Prolonged Grief Disorder Symptoms Research Articles

“I Changed After the Death”: Symptoms of Psychopathology Predict Lower Agency and Communion Themes in Loss Narratives Over 16 Months

Abstract Purpose Some individuals struggle to adjust after the death of a close other. Constructing an adaptive narrative about the loss is important to adjustment but symptoms of psychopathology may interfere with this process. We examined whether psychopathology symptoms measured 2 months after the loss of a spouse or parent predicted loss narratives with lower agency and communion themes as well as more negative emotional tone and self-event connections. Method Participants included 507 adults from the Aarhus Bereavement Study who completed psychopathology symptom measures at 2, 6, 11, and 18 months after the death of their spouse or parent. Symptom measures included prolonged grief disorder (PGD), PTSD, depression, and anxiety. Eighteen months after the death, participants wrote a narrative about the loss and answered questions about its emotional qualities (i.e., tone, self-event connections). The narratives were content coded for agency and communion themes. Results Multiple regressions showed that higher PGD symptoms at 2 months predicted less adaptive loss narratives at 18 months, even after controlling for neuroticism and age. Conclusion Individuals who experience high symptom levels are struggling to construct adaptive loss narratives. This may hinder identity changes needed to accommodate their altered life circumstances.

Toward Centrality Evaluation of Yearning Symptoms for Prolonged Grief Disorder: A Cross-Cultural Approach

Background: The new ICD-11 diagnosis of prolonged grief disorder (PGD) is characterized by the prominent role of yearning as hallmark symptom. A secondary analysis of eight international datasets on PGD was conducted to evaluate this assumption. Additionally, cross-cultural comparison explored whether the centrality of yearning differs across world regions. Methods: Primary studies originated from German-speaking countries (n = 4 samples), other European countries and Israel (n = 3 samples), as well as China (n = 1 samples). Different PGD measures were used, including yearning and longing as symptoms. For the centrality assessment of yearning, PGD symptoms were ranked by their factor loadings from confirmatory factor analyses, followed by statistical testing to determine significant differences between yearning and other symptoms of PGD in their factor loading estimates. Subsequently, ranking positions of yearning in three world regions (German-speaking, other Europe-Israel, and China) were compared. Finally, proxy thresholds for individuals at high-risk states for PGD were defined for the different datasets, and sensitivity-specificity analyses of yearning were performed. Results: Yearning was ranked high in five out of 12 models tested. In the German-speaking region, it was predominantly ranked among the most central symptoms; in the other Europe-Israel region as well as China, it tended to fall into the middle or lower rankings of symptom centrality. Sensitivity values were consistently high, while specificity values indicated moderate levels. Discussion: In line with previous research on the general outcomes of grief, the present study showed that yearning may be subject to a culture-specific distribution. Other central symptoms such as feeling as if a part of oneself died have also been shown to potentially play a central role in PGD across world regions. On the other hand, the sensitivity-specificity analyses revealed that yearning can be considered a significant (diagnostically highly sensitive) symptom for individuals in high-risk states for PGD, although it has only moderate specificity (i.e., its absence does not necessarily indicate individuals experiencing normative grief). Nonetheless, a culture-sensitive approach to psychopathology should consider the cultural differences in the centrality of this symptom group. More research is needed to better understand the role of yearning and its determinants across world regions.

Development and validation of the caregiver-report version of the international grief questionnaire (IGQ-CG): Results from a Ukrainian sample of parents.

The International Grief Questionnaire (IGQ) is a self-report measure of ICD-11 Prolonged Grief Disorder (PGD) in adults. This study sought to develop and validate a caregiver-report version of the IGQ for children and adolescents aged 7-17 years; the IGQ-Caregiver Version (IGQ-CG). 639 parents living in Ukraine provided data on themselves and one child in their household as part of the "The Mental Health of Parents and Children in Ukraine Study: 2023 Follow-up" study. The latent structure of the scale was tested using confirmatory factor analysis (CFA), while convergent validity was assessed through associations with other mental health correlates. Prevalence rates of probable ICD-11 PGD were estimated. CFA results supported a correlated two-factor model ('core' and 'associated' symptoms) and the internal reliability of the scale scores were acceptable. Convergent validity was supported through significant correlations with internalizing symptoms, while contact with the deceased, time since bereavement, and parental PGD were associated with higher scores on the IGQ-CG latent variables. The prevalence of probable ICD-11 PGD was 1.4%, and amongst those with a lifetime bereavement, the conditional rate was 3.2%. The IGQ-CG produces reliable and valid scores for ICD-11 PGD symptoms in children and adolescents as reported by their caregivers.

