Grief Trajectories Research Articles

Person-specific emotional dynamics: a story of a traumatic loss

The impact of traumatic loss on an individuals’ mental health is a critical area of study. While most research has focused on general grief patterns, the unique trajectories of trauma survivors have been understudied. This research utilizes a high-resolution dataset from a single individual over several years, including a period of unexpected tragedy. Using person-specific dynamic modeling and network analysis, the study examines the psychological processes related to traumatic loss. The results reveal a complex distress trajectory and emotional variability with increasing resilience over time. Findings suggest that traumatic loss can induce strongly interconnected emotional networks, typically linked to vulnerability to psychological disorders. Yet, a heightened correlation within a network representing both positive and negative aspects could indicate the emergence of adaptive coping strategies. The study emphasizes that analyzing emotional inertia and variability separately provides a holistic clinical perspective and deepens the understanding of diverse psychological states and affective dynamics. This research underlines the benefits of investigating individual experiences and stresses the need for idiographic approaches in trauma and grief studies. Future research utilizing high-resolution data from multiple individuals may provide a more comprehensive understanding of the diverse trajectories of grief and inform the future of personalized intervention and care.

Waves of Grief: Fluctuating Restrictions, Treatments of Corpses and Experiences of Loss during the COVID-19 Pandemic

ABSTRACT: With the advent of the COVID-19 pandemic, high mortality rates brought to the forefront the importance not only of the gestures performed and practices implemented on and about the deceased, but also, most importantly, of the entire sequence of funeral operations involved. The intensification of the work needed to take care of bodies in their biological component, from a technical point of view, generated uncertainties on the possibility to also adequately take care of the social components relating to families and loved ones. This raises questions about the factors influencing the experience of grief in these circumstances, and the extent to which funerary practices determine the nature and characteristics of grief work. Based on two anthropological research projects conducted in France and Switzerland in the mortuary and funeral realms, as well as with bereaved persons over the first eighteen months of the pandemic, this article aims at answering these questions. It argues that grief trajectories are strongly impacted by the way in which bodies were treated, as well as by whether the funeral was felt to have been conducted in a satisfactory manner. It also sheds new light on a series of factors pertaining to the temporality of the processes involved: dying circumstances; attitudes towards restrictions throughout the entire process of caring for the body, and not merely at the funeral; the period in the pandemic during which a death occurred, i.e., during or between “waves.” In so doing, the article broadens the ways in which we think about temporality and death.

Meaning Integration and Grief Trajectories Within in the First Two Years Among Chinese: Latent Growth Modeling

Studies on grief trajectories within the first two years following loss are limited, especially among eastern cultures. This study aims to examine distinct grief trajectories among Chinese bereaved individuals as well as the factors predicting them. The data were collected in three waves over 18 months and involved 181 participants who completed measures of grief, meaning integration, and demographic and death-related information. Latent class growth analysis was utilized to identify grief trajectories. Univariate logistical regression and multivariate logistical regression were used to investigate the predictors. Four grief trajectories were identified: resilient (44.19%), chronic (17.15%), recovery (31.71%), and delayed (6.32%). Meaning integration at six months following loss distinguished the chronic trajectory from the resilient group, but not from the recovery group. Meaning integration at 12 months distinguished the chronic trajectory from the resilient trajectory and the recovery trajectory. However, it did not differentiate delayed pattern from recovery or resilient classes. These findings emphasize the need for caution in predicting grief trajectories by meaning integration early in the bereavement process.

Long-term bereavement outcomes in family members of those who died in acute care hospitals before and during the first wave of COVID-19: A cohort study

Background: Severe grief is highly distressing and prevalent up to 1 year post-death among people bereaved during the first wave of COVID-19, but no study has assessed changes in grief severity beyond this timeframe. Aim: Understand the trajectory of grief during the pandemic by reassessing grief symptoms in our original cohort 12–18 months post-death. Design: Prospective matched cohort study. Settings/participants: Family members of decedents who died in an acute care hospital between November 1, 2019 and August 31, 2020 in Ottawa, Canada. Family members of patients who died of COVID (COVID +ve) were matched 2:1 with those who died of non-COVID illness (COVID −ve) during pandemic wave 1 or immediately prior to its onset (pre-COVID). Grief was assessed using the Inventory of Complicated Grief (ICG). Results: Follow-up assessment was completed by 92% (111/121) of family members in the initial cohort. Mean ICG score on the 12–18-month assessment was 19.9 (SD = 11.8), and severe grief (ICG > 25) was present in 28.8% of participants. One-third (33.3%) had either a persistently high (>25) or worsening ICG score (⩾4-point increase between assessments). Using a modified Poisson regression analysis, persistently high or worsening ICG scores were associated with endotracheal intubation in the deceased, but not cause of death (COVID +ve, COVID −ve, pre-COVID) or physical presence of the family member in the final 48 h of life. Conclusions: Severe grief is a substantial source of psychological morbidity in the wake of the COVID-19 pandemic, persisting more than a year post-death. Our findings highlight an acute need for effective and scalable means of addressing severe grief.

