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

Josefin Sveen,Kerstin Bergh Johannesson,Martin Cernvall,Filip K Arnberg,Oliver Gruebner

doi:10.1371/journal.pone.0209757

Abstract

BackgroundThe long-term trajectories of prolonged grief are poorly understood. The aims were to examine the course of grief among bereaved disaster survivors up to six years post loss and factors predicting worse bereavement outcome. A third aim was to explore differences in grief indicators between trajectories.MethodsBereaved Swedish tourists who survived the 2004 Indian Ocean tsunamis responded to surveys including the Inventory of Complicated Grief 1 to 6 years after the disaster. Latent growth mixture modeling was used to identify longitudinal trajectories of grief. Multinomial logistic regression analysis was used to examine predictors of class membership.ResultsThree trajectories were identified: resilient (41% of the sample), recovering (48%), and chronic (11%). The strongest predictor of chronic grief was the loss of one’s child. When examining grief indicators, the chronic trajectory was characterized by not accepting the loss, while yearning was common in all trajectories.ConclusionsThis study highlights the importance of considering how traumatically bereaved individuals can be affected by loss for several years after a disaster, especially after losing one’s child. An inability to accept the loss, more so than yearning, appears to characterize bereaved survivors at risk of a chronic trajectory of grief.

Highlights

The chronic trajectory was characterized by not accepting the loss, while yearning was common in all trajectories
Even though bereavement is common in disasters [1], most studies of disaster survivors have focused on posttraumatic stress rather than grief
The classes included a resilient trajectory comprising 41% of the sample characterized by moderately low levels of prolonged grief from one to six years post loss; a recovering trajectory including half of the individuals with initially high symptoms of prolonged grief and a gradual decrease in symptoms thereafter, and a chronic trajectory including 11% of the participants with high and unremitting levels of prolonged grief symptoms for as long as six years after the event

Summary

Introduction

Even though bereavement is common in disasters [1], most studies of disaster survivors have focused on posttraumatic stress rather than grief. While the majority of bereaved individuals adjust to the loss of a loved one without professional help, a significant minority will experience persistent and intensive grief reactions, commonly termed prolonged grief [4, 5], which can persist for years [6, 7]. An intense and lasting yearning for the deceased is considered one of the core symptoms of prolonged grief disorder (PGD) [5]. A recent meta-analysis, including studies up until 2016 of natural bereavement with time since loss ranging from 6 months to 12 years, reported a pooled prevalence rate of PGD to 9.8% (95% CI 6.8–14.0) [12]. A third aim was to explore differences in grief indicators between trajectories

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Discussion

Conclusion