Grief Trajectories Research Articles

Predictors of Prolonged Grief, Resilience, and Recovery Among Bereaved Spouses.

Most reactions to loss can be characterized by three prototypical trajectories of resilience, gradual recovery, and chronic distress (Bonanno, ). However, research on the factors that uniquely predict these trajectories of response has been limited. We examined theoretically relevant predictors of each of the trajectory patterns. We assessed 115 bereaved spouses at 1.5 to 3 years postloss and 74 married controls. To identify grief trajectory, we provided bereaved participants with a graphical depiction of the trajectories and asked them to select the one that best described their experience. Group comparisons revealed substantial differences between resilient and prolonged grievers, and almost no differences between resilient and married controls. Multivariate analyses indicated that prolonged grief, when compared to resilience, was uniquely associated with maladaptive dependency traits, difficulty accessing positive memories of the deceased, and higher recalled marital adjustment. The present results extend our understanding of factors associated with distinct trajectories of adjustment after loss.

Trajectories of complicated grief

Trajectories of complicated grief

Trajectories of depression following spousal and child bereavement: A comparison of the heterogeneity in outcomes

Our understanding of how individuals react to the loss of a close loved one comes largely from studies of spousal bereavement. The extent to which findings are relevant to other bereavements is uncertain. A major methodological limitation of current studies has been a reliance on retrospective reporting of functioning and use of samples of individuals who have self-selected for participant in grief research. To address these limitations, in the current study we applied Latent Growth Mixture Modelling (LGMM) in a prospective population-based sample to identify trajectories of depression following spousal and child bereavement in later life. The sample consisted of 2512 individual bereaved adults who were assessed once before and three times after their loss. Four discrete trajectories were identified: Resilience (little or no depression; 68.2%), Chronic Grief (an onset of depression following loss; 13.2%), Depressed-Improved (high pre-loss depression that decreased following loss; 11.2%), and Pre-existing Chronic Depression (high depression at all assessments; 7.4%). These trajectories were present for both child and spousal loss. There was some evidence that child loss in later life was associated more strongly with the Chronic Grief trajectory and less strongly with the Resilience trajectory. However these differences disappeared when covariates were included in the model. Limitations of the analyses are discussed. These findings increase our understanding of the variety of outcomes following bereavement and underscore the importance of using prospective designs to map heterogeneity of response outcomes.

The heterogeneity of long-term grief reactions

BackgroundIndividuals experience the loss of a spouse in varied ways. There is growing recognition of major depressive disorder and complicated grief as distinct post-bereavement disorders. However, most studies focusing on these different courses of functioning have not examined pre-loss functioning. MethodsWe used data from a prospective population based study to examine depression and grief among conjugally bereaved older adults. We compared latent trajectories of grief and depression symptoms based on data from pre-loss and 6, 18, and 48 months post-loss, and examined a number of pre- and post-loss predictor variables. ResultsThe chronic grief and chronic depression trajectories did not differ in grief symptoms at any post-loss time point. However, a number of pre- and post-loss variables uniquely differentiated these two distinct trajectories. LimitationsMeasures used in the current study were based on self-report and compared only two trajectories. Additionally, the sample was restricted to older adults (M age=72) and thus our findings may not generalize to younger populations. ConclusionsThese two distinct trajectories – chronic grief and chronic depression – may appear similar when examining grief symptoms alone, though it is apparent that they have different long-term courses of functioning. It is important to understand pre-loss functioning as well as variables associated with each group in order to appropriately target treatment.

