Somatic symptom distress and ICD-11 prolonged grief in a large intercultural sample

BackgroundBereaved ICU family surrogates are at risk of comorbid prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. Knowledge about temporal relationships between PGD, PTSD, and depression is limited by a lack of relevant studies and diverse or inappropriate assessment time frames given the duration criterion for PGD. We aimed to determine the temporal reciprocal relationships between PGD, PTSD, and depressive symptoms among ICU decedents’ family surrogates during their first 2 bereavement years with an assessment time frame reflecting the PGD duration criterion.MethodsThis prospective, longitudinal, observational study examined PGD, PTSD, and depressive symptoms among 303 family surrogates of ICU decedents from two academic hospitals using 11 items of the Prolonged Grief Disorder-13, the Impact of Event Scale—Revised, and the depression subscale of the Hospital Anxiety and Depression Scale, respectively, at 6, 13, 18, and 24 months post-loss. Cross-lagged panel modeling was conducted: autoregressive coefficients indicate variable stability, and cross-lagged coefficients indicate the strength of reciprocal relationships among variables between time points.ResultsSymptoms (autoregressive coefficients) of PGD (0.570–0.673), PTSD (0.375–0.687), and depression (0.591–0.655) were stable over time. Cross-lagged standardized coefficients showed that depressive symptoms measured at 6 months post-loss predicted subsequent symptoms of PGD (0.146) and PTSD (0.208) at 13 months post-loss. PGD symptoms did not predict depressive symptoms. PTSD symptoms predicted subsequent depressive symptoms in the second bereavement year (0.175–0.278). PGD symptoms consistently predicted subsequent PTSD symptoms in the first 2 bereavement years (0.180–0.263), whereas PTSD symptoms predicted subsequent PGD symptoms in the second bereavement year only (0.190–0.214). PGD and PTSD symptoms are bidirectionally related in the second bereavement year.ConclusionsPGD, PTSD, and depressive symptoms can persist for 2 bereavement years. Higher PGD symptoms at 6 months post-loss contributed to the exacerbation of PTSD symptoms over time, whereas long-lasting PTSD symptoms were associated with prolonged depression and PGD symptoms beyond the first bereavement year. Identification and alleviation of depression and PGD symptoms as early as 6 months post-loss enables bereaved surrogates to grieve effectively and avoid the evolution of those symptoms into long-lasting PGD, PTSD, and depression.

List of American patents which issued in January, 1836

Do prolonged grief disorder symptoms predict post-traumatic stress disorder symptoms following bereavement? A cross-lagged analysis

Prolonged Grief Disorder in the Next of Kin of Adult Patients Who Die During or After Admission to Intensive Care

BackgroundAlthough bereavement is likely a common stressor among patients referred to a psychotrauma clinic, no study has yet examined the co‐occurrence and relationships between symptoms of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder symptoms in this population.MethodIn a sample of patients seeking treatment following psychological trauma (n = 458), we used latent class analysis to identify classes of patients sharing the same profile of PGD, PTSD, and depression symptoms. We then used network analysis to investigate the relationships among these symptoms and with loss‐related variables.ResultsMost participants (65%) were members of a class that exhibited elevated endorsement of PGD symptoms. PGD, PTSD, and depression symptoms hung together as highly overlapping but distinguishable communities of symptoms. Symptoms related to social isolation and diminished sense of self bridged these communities. Violent loss was associated with more difficulty accepting the loss. The loss of close kin was most strongly associated with difficulty moving on in life.ConclusionsPGD symptoms are common in trauma‐exposed bereaved adults and closely associated with symptoms of PTSD and depression, illustrating the importance of assessing bereavement and PGD symptoms in those seeking treatment following trauma.

