Bidirectional associations between prolonged grief symptoms and depressive, anxiety, and posttraumatic stress symptoms: A systematic review.

Prolonged grief symptoms frequently co-occur with symptoms of depression, posttraumatic stress, and anxiety; however, little is known about how prolonged grief symptoms temporally relate to symptoms of neighboring stress-related and affective disorders. Clarifying such associations can help elucidate which symptoms to prioritize during treatment for distressed bereaved adults. We conducted a systematic review to provide a comprehensive overview of the empirical research on the bidirectional temporal associations between prolonged grief symptoms and symptoms of depression, posttraumatic stress, and anxiety. A search of the PsycInfo, Web of Science, and Scopus databases (final search: December 2023) identified eight relevant empirical longitudinal studies utilizing lower-level mediation (two studies), cross-lagged panel modeling (CLPM; four studies), or random-intercept CLPM (RI-CLPM; two studies). The studies included a total of 2,914 bereaved adult participants. Studies showed considerable methodological heterogeneity, including different sample characteristics, study designs (e.g., measurement moments, time frames), statistical analyses, and measures. Temporal associations between prolonged grief symptoms and different types of symptoms appeared intertwined. Prolonged grief symptoms more consistently predicted symptoms of depression and posttraumatic stress across measurement waves than vice versa, tentatively suggesting that prolonged grief may be a transdiagnostic risk factor for depressive and PTS symptoms. However, this pattern was not observed in the two studies utilizing RI-CLPM. Future research should aim to decrease methodological heterogeneity by using validated measures to capture prolonged grief symptoms, appropriate timeframes, and RI-CLPM to clarify associations between temporal within-person fluctuations of prolonged grief, depressive, posttraumatic stress, and anxiety symptoms.

Do insecure attachment styles predict prolonged grief symptoms? Significant null findings.

Insecure attachment is proposed to be a risk factor in the development and persistence of severe grief. Although prior research demonstrates positive cross-sectional and longitudinal correlations between attachment styles and prolonged grief symptoms, controlled longitudinal analyses yield fewer convincing results. Therefore, we sought to further clarify the concurrent and longitudinal associations between these constructs. A sample of 225 bereaved Dutch adults (87% women; Mean age: 48.86 years) participated in a three-wave longitudinal survey including measures of attachment anxiety and attachment avoidance at baseline and prolonged grief symptoms at baseline and 6- and 12-month follow-up. Attachment anxiety and attachment avoidance were significantly positively correlated with prolonged grief symptoms at all time-points. However, multiple regressions, controlling for baseline symptoms, showed that attachment anxiety, attachment avoidance, and their interaction did not predict residual change in prolonged grief symptoms. These findings cast doubt on the proposed role of insecure attachment styles in prolonged grief.

Cognitive reappraisal, emotional expression and mindfulness in adaptation to bereavement: a longitudinal study.

BACKGROUND AND OBJECTIVES: Maladaptive emotion regulation strategies increase prolonged grief and depressive symptoms following bereavement. However, less is known about the role of adaptive emotion regulation strategies in adaptation to loss. Therefore, we examined the concurrent and longitudinal associations of three putative adaptive emotion regulation strategies (cognitive reappraisal, emotional expression, and mindfulness) with prolonged grief and depression symptoms. DESIGN: A two-wave longitudinal survey. METHODS: A sample of 397 bereaved Dutch adults (89% female, mean age 54 years) completed validated questionnaires to assess trait cognitive reappraisal, emotional expression, mindfulness and prolonged grief and depression symptoms at baseline (T1) and 344 participants completed symptom measures again six months later (T2). RESULTS: Zero-order correlations demonstrated that mindfulness, cognitive reappraisal and emotional expression relate negatively to T1 and T2 prolonged grief and depression symptoms. In multiple regression analyses, controlling for relevant background variables, all emotion regulation strategies related negatively to T1 prolonged grief and depression symptoms. In multiple regression analyses, controlling for T1 symptoms and background variables, mindfulness predicted lower T2 depression symptoms. CONCLUSIONS: Adaptive emotion regulation strategies relate negatively to post-loss psychopathology symptoms, yet only mindfulness longitudinally predicts lower depression symptoms. Dispositional mindfulness may be a protective factor in psychological adaptation to bereavement.

Content overlap analyses of ICD-11 and DSM-5 prolonged grief disorder and prior criteria-sets.