A role for event centrality in prolonged grief disorder.

Having a traumatic or negative event at the centre of one's identity is associated with adverse psychological outcomes including post-traumatic stress, depression, and prolonged grief disorder (PGD). However, direct investigation of the role of centrality of a bereavement-event in the maintenance of PGD symptoms is scarce and has not compared immediate and long-term changes in event centrality nor examined the nature of the loss. Data from bereaved partners and adult children in The Aarhus Bereavement Study at four time points over 26months post-loss were included in this study. Participants completed a PGD symptom measure and the Centrality of Events Scale (CES) on each occasion. Results suggest that bereaved partners had higher PGD and CES scores than bereaved adult children at all four post-bereavement time points. Regardless of relationship type, maintaining higher CES scores over time predicted PGD symptoms, over and above initial symptoms. Our findings suggest a risk factor for maintaining PGD symptoms is the continued centrality of the bereavement to ones' life story and autobiographical memory. This finding links the mechanisms for maintaining PGD symptoms to those involved in other disorders such as post-traumatic stress, with implications for theoretical models of prolonged grief as well as treatment.

Correlates of public stigma towards prolonged grief disorder

BackgroundPublic stigma for grief may reduce the social support provided to bereaved persons and increase bereavement-related distress. The general public reports more stigmatizing responses towards bereaved persons with prolonged grief disorder (PGD) than towards persons experiencing non-clinical grief. No studies to date have investigated whether personal characteristics of the general public relate to public stigma towards PGD. The present study examined whether participants’ socio-demographic characteristics and personal bereavement experiences are associated with stigmatizing responses towards PGD. MethodWe combined data of three previously published vignette experiments to conduct a secondary analysis. All studies presented members of the general public (N = 452) with a description of a male bereaved person with PGD symptoms and a PGD diagnosis. Participants rated three indicators of public stigma - negative attributes (competence, warmth), emotional reactions (fear, anger), and preferred social distance. First, we examined whether gender, age, and educational level related to public stigma towards PGD. Second, we examined the association of participants’ personal bereavement experiences with public stigma. ResultsRegression analyses demonstrated that participants’ socio-demographic characteristics explained a significant amount of variance for warmth (ΔR² = .03; p < .05) and anger (ΔR² = .05; p < .01): Male participants rated the person in the vignette as less warm (β = -.13, p < .05). Being older related to lower ratings of warmth (β = -.12, p < .05) and higher ratings of anger (β = .18, p < .01). Participants’ educational level was not associated with stigma. Participants’ bereavement experiences explained a significant amount of variance for preferred social distance (ΔR² = .11; p <. 05): Participants reporting higher personal grief severity preferred less social distance from a person with PGD (β = -.29, p < .05). A higher number of experienced losses, the recency of the bereavement, and the cause of death (natural vs. unnatural) did not relate to public stigma. ConclusionsMale and older persons are more likely to demonstrate public stigma towards PGD. Experiencing severe grief oneself is associated with less preferred social distance from a person with PGD. Anti-stigma interventions may advance the public's knowledge about grief and PGD and address specific target groups (men and older persons).

The Norwegian traumatic grief inventory-self report plus (TGI-SR+): a psychometric evaluation in traumatically bereaved people

