Severe Grief Research Articles

The prevalence of severe grief reactions after bereavement and their associations with mental health, physical health, and health service utilization: a population-based study

ABSTRACT Background: Previous research has shown that bereaved individuals are at risk of developing physical and mental health problems. However, knowledge is scarce about the associations between severe grief reactions after bereavement and physical and mental health problems and the use of health services. Objectives: The present study sought to investigate the prevalence of severe grief reactions and to study the associations of severe grief reactions with mental and physical health and health care utilization. Method: The sample comprised 20,453 adults aged 40 and above (mean age = 57.2 years, SD = 11.3 years, 52.4% female) who participated in the seventh wave of the Tromsø study. Severe grief was assessed with one question asking whether the respondent has experienced the death of a loved one and currently has difficulty accepting the loss, yearns for the deceased, and experiences intense emotional pain related to the loss. Furthermore, participants answered questions about their current physical health, mental health (Hopkins Symptom Checklist – 10), and the use of health services in the past year. Results: Overall, 5.2% of the participants reported severe grief after a loss in childhood, 25.9% after bereavement in adulthood and 4.1% after bereavement in the previous year. Female gender, higher age, living without a partner, non-Norwegian ethnicity, and lower socio-economic status were associated with severe grief. Severe grief reactions were negatively related to self-reported health, predicted positively current levels of depression and anxiety, and were positively associated with the use of health services. Effect sizes were small. Gender differences in the use of health services were observed. Conclusion: Severe grief reactions are common in individuals aged 40 and older and associated with self-reported physical and mental health problems as well as increased use of health services. Health service providers should be attentive to possible severe grief in connection with health complaints.

Prolonged grief in refugees, parenting behaviour and children's mental health.

Many refugees experience bereavement, and as a result they suffer elevated rates of prolonged grief disorder. Evidence also indicates that elevated rates of psychological disturbance in refugee children can be associated with parental mental health. This study examined the extent to which prolonged grief disorder in refugees is associated with their parenting behaviour and in turn with their children's mental health. This study recruited participants from the Building a New Life in Australia prospective cohort study of refugees admitted to Australia between October 2013 and February 2014. The current data were collected in 2015-2016 and comprised 1799 adults, as well as 411 children of the adult respondents. Adult refugees were assessed for trauma history, post-migration difficulties, harsh and warm parenting, probable prolonged grief disorder and posttraumatic stress disorder. Children were administered the Strengths and Difficulties Questionnaire. The current analyses on bereaved refugees comprise 110 caregivers and 178 children. In this cohort, 37% of bereaved refugees reported probable prolonged grief disorder. Path analysis indicated that caregivers' grief was directly associated with children's emotional difficulties. Caregiver warmth was associated with reduced emotional problems in children of refugees with minimal grief but associated with more emotional problems in caregivers with more severe grief. More harsh parenting was associated with children's conduct problems, and this was more evident in those with less severe grief. Severity of prolonged grief disorder is directly linked to refugee children's mental health. The association between parenting style, grief severity and children's mental health highlights that managing grief reactions in refugees can benefit both refugees and their children.

Grief Before and During the COVID-19 Pandemic: Multiple Group Comparisons

ContextGrief researchers are concerned that the coronavirus disease 2019 (COVID-19) pandemic will precipitate increases in severe, persistent, and disabling grief, termed prolonged grief disorder or persistent complex bereavement disorder. We recently demonstrated that higher grief levels are experienced after COVID-19-related bereavement than natural bereavement. Death circumstances during the pandemic (e.g., reduced social support, limited opportunities for death rituals) may also hamper the grief process for non-COVID-19-related bereavement, yet no quantitative research has specifically addressed this issue. ObjectivesTo test if grief severity is higher during than before the lockdown after non-COVID-19-related bereavement. MethodsA cross-sectional survey including questions on sociodemographic and loss-related variables and a grief measure was conducted among a sample of 1600 bereaved adults (78% females), participating before (n = 731) or during (n = 869) the pandemic, including people who had experienced a loss before the pandemic (n = 456) or during the pandemic (n = 200) recently (five months ago or less). ResultsNo significant differences emerged between grief levels in people participating before or during the pandemic. However, being recently bereaved during the pandemic elicited more severe grief than before it (d = 0.17; d = 0.18). Effects remained significant after controlling analyses for relevant loss-related variables. ConclusionAmong all bereaved persons, grief severity was no different during the pandemic compared with before the pandemic. However, experiencing a recent loss during the pandemic elicited more severe acute grief reactions than before the pandemic, suggesting that dealing with loss may be more difficult during this ongoing health crisis.

