Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis

Abstract

‘Complicated grief reactions’ is an umbrella term covering symptoms of prolonged grief disorder (PGS) and other post-loss complications, including symptoms of depression, anxiety, and posttraumatic stress (PTS). While PGS often co-occurs with symptoms of depression, anxiety, and PTS, no pooled prevalence estimates of their co-occurrence have yet been established. The present systematic review and meta-analysis provided pooled prevalence estimates of co-occurrence of PGS and symptoms of depression, anxiety, and PTS based on the available literature, and examined possible moderators and risk of bias. Based on the 23 included studies, the pooled prevalence estimates indicated that 70% of adults with PGS experienced one or more other type of complicated grief reaction, and 46% experienced two or more other types of complicated grief reactions. Estimates of PGS with co-occurring depression, anxiety, and PTS were 63%, 54%, and 49%, respectively. Heterogeneity was considerable (I2=92.5–95.6), and subsequent moderator-analyses showed that higher estimates of co-occurrence were found in studies with longer mean time since loss, and when co-occurrence was assessed with interviews compared with questionnaires. The results should be considered preliminary due to high risk of bias of the included studies. Co-occurring cases of PGS and other types of complicated grief reactions were more prevalent than ‘pure’ cases of PGS with no co-occurrence. More population-based studies of symptom co-occurrence in non-traumatic bereavement are needed.