifestations and duration of grief in different occasions, and it is based on over 50 published papers, and discoveries in the Medline and Psych-Net databases. Commonly described reactions to grief are: shock, disbelief or denial, a high level of anxiety, distress, anger, sadness, insomnia, and a loss of appetite. As predictors for a high/slow decreasing trajectory of grief process are: female gender, reported symptoms of depression before the traumatic event, and higher scores on avoidance. However, grief is transient, even as we are is in the midst of its clutches. People should expect to fluctuate between moments of sadness and mourning, and moments of acceptance, or even happiness for being alive. Researchers suppose that when a crisis passes; most people will be able to bounce back and move on with their lives.

Machine yearning: How advances in computational methods lead to new insights about reactions to loss

The loss of a loved one is a potentially traumatic event that can result in disparate outcomes and symptom patterns. Machine learning methods offer computational tools to probe this heterogeneity and understand grief psychopathology in its complexity. In this article, we examine the latest contributions to the scientific study of bereavement reactions garnered through the use of computational methods. We focus on findings originating from trajectory modeling studies, as well as the recent insights originating from the network analysis of prolonged grief symptoms. We also discuss applications of artificial intelligence for the accurate identification of major depression and post-traumatic stress, as examples for their potential applications to the study of loss reactions.

Grief-related beliefs in shidu parents with and without prolonged grief disorder: Psychometric properties of a Chinese version of the Typical Beliefs Questionnaire

The Typical Beliefs Questionnaire (TBQ) assesses common grief-related cognitions, which demonstrated satisfactory psychometric properties in a treatment-seeking sample with prolonged grief disorder (PGD). Chinese shidu parents (bereaved parents over the age of 49 who have lost their only child) are at a high risk of PGD. The current study aimed to examine psychometric properties of the Chinese version of the TBQ (TBQ-C) in a community sample of shidu parents with and without PGD, to compare this to the original validation clinical sample in the United States bereaved of any close relationship and to consider its use as a clinical tool. We examined the rate of positive endorsement, factor structure, internal consistency and validity of the TBQ-C in 310 community-based shidu parents (including 102 who met the criteria for PGD). Results showed that the rate of positive endorsement for each item ranged from 7.2% to 48.6% among non-PGD participants and from 20.6% to 92.2% among PGD participants. Confirmatory factor analysis indicated that the original five-factor structure fit both the non-PGD and PGD shidu parents. The TBQ-C showed acceptable internal consistency and satisfactory convergent and concurrent validity in both groups. It had good discriminant validity and can be helpful in distinguishing shidu parents with and without PGD. The TBQ-C can be used to investigate common grief-related beliefs that may be problematic for both shidu parents with and without PGD.

Prevalence of prolonged grief disorder

BACKGROUND

Prolonged grief is a disorder (PGD) characterized by severe and disabling grief reactions for an extended period of time after the loss of a significant person. ICD-11 and DSM-5-TR differ substantially in individual criteria.

OBJECTIVE

Estimation of the respective prevalence of PGD_ICD-11 and PGD_DSM-5-TR and the frequency with which single symptoms of prolonged grief occur in the general population.

METHODS

Out of a representative sample of the German general population (N=2498), n = 914 reported a significant loss and prolonged grief symptoms based on the extended version of the self-reported Prolonged Grief Disorder-13+9 (PG13+9). Sociodemographic and loss-related characteristics were collected.

RESULTS

The probable prevalence of PGD_ICD-11 was 1.5% and that of PGD_DSM-5-TR was 1.2% in the general sample. Among bereaved persons (n=914), the prevalence of developing PGD_ICD-11 was 4.2% and that of PGD_DSM-5-TR was 3.3%. Diagnostic agreement between the two criteria-sets was very high and did not increase after heightening the accessory symptom threshold for PGD_ICD-11. Difficulties accepting the loss was the most frequent single symptom (14-25%) and grief-related impairment was common (10-16%). Over 60% of participants with a probable PGD diagnosis utilized health care services.