ABSTRACT Background: Prolonged grief disorder (PGD) has been added to the ICD-11 and DSM-5-TR. The Traumatic Grief Inventory-Self Report Plus (TGI-SR+) assesses self-rated PGD intensity as defined in ICD-11 and DSM-5-TR. The TGI-SR + is available in multiple languages, but has not been validated yet in Norwegian. Objective: The aim of this study was to evaluate the psychometric properties of the Norwegian TGI-SR + . Method: Bereaved adults (N = 307) whose child or sibling died ≥6 months ago due to a sudden or violent loss completed the TGI-SR + and measures for posttraumatic stress, depression, and precursor PGD symptoms. We examined the factor structure and internal consistency of the ICD-11 and DSM-5-TR PGD items. Convergent validity and known-groups validity was evaluated. Probable PGD cases, pair-wise agreement between diagnostic scoring rules for both PGD criteria-sets, and cut-off scores were calculated. Results: The 1-factor model for ICD-11 and DSM-5-TR PGD showed the best fit and demonstrated good internal consistency. Convergent validity was supported by strong associations between summed ICD-11 and DSM-5-TR PGD scores and summed posttraumatic stress, depression, and precursor prolonged grief scores. Known-groups validity was supported by PGD intensity being related to educational level and time since loss. The perfect pair-wise agreement was reached using the ICD-11 and DSM-5-TR PGD diagnostic scoring rules. The optimal cut-off score for detecting probable PGD cases, when summing all TGI-SR + items, was ≥73. Conclusions: The Norwegian TGI-SR + seems a valid and reliable instrument to assess ICD-11 and DSM-5-TR PGD intensity after losing a child or sibling under traumatic circumstances.

Prevalence and correlates of ICD-11-based prolonged grief disorder in a representative Slovakian sample of recently bereaved adults

ABSTRACT Background: Prolonged Grief Disorder (PGD) has recently been included in both the ICD-11 and DSM-5-TR diagnostic manuals. Studying its prevalence and correlates across cultures is vital for more effective identification, treatment, and prevention. Objective: This study aimed to examine prevalence rates of ICD-11-based PGD, in a representative Slovakian sample in response to deaths of loved ones occurring during the previous year. Further aims were to examine the factor structure of PGD symptoms and correlates of summed PGD item scores and PGD ‘caseness’. Method: Self-reported data on PGD, depression, anxiety, alcohol use, and descriptive characteristics were gathered from a representative sample of the Slovak population (N = 319). Results: Data were gathered from N = 1853 people; 319 participants (17.2%) reported a loss in the past year. The prevalence of probable PGD among these bereaved participants was 1.99% for recent losses (<6 months, n = 151) and 7.75% for more distant losses (6–12 months, n = 130). The most frequently endorsed symptoms included longing/yearning for the deceased, sadness, denial/unrealness, and difficulty accepting the death. PGD symptoms had a unitary factor structure which was consistent for subsamples bereaved 1–5 and 6–12 months. The severity of PGD varied with kinship. Depression and anxiety, but not alcohol misuse, were associated with PGD severity and PGD caseness. Conclusions: These findings underscore that a significant group of people develop PGD between 6–12 months following a loss. This emphasises the need for targeted psychological interventions.

Cluster analysis of prolonged grief, posttraumatic stress, and depression symptoms in bereaved asylum seekers and refugees

ABSTRACT Background: Refugees and asylum seekers (ASRs) are frequently exposed to loss in addition to a variety of other stressors and often display high levels of various psychological symptoms. Objective: The study aimed to primarily determine clusters of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression symptoms in bereaved ASRs and secondly identify predictors of cluster membership. Sociodemographic – and flight-related variables were investigated in exploratory analyses. Method: ASRs in Germany (N = 92) with interpersonal loss exposure, i.e. at least one missing or deceased relative or friend, were assessed with interview-based questionnaires for PGD, PTSD, and depressive symptoms. We used k-means cluster analysis to distinguish symptom profiles and logistic regression analyses to identify predictors of cluster membership. Results: We found a three-cluster-solution. The PGD-cluster (30%) was characterised predominantly by PGD symptoms, while the PGD/PTSD-cluster (32%) had high PGD and PTSD and moderate depressive symptoms. The resilient cluster (38%) showed low symptoms overall. insecure residence status predicted membership in the PGD and PGD/PTSD clusters relative to the resilient cluster, whilst higher attachment anxiety predicted membership in the PGD/PTSD cluster relative to the other clusters. Explorative analysis revealed duration of stay as a significant predictor. Conclusion: Findings can extend the current knowledge about different symptom profiles among bereaved ASRs in Europe. Insights to attachment – and migration-related variables distinguishing between these profiles offer starting points for interventions.