The Synergy between Burden and Anticipatory Grief among Caregivers of People Living with HIV/AIDS in Calabar Municipality, Nigeria

Contents: Caregiving remains the crux of management in terminal diseases, but little attention is given to the effects of terminal illnesses on the caregivers and the associated anticipatory grief that aggravates caregivers' burden.
 Aim: This study assesses the correlations between burden and anticipatory grief experienced among caregivers of people living with HIV/AIDS (PLWHA) in Calabar Municipality, Cross River State, Nigeria.
 Methods: Correlations and descriptive cross-sessional design were utilized to assess and purposefully recruit 231 eligible caregivers of PLWHA, respectively. Validated revised Zarit Burden Interview scale (ZBI) and Anticipatory Grief Scale were the primary data collection instruments. Data were analyzed using SPSS version 21.0.
 Results: Study findings revealed that the highest percentage, 36.4% (84) participants experienced a moderate burden, while 22.1% (51) experienced a severe burden. Similarly, the highest percentage, 33.3% (77) of the participants experienced moderate anticipatory grief at the range of 57-76, while 30.7% (71) participants experienced severe anticipatory grief within 77- 135. Positive and significant correlations (r = 0.61, P < 0.05; r = 0.53, P < 0.05; r = 0.66, P < 0.05) were obtained for the relationship between no anticipatory grief/burden; mild anticipatory grief/ burden and severe anticipatory grief/ burden respectively) during the study. These positive correlations revealed a strong synergy between the two variables, caregiver’s burden and anticipatory grief.
 Conclusion: As sub-Saharan African disproportionately bears the burden of HIV, more persons will have to take up family caregivers' roles despite the high level of burden and associated anticipatory grief. The need for educational intervention backed by the policy cannot be over-emphasized and should be implemented to enhance and acquaint caregivers on the nature of anticipatory grief and its connection with a terminal disease like HIV/AIDS.

Public stigma towards prolonged grief disorder: Does diagnostic labeling matter?

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.

Pandemic risks a rise in severe grief

The events around losing loved ones to coronavirus makes death harder to cope with

Critical care providers' support of families in bereavement: a mixed-methods study.

When people die in intensive care units (ICUs), as many as half of their family members may experience a severe grief reaction. While families report a need for bereavement support, most ICUs do not routinely follow-up with family members. Clinicians are typically involved in supporting families during death and dying, yet little is known about how they work with families in bereavement. Our goal was to explore how clinicians support bereaved families, identify factors that facilitate and hinder support, and understand their interest and needs for follow-up. Mixed-methods study of nurses and physicians working in one of nine adult medical-surgical ICUs in academic hospitals across Canada. Qualitative interviews followed quantitative surveys to reflect, expand, and explain the quantitative results. Both physicians and nurses perceived that they provided empathetic support to bereaved families. Emotional engagement was a crucial element of support, but clinicians were not always able to engage with families because of their roles, responsibilities, experiences, or unit resources. Another important factor that could facilitate or challenge engagement was the degree to which families accepted death. Clinicians were interested in participating in a follow-up bereavement program, but their participation was contingent on time, training, and the ability to manage their own emotions related to death and bereavement in the ICU. Multiple opportunities were identified to enhance current bereavement support for families, including the desire of ICU clinicians for formal follow-up programs. Many psychological, sociocultural, and structural factors would need to be considered in program design.