LIMITATIONS

Results are based on self-reported data. The PG13+9 was not designed to assess grief symptoms according to ICD-11 and DSM-5-TR diagnostic criteria.

CONCLUSIONS

Prolonged grief according to ICD-11 and DSM-5-TR is a notable disorder in the general population. Among bereaved persons, single symptoms of prolonged grief are relatively frequent and cause substantial degrees of impairment.

Prospective evaluation of the DSM-5 persistent complex bereavement disorder criteria in adults: dimensional and diagnostic approaches

BACKGROUND

We examine the performance of the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) persistent complex bereavement-related disorder (PCBD) criteria in bereaved adults to identify prolonged grief cases determined prospectively.

METHODS

Bereaved adults (n = 138) were assessed at 8, 21, 32, 67, and 90 months after the sudden death of a spouse or close relative. We used latent class growth analysis to identify the longitudinal trajectories of grief assessed using the Inventory for Complicated Grief. To validate the trajectory that corresponded to prolonged grief, we examined the baseline predictors of these trajectories and their relationship with functional impairment.

RESULTS

We found three distinct trajectories of grief reactions. One of these trajectories (13.8%) showed high and sustained grief reactions that persisted for almost 7.5 years after the death. Participants with prolonged grief showed greater functional impairment [relative risk ratio (RRR) = 0.82, 95% confidence interval (CI): 0.70 to -0.97; p = 0.02] and higher self-reported depression (RRR = 1.21, 95% CI 1.09 to 1.96; p = 0.001) than participants whose grief reactions subsided over time. The original PCBD (requiring 6 criterion C symptoms) criteria correctly identified cases (57.9-94.7%) with perfect specificity (100%) but low to high sensitivity (5.6-81.3%); however, its sensitivity increased when revising criterion C to require ⩾3 (45.5-94.1%). The dimensional approach showed high sensitivity (0.50-1) and specificity (0.787-0.97).

CONCLUSIONS

We recommend revisions to the PCBD criteria, which are overly restrictive and may exclude cases with clinically significant grief-related distress and impairment. In the meantime, clinicians need to monitor grief symptoms over time using available dimensional approaches to reduce the burden of grief.

Prolonged grief disorder among bereaved survivors after the 2011 Van Earthquake in Turkey

The aim of the current study was to investigate the ratio and predictors of probable Prolonged Grief Disorder (PGD) among bereaved survivors eight years after the 2011 Van earthquake. Among a sample of 495 survivors who experienced loss as a result of this earthquake, 8.9% met the criteria of probable PGD. In the binary logistic regression analysis, being woman, being aged 40 or over, personal injury, property damage, losing family members, and the psychological impact of the earthquake predicted probable PGD. The current study highlights the importance of considering PGD among bereaved survivors after earthquakes.

Time elapsed since loss or grief persistency? Prevalence and predictors of ICD-11 prolonged grief disorder using different applications of the duration criterion

BACKGROUND

Prolonged grief disorder (PGD), included in the ICD-11, encompasses a six-month duration criterion, but whether this covers 'time since loss' or 'grief persistency' is unclear. The study estimated prevalence and predictors of probable ICD-11 PGD using different applications of the duration criterion.

METHODS

A register-sampled cohort of bereaved spouses completed self-report questionnaires at two (T1, N=847), six (T2, N=777), and eleven months (T3, N=753) post-loss. The duration criterion was operationalized as single-point PGD (meeting criteria minimally six months post-loss; T2 or T3) and dual-point PGD (meeting criteria at two assessments separated by months; T1+T2 or T2+T3).

RESULTS

Single-point PGD prevalence rates (~15-20%) were significantly higher than dual-point prevalence rates (~10%). While single assessments of PGD varied between T2 and T3, the dual-point prevalence rates did not significantly differ. Early probable grief caseness emerged as the strongest predictor for later PGD.

LIMITATIONS

Without a structured clinical interview, only probable cases of PGD were identified. Caseness relied on a diagnostic algorithm, created by mapping items from different self-report questionnaires. Time frames between assessments did not cover an entire six-month period.

