Different Trajectories of Prolonged Grief in Bereaved Family Members After Terror.

Pål Kristensen,Rolf Gjestad,Kari Dyregrov

doi:10.3389/fpsyt.2020.545368

Abstract

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.

Highlights

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
Prolonged grief disorder (PGD) is a chronic, unrelenting grief that was included in the revised International Classification of Diseases (ICD-11) in 2018 [1] and is proposed for inclusion in DSM-5
The main aim of this study was to examine the trajectories of PGD among close family members bereaved by the 2011 terror attack at Utøya, Norway

Summary

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. PGD is distinguishable from other mental disorders such as depression and PTSD [2, 3], and is associated with poor physical health, reduced quality of life, and functional impairment [4]. The core symptoms of PGD are intense yearning or preoccupation with the deceased, combined with severe emotional pain related to the loss (e.g., difficulties accepting the death, anger or bitterness, feeling that life is meaningless). A recent meta-analysis found that 50% of bereaved after unnatural losses (e.g., suicide, homicide, accident or combat-related deaths) experience PGD [5]

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