Risk factors of severe prolonged grief disorder among individuals experiencing late-life bereavement in Japan: A qualitative study

This article explored how severe prolonged grief disorder (PGD) is associated with psychological and social variables using an interpretative phenomenological analysis. From a sample of 225 Japanese hospitalized adults with depression, seven participants were identified as having PGD based on their medical records and semi-structured interviews. Risk factors appeared to be psychological factors associated with the deceased (dependence on the deceased, feeling sorry for the deceased, intense self-blame, and infrequent expression of anger) and environmental factors (loneliness and isolation, lack of opportunity to determine separation, and release from practical burdens). These findings are discussed in relation to Japanese culture.

The Demography and Practice of Australians Caring for Native Wildlife and the Psychological, Physical and Financial Effects of Rescue, Rehabilitation and Release of Wildlife on the Welfare of Carers.

Simple SummaryLittle is known about the physical, financial and emotional effects on the 20,000 volunteers who rescue, rehabilitate and release injured and/or orphaned Australian wildlife. A survey for wildlife carers was instigated to address this knowledge gap. Collated survey responses from the wildlife carers suggested that their physical workload is on average 32 h per week but can be up to 100 h, their financial input is on average AUD5300 per year and over a lifetime of caring can go up to AUD800,000. The emotional input is such that 28% of the respondents were experiencing moderate to severe grief. Grief increases as more joeys die in care and as expenditure rises, and is age dependent. Burnout and compassion fatigue are likely outcomes. Over 65% of respondents felt that their welfare, and that of the animals for whom they care, is neglected and unappreciated by government agencies. Unless these deficiencies are corrected by financial and emotional support and workload is reduced for carers, animal and wildlife carer welfare will be compromised.The rescue, rehabilitation and release of injured and orphaned Australian wildlife is managed by over 20,000 carers, mostly voluntarily. These volunteers experience mental, physical and financial challenges that have not been researched adequately. This study collated the responses (n = 316) to a survey conducted among Australian wildlife carers who actively foster orphaned joeys for hand-raising and injured adult mammals for rehabilitation and release. It confirmed 86% of rehabilitators are female, 70% are over the age of 46 years and their prime motivation is an affinity with animals. The average time spent in the sector is 11.5 years, and the work week is 31.6 h, caring for 15 animals per year, with an average of 2.6 dying. The average financial commitment is AUD5300 annually and up to AUD800,000 over a lifetime. Regarding the grief experienced by carers, the lower the age, the longer the time spent, the greater the financial input and the more joeys that died, the more severe is the grief experienced. Moderate to severe grief is experienced by 28% of carers, which, coupled with other factors, could lead to burnout or compassion fatigue. Soon, wildlife carer welfare will likely be compromised unless financial and mental support is provided and their workload reduced.

CHILD SUICIDE: FAMILY’S REACTIONS

Introduction: Suicide is a major public health problem, in which relatives play an important role in the prevention of the said problem. However, suicide and suicidal behavior affect the relatives’ lives profoundly, both emotionally and socially. 
 Aim: This study is an initial investigation of families’ emotional and behavioral responses to adolescents’ suicide 
 Methodology: An extensive literary review of relevant articles for the period 2000-2017, was performed using Medline, PubMed and Google databases, with the following key words: “child suicide, parent’s reactions, bereavement, risk factors, warnings sign, and mental health problems”.
 Results: Suicide is uncommon in childhood but becomes an extremely serious issue among adolescents. Several risk factors have been identified and include the presence of psychiatric illness, a previous suicide attempt, family factors, substance abuse, sexual and physical abuse, or bullying. The death of a child of any age is extremely painful for parents. Most parents experience a profound sense of guilt, shame, pain, depression when harm comes to their child, even if through no fault of their own. The same feelings are often present and are associated with help seeking in siblings bereaved by suicide. All of these factors lead to a devastating grief that is much longer lasting than most people realize.
 Conclusion: Families that have experienced a suicide present severe prolonged grief with many psychological and physical symptoms such as depression, feelings of guilt, shame, pain, heart failure, hypertension, diabetes. However, the psychosocial impact on families is a very important issue who needs further investigation.

Is the bereavement grief intensity of survivors linked with their perception of death quality?