CONCLUSIONS

Momentarily assessed, six-month PGD symptomatology may represent a fluctuating, but remitting grief process for some individuals. Further research could test whether multiple diagnostic indicators during the first year of bereavement improve the identification of genuinely prolonged grief reactions.

DSM-5-TR prolonged grief disorder and DSM-5 posttraumatic stress disorder are related, yet distinct: confirmatory factor analyses in traumatically bereaved people

BACKGROUND

Prolonged grief disorder (PGD) is newly included in the text revision of the DSM-5 (DSM-5-TR). So far, it is unknown if DSM-5-TR PGD is distinguishable from bereavement-related posttraumatic stress disorder (PTSD). Prior research examining the distinctiveness of PTSD and pathological grief focused on non-traumatic loss samples, used outdated conceptualizations of grief disorders, and has provided mixed results.

OBJECTIVE

In a large sample of traumatically bereaved people, we first evaluated the factor structure of PTSD and PGD separately and then evaluated the factor structure when combining PTSD and PGD symptoms to examine the distinctiveness between the two syndromes.

METHODS

Self-reported data were used from 468 people bereaved due to the MH17 plane disaster (N = 200) or a traffic accident (N = 268). The 10 DSM-5-TR PGD symptoms were assessed with the Traumatic Grief Inventory-Self Report Plus (TGI-SR+). The 20-item Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was used to tap PTSD symptoms. Confirmatory factor analyses were conducted.

RESULTS

For PTSD, a seven factor, so-called 'Hybrid' model yielded the best fit. For PGD, a univariate factor model fits the data well. A combined model with PGD items loading on one factor and PTSD items on seven factors (associations between PGD and PTSD subscales r ≥ .50 and ≤.71), plus a higher-order factor (i.e. PTSD factors on a higher-order PTSD factor) (association between higher-order PTSD factor and PGD factor r = .82) exhibited a better fit than a model with all PGD and PTSD symptom loading on a single factor or two factors (i.e. one for PGD and one for PTSD).

CONCLUSIONS

This is the first study examining the factor structure of DSM-5-TR PGD and DSM-5 PTSD in people confronted with a traumatic loss. The findings provide support that PGD constitutes a syndrome distinguishable from, yet related with, PTSD.

Are there gender differences in prolonged grief trajectories? A registry-sampled cohort study

Research suggests variation in how grief develops across time, and gender may account for some of this variation. However, gender differences in growth patterns of the newly codified ICD-11 prolonged grief disorder (PGD) are unknown. This study examined gender-specific variances in grief trajectories in a registry-sampled cohort of 857 spousal bereaved individuals (69.8% female). Participants completed self-report questionnaires of PGD symptoms at 2, 6, and 11 months post-loss. Using Growth Mixture Modeling, four PGD trajectories emerged: resilient characterized by low symptoms (64.4%), moderate-stable characterized by moderate symptoms (20.4%), recovery characterized by elevated symptoms showing a decrease over time (8.4%), and prolonged grief characterized by continuous elevated symptoms (6.8%). Similar proportions of men and women comprised the four trajectories. Gender influenced the parameter estimates of the prolonged grief trajectory as men evidenced more baseline symptoms (higher intercept) than women did and a decreasing symptom-level (negative slope), while women showed symptom-increase over time (positive slope). The prolonged grief trajectory captured the largest proportion of probable PGD cases in both genders. Low optimism and low mental health predicted membership in this class. Altogether, the absolute majority of both men and women followed a low-symptom resilient trajectory. While a comparable minority followed a high-symptom prolonged grief trajectory, men and women within this trajectory expressed varying symptom development. Men expressed prolonged grief as an acute, decreasing reaction, whereas women showed an adjourned, mounting grief reaction. This study suggests that gender may influence symptom development in highly distressed individuals across early bereavement.