The recent introduction of prolonged grief disorder (PGD) as a diagnostic category may cause negative social reactions (i.e. public stigma). Vignette experiments demonstrate that persons with both PGD symptoms and a PGD diagnosis elicit more public stigma than persons who experience integrated grief. However, the strength of the influence of the diagnosis itself remains unclear: We aimed to clarify if the diagnostic label PGD produces additional public stigma beyond PGD symptoms. We further compared whether public stigma varies between the label PGD and the label major depressive episode (MDE) (when PGD symptoms are present) and if gender of the bereaved person influences public stigma or moderates the aforementioned effects. Eight-hundred fifty-two participants (77% female; Mage = 32.6 years, SD = 13.3) were randomly assigned to read online one of eight vignettes describing either a bereaved male or female, with PGD symptoms and PGD diagnosis; PGD symptoms and MDE diagnosis; PGD symptoms and no diagnosis, or no PGD symptoms and no diagnosis (i.e., integrated grief). Following the vignettes, participants indicated which negative characteristics they ascribed to the person, their emotional reactions, and preferred social distance from the person. People with PGD symptoms and PGD (or MDE) diagnosis were attributed more negative characteristics, and elicited more negative emotions and a stronger desire for social distance than people with integrated grief. However, public stigma did not differ for people with both PGD symptoms and diagnosis compared to people only experiencing PGD symptoms. Gender of the bereaved only had an influence on desired social distance, which was larger towards men. Helping severely distressed bereaved people (regardless of diagnostic status) cope with negative social reactions may help them adapt to bereavement. Results demonstrate that the experience of severe grief reactions, yet not a diagnostic label per se, causes public stigma.

Objective:The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision includes prolonged grief disorder as a novel disorder. Prolonged grief disorder can be diagnosed when acute grief stays distressing and disabling, beyond 12 months following bereavement. Evidence indicates that elevated prolonged grief disorder symptoms in the first year of bereavement predict pervasive grief later in time; targeting early elevated grief may potentially prevent symptoms getting chronic. There is limited knowledge about the characteristics of people in the first year of bereavement who have an elevated chance of developing full prolonged grief disorder beyond the 12-month time point. This study examined these characteristics.Methods:We used self-reported data from 306 adults who all completed questions on socio-demographic and loss-related characteristics plus a measure of prolonged grief disorder within the first year of bereavement (Wave 1; time since loss: M = 4.97, SD = 3.13 months) and again 1 year later (Wave 2; time since loss: M = 17.84, SD = 3.38 months). We examined the prevalence rates of probable prolonged grief disorder (Wave 2), measurement invariance of prolonged grief disorder symptoms between waves, and associations of socio-demographic and loss-related variables, and Wave 1 prolonged grief disorder with probable prolonged grief disorder at Wave 2.Results:Regarding prevalence, 10.1% (n = 31) met criteria for probable prolonged grief disorder (Wave 2). Multigroup confirmatory factor analysis supported longitudinal measurement invariance of prolonged grief disorder symptoms. People meeting criteria at Wave 1 (except the time criterion) had a significantly increased risk of meeting criteria at Wave 2. Variables best predicting probable prolonged grief disorder at Wave 2 were prolonged grief disorder at Wave 1, lower education, loss of a child and loss to unnatural/violent causes (sensitivity = 56.67%, specificity = 98.12%, 93.92% correct classifications).Conclusion:People meeting criteria for prolonged grief disorder (except the time criterion) before the first anniversary of the death are at risk of full-blown prolonged grief disorder beyond this time point, particularly those who have lower education, confronted the death of a child and confronted unnatural/violent loss. Findings may inform advances in preventive bereavement care.