Some people experience exceptionally severe bereavement grief, and this level of post-death grief could potentially be the result of a low quality dying process. A pilot study was conducted to determine if a relationship exists between perceived death quality and bereavement grief intensity. A questionnaire was developed and posted online for data on bereavement grief intensity, perceived death quality, and decedent and bereaved person characteristics. Data from 151 Canadian volunteers were analysed using bi-variate and multiple linear regression tests. Half had high levels of grief, and over half rated the death as more bad than good. Perceived death quality and post-death grief intensity were close to being negatively correlated. These findings indicate research is needed to explore possible connections between bereavement grief and the survivor's perceptions of whether a good or bad death took place. In the meantime, it is important for palliative care nurses to think of the quality of the dying process as being potentially very impactful on the people who will be left to grieve that death.

CU BEREAVE: Feasibility of a Multi-component Bereavement Support Intervention to Prevent Severe Grief Reaction

CU BEREAVE: Feasibility of a Multi-component Bereavement Support Intervention to Prevent Severe Grief Reaction

Grief: A Brief History of Research on How Body, Mind, and Brain Adapt.

Using an integrative view of psychology, neuroscience, immunology, and psychophysiology, the present review of literature curates the findings that have had an impact on the field of bereavement research and shaped its development. Beginning with pivotal systematic descriptions of medical and psychological responses to the death of a loved one by Lindemann in the mid-1940s, this selective review integrates findings in bereavement research from studies that investigate medical outcomes after loss, their psychological predictors, and biopsychosocial mechanisms. Morbidity and mortality after the death of a loved one have long been a topic of research. Early researchers characterized somatic and psychological symptoms and studied immune cell changes in bereaved samples. More recent research has repeatedly demonstrated increased rates of morbidity and mortality in bereaved samples, as compared with married controls, in large epidemiological studies. Recent developments also include the development of criteria for prolonged grief disorder (also termed complicated grief). Newer methods, including neuroimaging, have observed that the greatest impact of the death of a loved one is in those who have the most severe psychological grief reactions. Research addressing the mechanisms tying bereavement to medical outcomes is relatively scarce, but differences in rumination, in inflammation, and in cortisol dysregulation between those who adapt well and those who do not have been offered with some evidence. Recommendations to propel the field forward include longitudinal studies to understand differences between acute reactions and later adaptation, comparing samples with grief disorders from those with more typical responses, and integrating responses in brain, mind, and body.

Evaluation of a guided internet-based self-help intervention for older adults after spousal bereavement or separation/divorce: A randomised controlled trial

BackgroundWhile several internet interventions target severe prolonged grief symptoms after bereavement, no randomised controlled trial investigated interventions for prolonged grief after separation/divorce. MethodsThis randomised controlled trial aimed to evaluate the efficacy of a guided internet-based self-help intervention for prolonged grief symptoms after spousal bereavement or separation/divorce compared to a wait-list control group. Furthermore, we analysed whether the intervention was also efficacious for participants with milder grief symptoms. ResultsA total of 110 participants were mainly recruited by newspaper articles. Average age was 51 years, 77% were separated/divorced, 79% were female. Dropout rate was 11%. Compared to the control group, the intervention resulted in significant reductions in grief (d = 0.81), depression (d = 0.59), psychopathological distress (d = 0.39) (primary outcomes), embitterment (d = 0.37), loneliness (d = 0.37) and an increase in life satisfaction (d = −0.41) (secondary outcomes). These gains were maintained over three months. Improvements were similar among widowed and separated/divorced participants as well as among participants with low, medium or high levels of grief at baseline. LimitationsLimitations include the self-selective sample and a rather small number of widowed participants. ConclusionsFindings indicate that an internet intervention based on models for coping with grief after bereavement was not only beneficial for widowed but also separated or divorced participants. Furthermore, also participants with lower levels of grief at baseline benefitted from the intervention. This corroborates that indicated prevention efforts for grief are efficacious.