How Can Psychologists and Psychiatrists Help COVID-19 Bereaved Persons: Five propositions to Understanding Contextual Challenges

The COVID-19 pandemic is causing unprecedented cumulative deaths and leaving behind millions of bereaved families and individuals. Moreover, the pandemic is disrupting social fabrics in the conventional way we mourn our deads. In this context therefore, how can psychologists, psychiatrists and other health care professionals help bereaved families and individuals more effectively? This opinion paper proposed five recommendations that cover mental health care needs and challenges which may emerge from the management of these traumatic deaths. In all, efforts to comply with either DSM-5 or ICD-11 PGD guidelines could help COVID-19 bereaved persons with overwhelming distress, as they ensure therapists' use of appropriate terminologies in therapeutic alliances. However, clinicians need to have a global perspective of COVID-19 bereavement courses, political and public health measures due to the pandemic, and flexible attitudes about the ICD-11 and of DSM-5 time-criterion for diagnosis. This paper emphasizes the importance of social and collective recognition of COVID-19 deaths through various symbolic and materialized forms to free up collective and individual capacities for resilience. The necessity of individual and group interventions through online platforms is underscored, however these modes of therapies may not reinforce social inequalities by excluding bereaved individuals who really need them.

The Impact of Covid-19 Experiences and Associated Stress on Anxiety, Depression, and Functional Impairment in American Adults

Background

The COVID-19 pandemic has had a profound impact on health and well-being worldwide and there is increasing recognition of the need to understand the psychological impact of COVID-19 experiences and stress in addition to the physical health consequences.

Methods

The present study examined how experiences related to COVID-19 and associated stress impact, anxiety, depression, and functional impairment in a convenience sample of 565 American adults (57.9% male) recruited through MTURK.

Results

COVID-19 experiences were consistently associated with higher odds of probable anxiety and depression diagnoses (ORs ≥ 3.0). COVID-19 associated stress also predicted large proportions of variance (R² ≥ 30) in anxiety, depression, health anxiety, and functional impairment in latent variable analyses.

Conclusions

These findings highlight that personal experiences related to the diagnosis of COVID-19, mortality in acquaintances, and COVID-19 associated stress is associated with a greatly elevated risk of emotional disorder symptomatology and that the COVID-19 pandemic may result in increased demand for mental health services.

Complicated Grief: What to Expect After the Coronavirus Pandemic

The COVID-19 pandemic is one of the worst public health crises in a century, with an expected amount of deaths of several million worldwide and an even bigger number of bereaved people left behind. Although the consequences of this crisis are still unknown, a significant number of bereaved people will arguably develop Complicated Grief (CG) in the aftermath of this emergency. If the current pandemic is unprecedented, the grief following the coronavirus outbreak is likely to share features with grief related to natural disasters and after Intensive Care Unit (ICU) treatment. The aim of this paper is to review the most prominent literature on CG after natural disasters, as well as after diseases requiring ICU treatment. This body of evidence may be useful for helping bereaved people during the acute phase of the COVID-19 pandemic and for drawing clinical attention to people at risk for CG.

Posttraumatic Stress and Depression in the Aftermath of Environmental Disasters: A Review of Quantitative Studies Published in 2018

PURPOSE OF REVIEW

As interest in the mental health consequences of environmental disasters increases, this review aimed to summarize peer-reviewed studies published in 2018 on posttraumatic stress disorder (PTSD) and depression symptoms after such events.

RECENT FINDINGS

Notable trends in the past year of research included studies focusing on vulnerable populations (e.g., persons with preexisting physical health conditions), assessing the cumulative impact of exposure to multiple disasters, exploring pathway leading to PTSD and depression symptoms, and evaluating the effectiveness of post-disaster interventions. Over 100 articles were identified, focused on 40 disasters that occurred between 1982 and 2017. Prevalence estimates ranged from 0 to 70.51% for PTSD and 1.9 to 59.5% for depression. Consistent predictors of adverse outcomes included female gender, socioeconomic disadvantage, high disaster exposure, and low psychosocial resources. Further research that expands upon recent advances in the literature is critical given the large proportion of the world's population exposed to disasters and the increasing incidence of such events.