Testing the distinctiveness of prolonged grief disorder from posttraumatic stress disorder and depression in large bereaved community samples

BackgroundThis study sought to test the distinctiveness of symptoms of prolonged grief disorder (PGD) from posttraumatic stress disorder (PTSD) and depression. MethodsConfirmatory factor analysis (CFA) and target exploratory factor analysis (EFA), were used to test the distinctiveness of PGD from PTSD and depression symptoms in a large sample of adults bereaved for at least six months (N = 1917). Identified factors were explored in relation to demographic (i.e., age, gender) and loss-related (i.e., time since bereavement, nature of death, relationship to deceased, age of deceased, and frequency of contact with deceased) correlates. ResultsThe CFA model provided a good fit to the data, while the target EFA provided a slightly improved fit. All items loading strongly and significantly onto their respectively factors, and the IGQ items had few significant cross-factor loadings. All demographic and loss-related variables (except for death of a sibling and death from other causes) were associated with each of the factors, however, these associations were strongest for the PGD factor. LimitationsParticipants were recruited using a non-probability sampling method and were from a relatively affluent Western nation. ConclusionFindings from the current study demonstrate that PGD reflects an empirically distinguishable albeit related disorder to PTSD and depression in a sample of bereaved adults. The identification of correlates common to PGD, PTSD, and depression, as well as those unique to PGD, affords a comprehensive understanding of the risk factors associated with bereavement-related psychopathology.

A comprehensive investigation of comorbidities of prolonged grief disorder in a bereaved inpatient psychiatric sample

Prolonged Grief Disorder (PGD) was recently added to ICD-11 and DSM-5-TR. Depression and Posttraumatic Stress Disorder (PTSD) are frequent comorbidities, but findings regarding comorbid somatoform disorder and personality disorders remain mixed and studies with severely impaired patients are scarce. It was therefore the objective of the present study to examine comorbidities of PGD in a bereaved inpatient psychiatric sample. We assessed N = 101 bereaved inpatients in a psychiatric hospital with clinical interviews and self-report questionnaires. We calculated differences between patients with and without a PGD-diagnosis in number and type of comorbid disorders as well as associations between the severity of PGD and comorbid disorders. On average, patients had 2.53 comorbid psychiatric diagnoses. Patients with and without a PGD-diagnosis did not differ in their number of comorbid diagnoses, and there was no association between number of comorbid diagnoses and PGD-severity. However, patients with PGD, had significantly more comorbid diagnoses belonging to neurotic-, stress-related and somatoform disorders of the ICD-10. Patients with PGDICD-11 also had significantly higher scores in self-reported depressive, PTSD-, and somatoform symptoms, as well as the negative affectivity personality domain than those without a PGD diagnosis. To the best of our knowledge, this is the first study to provide insights into comorbidities of PGD in a bereaved inpatient psychiatric sample. It highlights the importance of considering PGD symptoms as part of the complaints of bereaved patients to achieve a tailored treatment approach. Future longitudinal studies are needed to unveil relationships between pre-existing mental disorders and PGD.

End-of-life care and grief: study conducted with family members of COVID-19 victims.

This article aims to investigate the implications of grief among family members of COVID-19 victims; verify the prevalence of prolonged grief symptoms; and identify family members' expectations regarding end-of-life care for their loved ones affected by COVID-19. Descriptive, cross-sectional research, with a quantitative-qualitative approach. Data collection was performed using an online questionnaire, guided by the PG-13 instrument. Descriptive and inferential statistics were applied. The results were presented descriptively and with the aid of tables. The study sample included 142 family members, mostly female, who presented emotional, physical, social, and financial implications as a result of grief. A prevalence of prolonged grief symptoms was observed in 11.4% of the mourners with more than six months and 29.6% of those with less than six months. Three thematic categories were identified: transparency in communicating the health situation, access to moments of farewell, and promotion of comfort in care actions. The symptoms of Prolonged Grief Disorder have a significant association with the degree of kinship. In final care, family members' expectations were classified as: permission for a dignified farewell, effective communication, and promotion of comfort and care.

From loss to disorder: The influence of maladaptive coping on prolonged grief

Research indicates that post-bereavement coping strategies can be adaptive or maladaptive. Understanding which strategies lead to poorer outcomes is an important clinical and theoretical question with the potential to guide intervention.The Oxford Grief – Coping Strategies scale was developed from interviews with bereaved people with and without prolonged grief disorder (PGD) to assess the frequency of maladaptive cognitive and behavioural strategies after bereavement. Factorial and psychometric validity were assessed using exploratory and confirmatory factor analysis (N = 676). A three-wave cross-lagged panel model (N = 275) was used to assess the predictive validity of the tool in explaining symptoms of PGD.Results supported a four-factor solution (Avoidance, Proximity Seeking, Loss Rumination, Injustice Rumination) with good psychometric properties. The OG-CS predicted prospective symptoms of PGD in the short-term (6–12 months) and long term (12–18 months), controlling for baseline symptoms and autocorrelations. Subscale analyses demonstrated that the use of coping strategies predicted ICD-11 PGD in both the short-term and the long-term. However, avoidance was not predictive of outcomes early in the grieving process. At 6–12 months, avoidance predicted PGD at 12–18 months.