Grief reactions and coping strategies of trainee doctors working in paediatric intensive care

BackgroundThe death of a child can have significant emotional effects on doctors responsible for their care. Trainee doctors working in the paediatric intensive care unit (PICU) may be particularly vulnerable. The aim of this study was to examine the emotional impact of, and grief reactions to, a child’s death in PICU trainee doctors, along with coping strategies they used. MethodsIn a prospective, cross-sectional, observational study, qualitative and quantitative data were recorded on anonymised, written questionnaires. Grief severity was assessed using the Texas Revised Inventory of Grief. Emotional impact was assessed using the shortened Impact of Event Scale. The BriefCOPE tool was used to assess coping strategies. Qualitative data was analysed using conventional content analysis. Data are presented as median (inter-quartile range) or number (%). ResultsAll invited trainee doctors (23 anaesthetists; 5 paediatricians) completed the questionnaire (age, 30 [29–34] yr; 13/28 [46%] female). Two (7%) doctors experienced severe grief (Texas Revised Inventory of Grief score <39), with five (18%) doctors severely affected by the deaths as measured by the Impact of Event Scale. Qualitative analysis revealed prominent themes of sadness, helplessness, guilt, shock, and concern for the bereaved family. There was limited use of coping strategies. Speaking with another trainee doctor was the principal coping strategy. Requests for debriefing sessions, greater psychological support and follow-up with the patient’s family were frequently suggested. ConclusionsPaediatric deaths evoke significant grief and emotional reactions in a subset of PICU trainee doctors. Trainee PICU doctors highlighted a lack of professional support and tailored debriefs.

THE GRIEVING RESPONSE OF CERVICAL CANCER PATIENTS IN A REFERRAL HOSPITAL IN BANDUNG CITY

The grief response could affect the treatment process and the condition of cervical cancer patients which directly gives impact on the patients quality of life. The medical practisers are responsible for helping the patients to pass through the grief process to prevent the adverse effects for the patients, thus it is necessary to know the condition of grief response as the data to analyze the problems and to plan the nursing interventions. This study purpose was to identify the grief response in cervical cancer patients at central hospital Dr. Hasan Sadikin Bandung. The research design was a quantitative descriptive by used the questionary of Preparatory Grief in Advanced Cancer Patients (PGAC) with the validity value of 0.823-0.864 and the reliability value of 0.83. The research sample was the patients of cervical cancer with the total number of 50 persons. The technique of sample selection used an Accidental Sampling carried out in the period of two weeks. The research result from 50 patients showed that most respondents (76%) had low grief and a small number of patients (24%) had severe grief which required further intervention. A big number of respondents (60%) had prolonged grief. The grief responses which mostly existed were the response of emotional sadness (58%), meanwhile, the lowest response was religious comfort response (16%). Although the majority of respondents experienced low grief response, there are still existed severe grief response and also experienced prolonged grief. The high response of sadness showed all the patients of cervical cancer needed emotional and spiritual support as the efforts to prevent the low grief become severe grief response and also to overcome the severe grief and it not to be the prolonged grief.Keywords : Cervical cancer, grief response, preparatory grief.

The Correlation between Post-Abortion Grief and Quality of Life in Females With a History of Abortion Visiting Health Centers and Hospitals of Shahid Beheshti University of Medical Sciences, Iran During Year 2016

Background: Grief is a common reaction pf parents to abortion. It may be followed by various psychological complications that affect women's individual-social quality of life. This study aimed to determine the correlation between post-abortion grief and quality of life of women with a history of abortion. Materials and Procedures: This descriptive-correlational study was conducted in 2016. Convenience sampling was applied to select 165 women with a history of abortion from health centers and hospitals affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran). A demographic and fertility questionnaire, the Perinatal Bereavement Grief Scale, and the World Health Organization Quality of Life Questionnaire were used to collect data. Descriptive statistics and Pearson’s and Spearman’s correlation tests were administered to analyze the data. All analyses were performed using SPSS 20. Findings: There was a significant relationship between quality of life and post-abortion grief (r = -0.387; p < 0.001) and the mean score of quality of life decreased with an increase in the intensity of post-abortion grief. Women with a history of abortion had a moderate level of post-abortion grief (mean score out of 100: 47.52 ± 9.01 ) and intensity of post-abortion grief in less than 3 months from abortion occurrence until completion of the questionnaire has been at its highest level (with a mean and standard deviation of 421.3 ± 99.3) and has declined over the time. However, there was no significant relationship between the intensity of the grief and the time of abortion. and desirable quality of life (mean score: 91.90 ± 14.43). Conclusion: The findings of this study suggested an association between more severe post-abortion grief and decreased quality of life, i.e. post-abortion grief had adverse effects on women’s quality of life. Therefore, fertility health policy makers are recommended to develop appropriate measures to reduce grief and improve the quality of life of women after abortion.