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

ABSTRACT 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.

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.

Understanding Black and African American Grief Following Inclusion of Prolonged Grief Disorder in the DSM-5-TR.

Black and African Americans experience bereavement more frequently and earlier in life than White Americans and thus may be more impacted by prolonged grief disorder (PGD). With the revision of the DSM-5 and the inclusion of PGD as a recognized psychiatric syndrome, researchers have an opportunity to further the understanding, diagnosis, and treatment of PGD in Black grievers residing in the United States. Relatively little research has been devoted to the specific risks and resiliencies impacting bereavement-related mental health outcomes among these individuals. Participants in our study were invited to participate in a Qualtrics-based survey disseminated through Centiment. A total of 259 participants were included in the final sample. Overall findings suggest demographic factors such as educational attainment and gender were not significantly associated with PGD. Factors such as younger age, prior trauma exposure, and violent circumstances of the death were associated with PGD, though only PTSD and anxiety symptoms were associated with PGD after adjusting for co-occurring mental health symptoms. These findings point to identifiable risk factors and resilience factors that may contribute to grief trajectories among Black grievers.

Perceptions of crime severity and stigma toward family members grieving the loss of a person to incarceration

ABSTRACT Family members of incarcerated persons may experience grief related to the incarceration. We examined laypeople’s perceptions of family members grieving the loss of an individual to incarceration. Participants (N = 1095) were randomized to read vignettes that varied by grief trajectory (prolonged vs. resilient), race (Black vs. White vs. Latine), and crime type (violent vs. non-violent). Participants answered questions assessing grief response appropriateness, comfort providing support to the grieving person, beliefs that the grieving person should seek therapy, and how severe they believed the incarcerated person’s crime was. Results indicated that prolonged grief trajectories and greater perceived crime severity were associated with decreased ratings of grief response appropriateness. Participants were more likely to endorse the need for therapy-seeking for individuals with prolonged grief (vs. resilience). Participants were less likely to recommend therapy for Black (vs. White) individuals, and women were more likely to recommend seeking therapy than men. The results suggest stigma might exist toward family members grieving the loss of individuals who committed crimes perceived to be more severe by laypeople, which could contribute to negative bereavement outcomes.

Complicated Grief Following the Traumatic Loss of a Child: A Systematic Review.

Complicated grief is a disabling condition that occurs when the natural grief process is disturbed or prolonged. Research demonstrates that complicated grief is more prevalent following the sudden or violent loss of a child. Despite the high incidence of accidental death worldwide, little research has focused on parental grief trajectories following this form of traumatic loss. A systematic review was conducted to explore parental bereavement outcomes following accidental death. Studies were included if they specifically examined complicated grief in parents bereaved by the accidental death of their child. A total of 767 articles were identified and seven studies met the eligibility criteria for review. Poorer outcomes were identified in relation to the mode of death, relationship type, time post-loss, perceived support, perceived justice and comorbidities. Results of the current study may be used to inform the development of clinical practice guidelines for the treatment of complicated grief.

Perceptions of grief reactions in family members of incarcerated individuals: A vignette-based experiment

We examined perceptions of individuals grieving the loss of a family member to incarceration. Participants (N = 1095) were randomized to a vignette that varied by race-ethnicity, crime type, and grief trajectory to assess their perceptions. Results indicated: (1) participants perceived prolonged grief as less appropriate than resilience; (2) Black family members grieving someone who committed a violent crime as more appropriate compared to White family members; and (3) women endorsed both grief trajectories as more appropriate and indicated greater comfort supporting the family member. Lastly, participants indicated prolonged, White and Latinx grievers should seek therapy more than resilient or Black individuals.