Prolonged Grief Disorder in ICD-11 and DSM-5-TR: Factor structure, and psychosocial and loss-related correlates in a sample of widowed persons.

This study sought to determine whether the symptoms of prolonged grief disorder (PGD) according to ICD-11 and DSM-5-TR have a unifactorial structure. Second, we sought to determine the sociodemographic and loss-related correlates of PGD symptom severity according to ICD-11 and DSM-5-TR. People who had lost a spouse (N = 144) in the past six months were examined using the Polish versions of the Prolonged Grief Disorder-13 scale (PG-13) and Inventory of Complicated Grief (ICG). Selected PG-13 and ICG items were included in the analyses to cover the PGD criteria according to ICD-11 and DSM-5-TR. Confirmatory factor analyses supported the one-dimensional structure of both sets of symptoms of the disorder. Briefer time since loss and loss due to an accident were associated with PGD symptom severity according to both ICD-11 and DSM-5-TR. PGD is a one-dimensional and internally consistent psychopathological syndrome. Widows and widowers who have recently lost their spouse due to an accident may be at especially heightened risk of developing severe levels of PGD symptoms.

Internet-based grief therapy program for bereaved individuals at risk: A case series study

Interest in internet-based interventions has increased considerably. The effectiveness of these applications continues to be investigated for the treatment of Prolonged Grief Disorder. This study includes preliminary findings of the internet-based and therapist-supported prolonged grief intervention program developed in Turkish. The internet-based program consists of 10 written sessions, and after each session the participants receive written feedback from the therapist. The program takes approximately 6-8 weeks. The preliminary findings of the program were handled in a proof-of-concept study style based on a case series design. Self-report measures were taken from the first eight participants who completed the program at four different times (pre-test, post-test, 1st and 3rd month follow-ups). In addition, the written contents of the first and last sessions were analyzed by content analysis. As a result of the descriptive findings, remarkable decreases were observed in traumatic grief, global meaning violation, depressive symptoms, and stress levels in a significant part of the participants between pre-post and follow-up measurements. Also, five of the participants had considerable increases in meaning reconstruction scores. In addition, the results of the content analysis indicated that following the intervention, the bereaved individuals expressed less negative and more positive content, as expected. These two data show that the intervention program is promising in reducing the symptoms of Prolonged Grief Disorder in bereaved individuals and may yield good results with controlled designs for a broader range of participants.

Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder

Although grief-focused cognitive behavior therapies are the most empirically supported treatment for prolonged grief disorder, many people find this treatment difficult. A viable alternative for treatment is mindfulness-based cognitive therapy. To examine the relative efficacies of grief-focused cognitive behavior therapy and mindfulness-based cognitive therapy to reduce prolonged grief disorder severity. A single-blind, parallel, randomized clinical trial was conducted among adults aged 18 to 70 years with prolonged grief disorder, as defined in the International Classification of Diseases, 11th Revision, and assessed by clinical interview based on the Prolonged Grief-13 (PG-13) scale. Those with severe suicidal risk, presence of psychosis, or substance dependence were excluded. Between November 2012 and November 2022, eligible participants were randomized 1:1 to eleven 90-minute sessions of grief-focused cognitive behavior therapy or mindfulness-based cognitive therapy at a traumatic stress clinic in Sydney, Australia, with follow-up through 6 months. Both groups received once-weekly 90-minute individual sessions for 11 weeks. Grief-focused cognitive behavior therapy comprised 5 sessions of recalling memories of the deceased, plus cognitive restructuring and planning future social and positive activities. Mindfulness-based cognitive therapy comprised mindfulness exercises adapted to tolerate grief-related distress. The primary outcome was change in prolonged grief disorder severity measured by the PG-13 scale assessed at baseline, 1 week posttreatment, and 6 months after treatment (primary outcome time point), as well as secondary outcome measures of depression, anxiety, grief-related cognition, and quality of life. The trial included 100 participants (mean [SD] age, 47.3 [13.4] years; 87 [87.0%] female), 50 in the grief-focused cognitive behavior therapy condition and 50 in the mindfulness-based cognitive therapy condition. Linear mixed models indicated that at the 6-month assessment, participants in the grief-focused cognitive behavior therapy group showed greater reduction in PG-13 scale score relative to those in the mindfulness-based cognitive therapy group (mean difference, 7.1; 95% CI, 1.6-12.5; P = .01), with a large between-group effect size (0.8; 95% CI, 0.2-1.3). Participants in the grief-focused cognitive behavior therapy group also demonstrated greater reductions in depression as measured on the Beck Depression Inventory than those in the mindfulness-based cognitive therapy group (mean difference, 6.6; 95% CI, 0.5-12.9; P = .04) and grief-related cognition (mean difference, 14.4; 95% CI, 2.8-25.9; P = .02). There were no other significant differences between treatment groups and no reported adverse events. In this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy. Although both treatments may be considered for prolonged grief disorder, grief-focused cognitive behavior therapy might be the more effective choice, taking all factors into consideration. anzctr.org.au Identifier: ACTRN12612000307808.