Building a maternity services system

Research suggests variation in how grief develops across time, and gender may account for some of this variation. However, gender differences in growth patterns of the newly codified ICD-11 prolonged grief disorder (PGD) are unknown. This study examined gender-specific variances in grief trajectories in a registry-sampled cohort of 857 spousal bereaved individuals (69.8% female). Participants completed self-report questionnaires of PGD symptoms at 2, 6, and 11 months post-loss. Using Growth Mixture Modeling, four PGD trajectories emerged: resilient characterized by low symptoms (64.4%), moderate-stable characterized by moderate symptoms (20.4%), recovery characterized by elevated symptoms showing a decrease over time (8.4%), and prolonged grief characterized by continuous elevated symptoms (6.8%). Similar proportions of men and women comprised the four trajectories. Gender influenced the parameter estimates of the prolonged grief trajectory as men evidenced more baseline symptoms (higher intercept) than women did and a decreasing symptom-level (negative slope), while women showed symptom-increase over time (positive slope). The prolonged grief trajectory captured the largest proportion of probable PGD cases in both genders. Low optimism and low mental health predicted membership in this class. Altogether, the absolute majority of both men and women followed a low-symptom resilient trajectory. While a comparable minority followed a high-symptom prolonged grief trajectory, men and women within this trajectory expressed varying symptom development. Men expressed prolonged grief as an acute, decreasing reaction, whereas women showed an adjourned, mounting grief reaction. This study suggests that gender may influence symptom development in highly distressed individuals across early bereavement.

A study of midwives who conduct universal opportunistic antenatal screening for chlamydia infection in a rural Tasmanian hospital: reflective practice narratives

Research suggests variation in how grief develops across time, and gender may account for some of this variation. However, gender differences in growth patterns of the newly codified ICD-11 prolonged grief disorder (PGD) are unknown. This study examined gender-specific variances in grief trajectories in a registry-sampled cohort of 857 spousal bereaved individuals (69.8% female). Participants completed self-report questionnaires of PGD symptoms at 2, 6, and 11 months post-loss. Using Growth Mixture Modeling, four PGD trajectories emerged: resilient characterized by low symptoms (64.4%), moderate-stable characterized by moderate symptoms (20.4%), recovery characterized by elevated symptoms showing a decrease over time (8.4%), and prolonged grief characterized by continuous elevated symptoms (6.8%). Similar proportions of men and women comprised the four trajectories. Gender influenced the parameter estimates of the prolonged grief trajectory as men evidenced more baseline symptoms (higher intercept) than women did and a decreasing symptom-level (negative slope), while women showed symptom-increase over time (positive slope). The prolonged grief trajectory captured the largest proportion of probable PGD cases in both genders. Low optimism and low mental health predicted membership in this class. Altogether, the absolute majority of both men and women followed a low-symptom resilient trajectory. While a comparable minority followed a high-symptom prolonged grief trajectory, men and women within this trajectory expressed varying symptom development. Men expressed prolonged grief as an acute, decreasing reaction, whereas women showed an adjourned, mounting grief reaction. This study suggests that gender may influence symptom development in highly distressed individuals across early bereavement.

Delivering care: Developing an appropriate model for women from refugee backgrounds

Research suggests variation in how grief develops across time, and gender may account for some of this variation. However, gender differences in growth patterns of the newly codified ICD-11 prolonged grief disorder (PGD) are unknown. This study examined gender-specific variances in grief trajectories in a registry-sampled cohort of 857 spousal bereaved individuals (69.8% female). Participants completed self-report questionnaires of PGD symptoms at 2, 6, and 11 months post-loss. Using Growth Mixture Modeling, four PGD trajectories emerged: resilient characterized by low symptoms (64.4%), moderate-stable characterized by moderate symptoms (20.4%), recovery characterized by elevated symptoms showing a decrease over time (8.4%), and prolonged grief characterized by continuous elevated symptoms (6.8%). Similar proportions of men and women comprised the four trajectories. Gender influenced the parameter estimates of the prolonged grief trajectory as men evidenced more baseline symptoms (higher intercept) than women did and a decreasing symptom-level (negative slope), while women showed symptom-increase over time (positive slope). The prolonged grief trajectory captured the largest proportion of probable PGD cases in both genders. Low optimism and low mental health predicted membership in this class. Altogether, the absolute majority of both men and women followed a low-symptom resilient trajectory. While a comparable minority followed a high-symptom prolonged grief trajectory, men and women within this trajectory expressed varying symptom development. Men expressed prolonged grief as an acute, decreasing reaction, whereas women showed an adjourned, mounting grief reaction. This study suggests that gender may influence symptom development in highly distressed individuals across early bereavement.