Attentional bias during acute grief predicts clinical outcome in suicide-related bereavement

BackgroundIndividuals who have lost a loved one to suicide are at increased risk for developing complicated grief (CG). It is unclear why only a subgroup of bereaved develops pathological forms of grief. Vulnerability may be related to the ability to regulate attention toward reminders of the deceased during the acute phase of grief. Using a longitudinal design, we determined whether loss-related attentional bias during acute grief predicts grief severity one year later. MethodsThirty-seven participants grieving a first-degree relative or partner to suicide in the prior 6 months performed an emotional Stroop task using words related to the deceased, a living attachment figure, living non-attachment figure, and color congruent Stroop to quantify related attentional bias during the acute grief period. Clinical interviews were conducted at baseline (N = 37) and one year later (N = 35). ResultsParticipants showed greater attentional bias to deceased-related word trials compared with living attachment, non-attachment, and congruent trials, controlling for age, time since loss, depression, and psychiatric medication. A greater reduction in grief severity over time was associated with more deceased-related attentional bias at baseline. Self-reported grief avoidance was related to deceased-related attentional bias, with lower avoidance scores associated with greater bias. LimitationsLack of non-suicide grief control and small sample size. ConclusionsLess deceased-related bias following the loss may hinder the transition from acute to integrated grief and result in poorer grief trajectories.

Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study.

To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an increased risk of self-harm and suicide around dates of (i) anniversaries of the death and (ii) the deceased's birthday, compared with intervening periods. We conducted a self-controlled case series study using national register data on all individuals living in Denmark from 1 January 1980 to 31 December 2016 and who were bereaved by the suicide of a first-degree relative or partner (spouse or cohabitee) during that period, and who had the outcome (any episode of self-harm or suicide) within 5years and 6weeks of the bereavement. We compared relative incidence of suicidal behaviour in (i) the first 30days after bereavement and (ii) in the aggregated exposed periods (6 weeks either side of death anniversaries; 6weeks either side of the deceased's birthdays) to the reference (aggregated unexposed intervening periods). As an indirect comparison, we repeated these models in people bereaved by other causes. We found no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased's birthdays in people bereaved by suicide (adjusted incidence rate ratio [IRRadj]=1.00; 95% confidence interval [CI]=0.87-1.16) or other causes (IRRadj=1.04; 95% CI=1.00-1.08) compared with intervening periods. Rates were elevated in the 30days immediately after bereavement by other causes (IRRadj: 1.95, 95% CI: 1.77-2.22). Although people bereaved by suicide are at elevated risk of self-harm and suicide, our findings do not suggest that this risk is heightened around emotionally significant anniversaries. Bereavement care should be accessible at all points after a traumatic loss as needs will differ over the grief trajectory.

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.

No wrong decisions in an all-wrong situation. A qualitative study on the lived experiences of families of children with diffuse intrinsic pontine glioma.

Diffuse intrinsic pontine glioma (DIPG) is a rare, but lethal pediatric brain tumor with a median survival of less than 1year. Existing treatment may prolong life and control symptoms, but may cause toxicity and side effects. In order to improve child- and family-centered care, we aimed to better understand the treatment decision-making experiences of parents, as studies on this topic are currently lacking. The data for this study came from 24 semistructured interviews with parents whose children were diagnosed with DIPG in two children's hospitals in Switzerland and died between 2000 and 2016. Analysis of the dataset was done using reflexive thematic analysis. For most parents, the decision for or against treatment was relatively straightforward given the fatality of the tumor and the absence of treatment protocols. Most of them had no regrets about their decision for or against treatment. The most distressing factor for them was observing their child's gradual loss of independence and informing them about the inescapability of death. To counter this powerlessness, many parents opted for complementary or alternative medicine in order to "do something." Many parents reported psychological problems in the aftermath of their child's death and coping strategies between mothers and fathers often differed. The challenges of DIPG are unique and explain why parental and shared decision-making is different in DIPG compared to other cancer diagnoses. Considering that treatment decisions shape parents' grief trajectory, clinicians should reassure parents by framing treatment decisions in terms of family's deeply held values and goals.

Grief Trajectories of Bereaved Parents of Adolescents and Young Adults With Advanced Cancer: A Qualitative Analysis Using Phenomenology.

Different parents grieve differently. However, research directed at understanding the important contextual or individual factors that influence the path each bereaved parent takes is lacking. In this qualitative analysis we seek to understand the array of bereaved parent experiences more completely. By deeply diving into one parent dyad using interpretive phenomenology analysis and situating that story within the conventional content analysis of 13 other bereaved parents of adolescents and young adults (AYAs) who died from advanced cancer, we illustrate the roles of religion/spirituality, maintaining a connection, and fulfilling parental roles as elements of grief processing. Clinicians and investigators should consider similar individualized approaches to understanding and supporting the grief experiences of bereaved parents before and after the death of a child.