High levels of somatic symptom distress and health anxiety have been linked to difficulties in emotion generation, identification, and regulation. However, these findings stem largely from correlational studies using questionnaires. Mechanistic experimental evidence is scarce and inconclusive. The present study investigated associations between somatic symptom distress (SSS-8), health anxiety (MK-HAI), alexithymia (TAS-20), and experimental indicators of emotion generation in N=78 participants (Age: M=23.12, SD=3.50; Gender: 80.8% female, 19.2% male). An innovative experimental paradigm of emotion generation by Givon et al (2023) was used, which assesses emotional responses to normed negative or positive pictures. It allows the calculation of evidence accumulation parameters, that reflect emotion processing efficiency (drift-rate) and response bias in emotion reporting (threshold), based on a linear ballistic accumulator model. Somatic symptom distress was not associated with emotion processing efficiency (drift-rate) for negative emotions (BFinclusion=0.49). There was anecdotal evidence for an effect of health anxiety (BFinclusion=2.53), but the effect was small and inconclusive (b=-0.01, SD=0.004, 95% CI [-0.01, <0.001]), thus failing to support a strong association. Experimental indicators of emotion generation were also unrelated to self-reported alexithymia (0.14 <BF10 <0.18). The study did not provide evidence that somatic symptom distress or health anxiety are linked to a markedly reduced efficiency in processing of negative emotions. As this was a convenience sample with predominantly non-clinical symptom levels, future studies should test the generalizability of these findings to clinical samples.

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.

Objective Three theoretically grounded hypotheses were tested that predict interactions between modern health worries (MHWs), somatic symptom distress, and negative affect. Design Cross-sectional. Main outcome measures Hypotheses were tested in a representative German sample (n = 2306) and a near-representative Swedish sample (n = 3406). Participants completed the 12-item Modern Health Worries Scale, the Patient Health Questionnaire 15-Item Somatic Symptom Severity Scale (both samples), the Patient Health Questionnaire 9-Item Depression Scale (German sample), and the Hospital Anxiety and Depression Scale (Swedish sample). Results According to the results obtained from the two samples, MHWs were only weakly associated with somatic symptoms and negative affectivity. Frequentist and Bayesian linear regression analyses showed an interaction only in one case. All other factors being equal, individuals high on somatic symptoms and MHWs did not experience disproportionately less anxiety or depression; those high on MHWs and negative affect were characterized by disproportionately more symptoms in the German sample but not in the Swedish sample; and high level of negative affect did not strengthen the positive association between somatic symptoms and MHWs. Conclusion Based on data from two large community samples, temporal stability of MHWs cannot be explained by somatic symptom distress and negative affectivity.

High levels of somatic symptom distress represent a core component of both mental and physical illness. The exact aetiology and pathogenesis of this transdiagnostic phenomenon remain largely unknown. The Affective Picture Paradigm (APP) represents an innovative experimental paradigm to study somatic symptom distress. Based on the HiTOP framework and a population-based sampling approach, associations between facets of somatic symptom distress and symptoms induced by the APP were explored in two studies (N 1 = 201; N 2 = 254) using structural equation bi-factor models. Results showed that the APP effect was significantly positively correlated with general somatic symptom distress (PHQ-15, HiTOP), cardio-respiratory symptoms (PHQ-15), as well as difficulties identifying feelings. In conclusion, negative affective cues in the APP can elicit somatic symptoms, particularly in people with higher levels of somatic symptom distress. Difficulties identifying feelings might contribute to this phenomenon. Results are compatible with a predictive processing account of somatic symptom perception.

