Prevalence of prolonged grief disorder in bereaved children and adolescents: A systematic review.

PURPOSE: Prolonged Grief Disorder (PGD) is a condition recently introduced in international classifications of mental disorders. Although PGD is associated with significant distress and impairment that may have developmental consequences, to date, little is known about its prevalence and associated factors in children and adolescents. The present systematic review registered in PROSPERO (CRD42021236026) aimed to: (i) review existing data on the prevalence of PGD in bereaved children and adolescents; and (ii) identify factors associated with PGD in this population. METHODS: Six electronic databases, grey literature and a manually searched journal identified 1,716 articles with no backward limit to September 2021. Epidemiological studies were included if they reported the prevalence of PGD in bereaved children and adolescents. Study characteristics, diagnostic and assessment tools, population, loss-related characteristics and prevalence of PGD were reviewed. RESULTS: Five studies met our inclusion criteria. The reported prevalences of PGD ranged from 10.4% to 32%. Female gender, cognitive avoidance, chronic stressors such as economic hardship, exposure to trauma or other losses appear to be associated with more severe symptoms or even a higher risk of PGD. Conversely, data suggest social support may be protective. CONCLUSION: This first systematic review found a relatively high prevalence of PGD in bereaved children and adolescents. While further large epidemiological studies are needed, this review highlights the importance of evaluating PGD in current clinical practice and suggests that further research into diagnostic and therapeutic approaches targeting this disorder is warranted.

From love to pain: is oxytocin the key to grief complications?

While most adults confronted with the death of a loved one manage to grieve, about 10-20% of individuals develop complicated grief, characterized by persistent distress and impaired social skills, or pathological grief, defined by the onset or decompensation of a psychiatric disorder. Little is known about the biological causes of these grief complications. Recent work suggests that oxytocin, a major neuroendocrine hormone regulating many neurocognitive mechanisms, may be involved in this process. Oxytocin is widely studied and well known for its impact on the mother-child bond and hormonal and brain systems related to attachment and social interactions. In this article, we propose a neurocognitive model of grief complications based on existing data on the role of oxytocin in interpersonal attachment and its impact on brain activity. We suggest that complicated grief is associated with dysfunctional cerebral oxytocinergic signaling and persistent hyperactivation of the nucleus accumbens. This mechanism is involved in limiting the reduction of interpersonal attachment to the deceased during acute phases and in searching for new interpersonal relationships during the recovery phase. We show how the exploration of cerebral oxytocinergic signaling would improve the understanding of physiological grief mechanisms in the general population and could allow the development of new therapeutic perspectives against the complications of grief.

[How grief moved from culture to psychiatry]. / Comment le deuil est passé de la culture à la psychiatrie.

Bereavement has been debated among psychiatric experts since 2000. In addition to its precise manifestations, its duration is discussed: six months for the ICD-1, one year for the DSM-5-TR. Grief is not an illness but a process that can be blocked in the announcement phase of the death or in the depression phase following the absence. In all cases, acceptance of the loss is impossible. Psychiatric treatment can define a bereaved person who is suffering too much, and can reduce his or her suffering, but it cannot accelerate the process of remembering and then resuming a life without the loved one. Social rituals and psychosocial support have had this place for millennia in cultures throughout humanity.