Background: The International Classification of Diseases eleventh edition (ICD-11) has recently included prolonged grief disorder (PGD), a diagnosis characterized by severe, persistent, and disabling grief. The text revision of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5-TR) is scheduled to include a similar but distinct diagnosis, also termed PGD. Concerns have been raised that these new diagnoses are qualitatively different from both prior proposed diagnoses for pathological grief and each other, which may affect the generalizability of findings obtained with different criteria sets. Objective: We conducted a content overlap analysis of PGDICD-11, PGDDSM-5-TR, and previous proposals for pathological grief diagnoses (i.e. PGD 2009; complicated grief (CG), PGD ICD-11 beta draft, persistent complex bereavement disorder (PCBD) per DSM-5). Methods: Using the Jaccard's Index, we established the degree of content overlap between core and accessory symptoms of PGDICD-11, PGDDSM-5-TR, and prior proposals for pathological grief diagnoses. Results: Main findings are that PGDICD-11 and PGDDSM-5-TR showed moderate content overlap with each other and with most prior proposed diagnoses for pathological grief. PGDICD-11 and PGDDSM-5-TR showed the strongest content overlap with their direct predecessors, PGDICD-11 beta draft and PCBD, respectively. Conclusions: Limited content overlap between PGDICD-11 and PGDDSM-5-TR and preceding criteria sets may threaten generalizability of past research on phenomenological characteristics of pathological grief to current criteria sets. Similarly, findings obtained with instruments to assess PGDICD-11 may not generalize to PGDDSM-5-TR and vice versa. Researchers should aim to determine under which circumstances criteria sets for PGD yield similar or distinct characteristics. Convergence of criteria sets for PGD remains an important goal for the future.

Antecedentes: La Decimoprimera Clasificación Internacional de Enfermedades (CIE-11) ha incluido recientemente el Trastorno Por Duelo Prolongado (PGD por sus siglas en ingles), un diagnóstico caracterizado por un duelo severo, persistente e incapacitante. La versión revisada del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5-TR) tiene agendado incluir un diagnóstico similar pero diferente, también llamado PGD. Ha existido preocupación de que ambos diagnósticos sean cualititativamente diferentes de aquellos propuestos previamente para duelo patológico y también entre sí, lo que puede afectar la posibilidad de generalización de los hallazgos obtenidos con cada conjunto de criterios diagnósticos.Objetivo: Conducimos un análisis de solapamiento de contenido de los criterios diagnósticos del PGD de acuerdo a la CIE-11, del PGD de acuerdo al DSM-5-TR y de propuestas previas para diagnósticos de duelo patológico [como el PGD de Prigerson y colaboradores, publicado el 2009, Duelo complicado (CG por sus siglas en inglés) del borrador beta de la CIE 11, el Trastorno por Duelo Complejo Persistente (PCBD por sus siglas en inglés) del DSM-5].Métodos: Usando el Índice de Jaccard, establecimos el grado de solapamiento del contenido entre los síntomas principales y accesorios de los criterios diagnósticos del PGD de acuerdo a la CIE-11, del PGD de acuerdo con el DSM-5-TR y de propuestas previas para diagnósticos de duelo patológico.Resultados: Los resultados principales son que los criterios diagnósticos del PGD de acuerdo a la CIE-11 y PGD de acuerdo al DSM-5-TR mostraron un solapamiento de contenido moderado entre ellos y también con la mayoría de los diagnósticos de duelo patológico previamente propuestos. Ambos diagnósticos mostraron el mayor solapamiento de contenidos con sus predecesores directos, el Duelo Complicado del borrador beta de la CIE-11 y el PCBD respectivamente.Conclusiones: el solapamiento limitado de contenidos entre los criterios diagnósticos del PGD de acuerdo a la CIE-11 y PGD de acuerdo al DSM-5-TR y los criterios precedentes pueden amenazar la generalización de investigación pasada de las características fenomenológicas del duelo patológico en los criterios diagnósticos actuales. En forma similar, los hallazgos obtenidos con instrumentos para evaluar el PGD de acuerdo a la CIE-11 pueden no ser generalizables al PGD de acuerdo al DSM-5-TR. Los investigadores debiesen determinar bajo qué circunstancias los criterios diagnósticos de PGD muestran características distintas o similares. La convergencia de los criterios diagnósticos de PGD sigue siendo una importante meta para el futuro.