Co-occurrence of prolonged grief disorder (PGD) with psychologic distress like posttraumatic stress disorder (PTSD) and depression is widely studied. However, only two non-ICU studies from Western countries have cross-sectionally examined co-occurring PGD, PTSD, depression, and anxiety symptoms among individuals who experienced traumatic bereavement, yielding inconsistent findings. Despite this, PGD symptoms frequently co-occur with anxiety symptoms, which strongly predicts PTSD-depression trajectories and PGD-PTSD-depression symptom states. To identify and examine transitions through distinct states of co-occurring PGD, PTSD, depression, and anxiety symptoms over the first two bereavement years among Taiwanese ICU bereaved who lost a family member to diseases. Prospective cohort study. MICUs of two Taiwanese medical centers. Three hundred three family members. None. Participants were surveyed at 6, 13, 18, and 24 months of post-bereavement with 11 items from the PG-13, the Impact of Event Scale-Revised, and depression and anxiety subscales of the Hospital Anxiety and Depression Scale. Latent transition analysis was used to examine the PGD-PTSD-depression-anxiety symptom states and their prevalence over time. At 6 months of post-bereavement, we identified four distinct PGD-PTSD-depression-anxiety symptom states (prevalence): resilient (62.7%), subthreshold PGD-depression (21.2%), PGD-dominant (11.2%), and co-occurring PGD-PTSD-depression-anxiety (4.9%). Symptom states were mostly stable over time; however, when participants transitioned between states, they typically moved toward lower distress states. At 24 months of post-bereavement, the prevalence rankings remained unchanged: resilient (81.1%), subthreshold PGD-depression (10.9%), PGD-dominant (5.5%), and co-occurring PGD-PTSD-depression-anxiety (2.5%). We consistently observed four distinct PGD-PTSD-depression-anxiety-symptom states during the first two bereavement years of ICU family members. Persistently elevated PGD symptoms, alone or with PTSD, depression, and anxiety, can already be detected within 6 months of bereavement, underscoring the need for early screening to provide timely psychologic support or treatments for those at risk of chronic PGD or co-occurring symptom states.

Posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) are well-documented in parentally bereaved adolescents. Whether or not the parent's death is perceived as traumatic may be influenced by several end-of-life-related factors. This study aimed to examine the associations between end-of-life-related factors, symptoms of posttraumatic stress disorder (PTSD), symptoms of prolonged grief disorder and PGD, and the association between PTSD and PGD. Mann-Whitney U tests and Spearman correlation were used to analyze the relationships between end-of-life-related factors, PTSD, and PGD. Regretting one's decision to be present or not present at the time of death resulted in a significant difference in self-reported scores for PTSD, but not PGD.

Climate change anxiety and its association with somatic symptom distress and idiopathic environmental intolerances: A cross-sectional study

BackgroundRecognition that the loss of a loved one may result in prolonged grief disorder (PGD) has gained broad attention recently. PGD may disturb daily functioning to such a degree that mental health treatment is required. Because PGD symptoms often resemble symptoms of common mental disorders (CMD) such as anxiety, depressive, and post-traumatic stress disorder, clinicians may not consider a PGD diagnosis. Moreover, cultural varieties in expression of PGD may complicate recognition. This study explores the prevalence of PGD among both natives and refugees with anxiety, depressive, or trauma- and/or stressor-related disorders as well as clinicians' awareness and knowledge of PGD symptoms. In addition, a psychoeducation module on PGD symptoms is developed through patient expert collaboration.MethodsPrevalence of PGD symptoms is investigated among 50 participants who are referred to outpatient clinics for anxiety, depression, or post-traumatic stress, using the Traumatic Grief Inventory—Self Report Plus (TGI-SR+) and the Bereavement and Grief—Cultural Formulation Interview (BG-CFI). Clinicians will be interviewed on knowledge (gaps) with respect to PGD symptoms. Finally, focus groups with patient experts are held to develop a psychoeducation module tailored to the patients' needs, norms and values.ResultsThis study will show prevalence of PGD among patients who are referred for anxiety, depression, and post-traumatic stress, awareness and knowledge of clinicians on PGD symptoms, and will offer patient expert informed psychoeducation.DiscussionResearch on prevalence and recognition of PGD is vital. Study results of the prevalence of PGD will be compared to previous studies. Recognition of PGD as distinct disorder from CMDs requires clinicians' awareness of symptoms related to the loss of a loved one. Thereby, clinicians need to take cultural aspects related to death, bereavement and mourning into consideration.Ethics and disseminationThe study protocol will be carried out in accordance with relevant guidelines and regulations. Exploratory research to assess the prevalence of PGD in patients suffering from CMDs will facilitate adequate diagnosis by increasing clinician's awareness of PGD symptoms. Tailored PGD psychoeducation, co-created by culturally diverse patient experts and clinicians will be made publicly available.