Grief tied to Death

Influence of the experience of severe grief on the development of diseases of the cardiovascular system.

Narrative Identity and Grief Reactions: A Prospective Study of Bereaved Partners

The purpose of the study was to explore relations between narrative identity and reactions to bereavement. Approximately 2–3 months after losing their partner, 161 older participants completed questionnaires measuring grief symptoms, positive affect, and neuroticism. They also described past and future chapters in their life stories and rated chapters on positive and negative emotional tone. Past chapters were coded for whether they were related to the loss of the partner and these loss chapters were coded for positive and negative emotional tone. Future chapters were content coded for positive and negative emotional tone as well as whether the content reflected new roles/activities and continuation of roles/activities. At follow-up (5–6 months later), participants completed questionnaires measuring grief symptoms and positive affect. Individuals with more positive future chapters and future chapters emphasizing continuation of roles and activities experienced less severe grief reactions and more positive affect. Thus, narrative identity may be useful for understanding reactions to bereavement.

P.3.005 - Interactions of oxytocin receptor gene variation with behavioural inhibition and adult separation anxiety in complicated grief

Complicated grief (CG) refers to the severe and prolonged (≥ 6 months) grief reaction following the loss of a beloved person that occurs in approximately 10 – 20% of bereaved individuals and is associated with an increased risk for the development of depression and anxiety disorders [1]. So far, the underlying processes contributing to the vulnerability to CG are not yet well understood but likely comprise the complex interplay of genetic, temperamental and psychological factors that interactively influence the severity and persistence of grief reactions. In light of its central role in social behavior, stress regulation and attachment, the oxytocin receptor (OXTR) gene may play a key role in the conferral of CG. Additionally, temperamental traits such as behavioral inhibition (BI) or psychological characteristics such as symptoms of separation anxiety (SA) may predispose to the development of CG. For instance, adult SA has been linked to higher symptom severity and impairment in individuals with CG [2]. Therefore, the present study for the first time aimed to address the involvement of OXTR gene variation in the emergence of CG and the potential moderating effects of BI and SA. To this end, 96 adult outpatients (70 female, 26 male; mean age ± SD = 39.96 ± 12.71 years) with DSM-IV mood and anxiety disorders were assessed for CG using the Inventory of Complicated Grief (ICG). All patients were genotyped for OXTR rs2254298 and characterized for BI using the Retrospective Self-Report of Inhibition (RSRI) and SA symptoms using the Adult Separation Anxiety Scale (ASA-27). Patients were grouped according to genotype (GG vs. AG/AA carriers). The influence of grouped OXTR genotype, RSRI and ASA-27 scores, respectively, on ICG score was investigated via hierarchical multiple regression analyses. No differences were observed with regard to age, sex, or questionnaire scores (all p ≥ 0.05). No main effects of OXTR genotype, RSRI or ASA-27 scores on CG were observed, however ICG scores differed as a function of OXTR genotype and RSRI score (OXTR x BI, p=0.031), and, on a trend-level, ASA-27 score (OXTR x ASA, p=0.064). Specifically, in patients homozygous for the OXTR G allele, increased levels of both BI and ASA were related to higher ICG scores. Of note, this pattern appears to be reversed under conditions of low BI or low ASA. In line with the ‘differential susceptibility hypothesis’ [3], the present findings suggest that while OXTR GG genotype carriers are more vulnerable to the development of CG in the presence of risk-increasing factors, they at the same time are the least likely to develop CG in the absence of these risk factors. Taken together, the present results for the first time provide evidence for an interaction of OXTR gene variation with BI and potentially also symptoms of adult SA in the moderation of clinically relevant grief reactions and may therefore inspire new insights into the development and improvement of therapeutic options in the prevention and treatment of CG.