Different Trajectories of Prolonged Grief in Bereaved Family Members After Terror

Introduction: The loss of a loved one in a terror incident is associated with elevated risk for mental health disorders such as prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD), but the long- term adaptation after such losses are not well understood. This study aims to explore the trajectories of PGD among parents and siblings (n = 129) after the 2011 terror attack on Utøya Island, Norway. Methods: The 19-item Inventory of Complicated grief (ICG) was used to measure PGD at 18, 28, and 40 months post-loss. Latent class growth analysis (LCGA) was used to identify trajectories of grief and a multinomial regression analysis was conducted to examine predictors of class membership. Results: The analysis identified three grief trajectories; moderate/decreasing class (23%), high/slow decreasing class (64%), and a high/chronic class (13%). Predictors of high/slow recovery or chronic grief was female gender, previous depressive symptoms, and intrusion and avoidance symptoms. Conclusion: The findings highlights the difficult grief process and slow recovery that characterizes the majority of close family members bereaved by a terror-incident. Community mental health programs should strive for both early outreach and long-term follow-up after such incidents.

Trajectories of grief: Comparing symptoms from the DSM-5 and ICD-11 diagnoses

BACKGROUND

Diagnostic criteria for prolonged grief have appeared in the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5; persistent complex bereavement disorder, PCBD) and in the ICD-11 (prolonged grief disorder, PGD), and the question of which diagnosis is most clinically useful has been hotly debated. This study provides the first longitudinal comparison of PCBD and PGD in their ability to capture symptom change over time and their relation to long-term outcomes.

METHODS

A community sample was recruited consisting of 282 individuals who had recently lost a spouse. Structured clinical interviews were conducted at 3, 14, and 25 months postloss for symptoms corresponding to PCBD and PGD criteria. Outcomes at 25 months included PCBD and PGD caseness, depression, global functioning, and interviewer ratings of participant suffering.

RESULTS

PCBD and PGD trajectories determined by growth mixture modeling, each captured three primary outcomes: resilience, moderate-improving symptoms, and prolonged-stable symptoms. The PGD solution also identified trajectories of increasing and decreasing distress: prolonged-worsening and acute-recovering symptoms. Prediction of 25-month outcomes indicated differences conforming to the severity of PGD symptoms, and the prolonged-worsening trajectory was associated with the worst adjustment.

CONCLUSIONS

PGD symptoms were more differentiated, better-captured psychopathology, and other outcomes and were more sensitive to change over time compared to PCBD.

Cognitive predictors of grief trajectories in the first months of loss: A latent growth mixture model

Objective: The identification of modifiable cognitive antecedents of trajectories of grief is of clinical and theoretical interest. Method: The study gathered 3-wave data on 275 bereaved adults in the first 12–18 months postloss (T1 = 0–6 months, T2 = 6–12 months, T3 = 12–18 months). Participants completed measures of grief severity, cognitive factors (loss-related memory characteristics, negative appraisals, unhelpful coping strategies, and grief resilience), as well as measures of interpersonal individual differences (attachment and dependency). Latent growth mixture modeling was used to identify classes of grief trajectories. Predictors of class membership were identified using multinomial logistic regression and multigroup structural equation modeling. Results: Four latent classes were identified: 3 high grief classes (Stable, Low Adaptation, and High Adaptation) and a low grief class (Low Grief). When considered separately, variance in all four cognitive factors predicted membership of the high grief classes. When considered together, membership of the high grief classes was predicted by higher mean scores on memory characteristics. More negative appraisals predicted low or no adaptation from high grief severity. Losing a child also predicted membership to the stable class. Fast adaptation of high grief was predicted by a pattern of high memory characteristics but low engagement with unhelpful coping strategies. Conclusions: The findings have implications for clinical practice and point to early cognitive predictors of adaptation patterns in grief. Findings are consistent with cognitive models highlighting the importance of characteristics of memory, negative appraisals, and unhelpful coping strategies in the adaptation to highly negative life events.

The study identifies a number of modifiable cognitive predictors that are linked to grief severity and maintenance in the first months of loss. Targeting these cognitive predictors in the first 6 months of loss may prove helpful in facilitating grief adaptation.