Trajectories of Grief in Suddenly Bereaved Children

One in 20 U.S. children suffers the death of a parent before age 18. In a carefully done, population-based, longitudinal study in Pittsburgh,

Adaptive and maladaptive dependency in bereavement: Distinguishing prolonged and resolved grief trajectories

Interpersonal dependency is typically viewed as a risk factor for prolonged grief among conjugally bereaved adults. However, emerging empirical evidence and theoretical advances suggest that one manifestation of interpersonal dependency – adaptive dependency – may serve as a protective factor in coping with loss. This study compared adaptive and maladaptive dependency across three matched groups: prolonged grievers, asymptomatically bereaved adults, and a married comparison group. Results suggest a link between adaptive dependency and asymptomatic bereavement, and between maladaptive dependency and prolonged grief.

Follow-up study of complicated grief among parents eighteen months after a child's death in the pediatric intensive care unit.

We previously demonstrated that parents whose children die in a pediatric intensive care unit (PICU) have a high level of complicated grief symptoms 6 months after the death. In this study, we investigate the change in the extent of complicated grief symptoms among these parents between 6 and 18 months postdeath and identify factors predicting improvement. One hundred thirty-eight parents of 106 children completed surveys at 6 and 18 months. Surveys included the Inventory of Complicated Grief (ICG), measures of grief avoidance, attachment, caregiving and social support, and demographics. Multivariable analysis was performed using generalized estimating equations to identify characteristics independently associated with improvement in ICG score. ICG scores were 33.4 ± 13.6 at 6 months and 28.0 ± 13.5 at 18 months, representing an improvement in ICG score of 5.4 + 8.0 (95% confidence interval [CI] 4.1-6.8, p < 0.001). Variables independently associated with greater improvement in ICG score included traumatic death and greater grief avoidance. Variables independently associated with less improvement included being the biological parent and having more responsive caregiving. Parents with one or two surviving children had more improvement in ICG score than those with no surviving children whereas parents with three or more surviving children had less improvement. Complicated grief symptoms decrease among parents between 6 and 18 months after their child's death in the PICU; however, high symptom levels persists for some. Better understanding of the trajectory of complicated grief will allow parents at risk for persistent distress to receive professional support.

Resilient or at Risk? A 4-Year Study of Older Adults Who Initially Showed High or Low Distress Following Conjugal Loss

Following conjugal loss, some people show relatively little distress for the first several months, whereas others show considerable distress. In this article we examine these patterns over a 4-year period. Drawing on prior research defining grief trajectories, we conducted repeated measures analyses of variance on data from 92 bereaved elders with one preloss and three postloss assessments. Findings demonstrated that those with low initial distress continued to do well up to 4 years postloss. Differential findings among those who showed high distress initially and over time suggested that this pattern remained chronic only for those who had reported high distress preloss. Results underscore the need to refine the criteria used to identify those who are at risk for long-term problems.

Homelessness Felt

The felt—as both methodology and experiential terrain—remains under-explored and under-theorised in research on homelessness. This experimental piece traces the multi-sensory engagement of ethnographic and biographic fieldwork undertaken for separate projects with homeless people in two capital cities on Australia’s east coast. The epistemological contributions and emotional dimensions of seeing, tasting, touching, smelling and listening are explored. Through a series of short ‘felt’ reflections, consideration of the critical role of corporeality in coming to know and inscribe the experiences of others is prompted. The feeling, researching body is posited as central to new, productive and holistic intertwinings with felt-experience and the mixed trajectories of grief, humour, violence and trauma that often characterise persistent homelessness are made vivid.