Chinese college students' PGD symptoms and their relationship to cognitive variables: a latent profile analysis.

Bereavement is a commonly experienced grief event; however, bereavement can also trigger a number of psychological consequences, such as prolonged grief disorder (PGD). At present, the differences in prolonged grief disorder symptoms (PGD symptoms) among various individuals and how those symptoms relate to cognitive variables are unclear. In the present study, 817 Chinese college students with bereavement experience were selected as participants. Based on the evaluation results of their irrational beliefs, bereavement-related irrational beliefs, basic world assumptions, and PGD symptoms, an individual-centered latent profile analysis was used to divide a group with PGD symptoms into several subgroups and comprehensively examine the relationships between these subgroups and cognitive variables. (1) The severity of PGD symptoms among Chinese college students can be categorized into three subgroups: mild, moderate, and severe. (2) Cognitive variables such as irrational beliefs and basic world assumptions were all found to correlate with the severity of PGD symptoms; bereavement-related irrational beliefs was the variable with the largest correlation. However, for the first time, this study found that different dimensions of basic world assumptions had different directions of correlation, based on the severity of the PGD symptoms. Justice, control, randomness, and self-control had significantly positive correlations. Conversely, benevolence of the world, benevolence of people, and worthiness of the self had significantly negative correlations. These results have important reference value for cognitive behavioral therapy (CBT) treatment and interventions for PGD issues in Chinese college students.

Feasibility and Acceptability of a Mobile App for Prolonged Grief Disorder Symptoms.

Mobile apps provide a unique platform for mental health assessment and monitoring. They can provide real time, accessible data on symptoms of mental disorders that may yield rich data for detailed clinical assessment and help individuals gain insight into their current mental state. We developed one of the first apps for tracking symptoms of prolonged grief disorder. In this pilot feasibility study, we assess the feasibility and acceptability of a new mobile app mGAGE for use once a day for 3 weeks. 27 participants completed mental health assessments at t1 and t2. Adherence to the app protocol was very high with 100% for the first two weeks of use. A surprising finding was the improvement of grief symptoms at t2. Debriefing interviews revealed general qualitative categories including positive feedback, negative feedback and specific recommendations. Overall, the app was found to be feasible for use for the first two weeks and acceptable for bereaved individuals. This app could provide valuable data for in depth clinical assessment, may support individuals to gain greater insight into their symptoms and may have a therapeutic effect in terms of improved grief symptoms. Implications for future studies including use in larger intervention studies are discussed.

Associations Between Family-Assessed Quality-of-Dying-and-Death Latent Classes and Bereavement Outcomes for Family Surrogates of ICU Decedents.