Grief, self and narrative

ABSTRACT Various claims have been made concerning the role of narrative in grief. In this paper, we emphasize the need for a discerning approach, which acknowledges that narratives of different kinds relate to grief in different ways. We focus specifically on the positive contributions that narrative can make to sustaining, restoring and revising a sense of who one is. We argue that, although it is right to suggest that narratives provide structure and coherence, they also play a complementary role in disrupting established structure and opening up new possibilities. We add that both of these roles point to the importance of interpersonal, social and cultural factors in shaping the trajectory of grief. We conclude by briefly considering the implications for distinguishing between typical and pathological forms of grief.

"It Started After Trauma": The Effects of Traumatic Grief on Sleep Paralysis.

Adverse life events are associated with the often-terrifying REM sleep parasomnia of sleep paralysis (SP), but the impact of bereavement on SP has not been specifically examined. This exploratory, mixed-methods study (N = 168) includes qualitative data from 55 participants who described factors they believed led to their SP. Of these, almost half with a traumatic loss listed death-related precipitants. In unadjusted (bivariate) negative binomial regression models, traumatic death, time since death, religiosity, and age estimated increased SP frequency in the prior month, prior year, or both. In multivariable models, traumatic death, time since death, and age estimated increased frequency in the prior month, prior year, or both. Unexpectedly, in all models, as compared to death ≥9years earlier, prior month SP was greater with death 1-6years earlier, but not <1year earlier. Discussion includes the possible role of social constraints in traumatic grief trajectories and care provider recommendations.

Effects of nursing home placement on the mental health trajectories of family caregivers of people with dementia: findings from the Tele.TAnDem intervention study

Objectives The objective was to compare mental health trajectories between family caregivers of people with dementia (PwD) who institutionalize the care recipient (nursing home caregivers [NHC]) and caregivers who continue to provide care at home (at-home caregivers [AHC]) as well as investigate effects of a telephone-based cognitive-behavioral therapy (TEL-CBT) intervention on these trajectories. Methods Using linear growth models, we compared the trajectories of depressive symptoms, caregiver grief, anxiety, and quality of life (QoL) over one year (baseline – T0, 6 months – T1, and 12 months – T2) between 28 NHC and 163 AHC who had been randomized to receive 12 sessions of TEL-CBT (n = 99) or to usual care (n = 92). Results NHC reported significantly higher depression, anxiety, and caregiver grief at T0 and showed significant reductions in depression and anxiety over time compared to AHC. TEL-CBT significantly enhanced overall QoL of NHC. Conclusions The study extends previous findings of improved mental health of family caregivers of PwD after institutionalization and emphasizes the need for interventions before nursing home placement. TEL-CBT which has previously been shown to be effective for family caregivers of PwD also seems promising for supporting NHC. Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.2022598 .

The influence of depression on the relationship between loneliness and grief trajectories in bereaved older adults.

Loneliness is associated with adverse mental health outcomes in older adults. Bereavement triggers intense feelings of loneliness. This pilot study explored the association between baseline loneliness and grief symptom trajectories in bereaved elders and explored if this association is moderated by depressive symptom changes. 56 individuals aged 50 years and older, within 13-months following bereavement, completed assessments. Loneliness was measured at baseline using the UCLA loneliness scale-version 3. Grief and depressive symptoms were measured over 26 weeks using the inventory of complicated grief (ICG) and the 17-item Hamilton Depressive Rating (HAM-D) scales, respectively. Linear regression explored the cross-sectional association between loneliness and grief symptoms, after adjusting for covariates including depressive symptoms. A mixed-effects linear model tested whether baseline loneliness was related to grief symptom trajectory over 26 weeks, after accounting for depressive symptom changes. Loneliness was associated with grief symptom severity at baseline; however, this cross-sectional association was not significant after adjusting for depressive symptoms. Longitudinally, baseline loneliness was positively associated with grief symptom trajectories; however, depressive symptom changes moderated this association. Depressive symptom alterations appear to weaken the loneliness-grief symptom change association. These exploratory findings point to opportunities for interventions targeting loneliness and depression that may reduce grief intensity over time in bereaved elders.

Changing rituals and practices surrounding COVID-19 related deaths: implications for mental health nursing

With a rising number of coronavirus deaths, concerns have been raised over farewell rituals and the grieving processes. This commentary acknowledges the therapeutic potential of mental health nursing to help with the resolution of grief trajectories in the ongoing pandemic.