To examine associations between family surrogates' bereavement outcomes and four previously determined quality of dying and death (QODD) latent classes (high, moderate, poor-to-uncertain, and worst). Prospective, longitudinal, observational study. Medical ICUs at two academically affiliated medical centers in Taiwan. Three hundred nine family surrogates responsible for decision-making for critically ill patients at high risk of death (Acute Physiology and Chronic Health Evaluation II scores > 20) from a disease. None. Participants were assessed by the depression and anxiety subscales of the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, 11 items of the Prolonged Grief Disorder (PGD) scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey at 1, 3, 6, 13, 18, and 24 months post-loss. We simultaneously examined associations of four QODD latent classes with physical and mental health-related quality of life (HRQOL) and symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and PGD assessed over 24 bereavement months using multivariate hierarchical linear modeling. Surrogates' distinct QODD latent classes assessed at 1-month post-loss were significantly associated with bereavement outcomes, except for physical HRQOL and PGD symptoms. Significantly more depressive symptoms and worse mental HRQOL (β [95% CI]) were reported by bereaved surrogates in the moderate (1.958 [1.144-2.772], -2.245 [-3.961 to -0.529]), poor-to-uncertain (2.224 [1.438-3.010], -7.026 [-8.683 to -5.369]), and worst (2.081 [1.215-2.964], -4.268 [-6.096 to -2.440]) QODD classes than those in the high QODD class. Bereaved surrogates in the moderate (2.095 [1.392-2.798]) and poor-to-uncertain (0.801 [0.123-1.480]) QODD classes reported more anxiety symptoms, whereas those in the poor-to-uncertain QODD class suffered more PTSD symptoms (2.889 [1.005-4.774]) than those in the high QODD class. The four distinct QODD latent classes were significantly associated with ICU family surrogates' bereavement outcomes, suggesting targets to improve end-of-life care quality in ICUs.

Associations of dimensions of anger with distress following traumatic bereavement.

A prior study with people exposed to a traumatic event indicated that posttraumatic anger is a multidimensional construct that consists of five factors comprising anger at (a) the criminal justice system, (b) other people, (c) the self, and (d) a perpetrator and (e) a desire for revenge. Preliminary evidence shows that anger at the self and perpetrators is related to posttraumatic stress disorder (PTSD) symptoms. Expanding the focus from trauma victims to people exposed to a traumatic loss of a significant other, for example, due to road traffic accidents, may enhance our knowledge on factors that are amenable to change in the treatment of prolonged grief disorder (PGD) and PTSD. We examined the (a) factor structure of the 20-item Posttraumatic Anger Questionnaire in 209 Dutch people bereaved by road traffic accidents using confirmatory factor analysis and (b) associations between the posttraumatic anger factors and PGD and PTSD using structural equation models. The expected five-factor structure of the Posttraumatic Anger Questionnaire was supported. Anger at the self was related to greater PGD (β = .35) and PTSD (β = .50) symptoms over and above known risk factors of distress. A desire for revenge (β = .20) was uniquely and positively associated with PTSD symptoms. Pending replication of our findings in longitudinal studies, we conclude that anger subtypes relate differently to distress after traumatic loss. Anger toward the self seems the most detrimental type of anger and may therefore be an important target in treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predicting levels of prolonged grief disorder symptoms during the COVID-19 pandemic: An integrated approach of classical data exploration, predictive machine learning, and explainable AI

BackgroundPrior studies on Prolonged Grief Disorder (PGD) primarily employed classical approaches to link bereaved individuals' characteristics with PGD symptom levels. This study utilized machine learning to identify key factors influencing PGD symptoms during the COVID-19 pandemic. MethodsWe analyzed data from 479 participants through an online survey, employing classical data exploration, predictive machine learning, and SHapley Additive exPlanations (SHAP) to determine key factors influencing PGD symptoms measured with the Traumatic Grief Inventory - Self Report (TGI-SR) from 19 variables, comparing five predictive models. ResultsThe classical approach identified eight variables associated with a possible PGD (TGI-SR score ≥ 59): unexpected causes of death, living alone, seeking professional support, taking anxiety and/or depression medications, using more grief services (telephone or online supports) and more confrontation-oriented coping strategies, and higher levels of depression and anxiety. Using machine learning techniques, the CatBoost algorithm provided the best predictive model of the TGI-SR score (r2 = 0.6479). The three variables influencing the most the level of PGD symptoms were anxiety, and levels of avoidance and confrontation coping strategies used. ConclusionsThis pioneering approach within the field of grief research enabled us to leverage the extensive dataset collected during the pandemic, facilitating a deeper comprehension of the predominant factors influencing the grieving process for individuals who experienced loss during this period. LimitationsThis study acknowledges self-selection bias, limited sample diversity, and suggests further research is needed to fully understand the predictors of PGD symptoms.