Different Trajectories of Prolonged Grief in Bereaved Family Members After Terror

Abstract

Introduction: The loss of a loved one in a terror incident is associated with elevated risk for mental health disorders such as prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD), but the long-term adaptation after such losses are not well understood. This study aims to explore the trajectories of PGD among parents and siblings (n = 129) after the 2011 terror attack on Utøya Island, Norway. Methods: The 19-item Inventory of Complicated grief (ICG) was used to measure PGD at 18, 28, and 40 months post-loss. Latent class growth analysis (LCGA) was used to identify trajectories of grief and a multinomial regression analysis was conducted to examine predictors of class membership. Results: The analysis identified three grief trajectories; moderate/decreasing class (23%), high/slow decreasing class (64%), and a high/chronic class (13%). Predictors of high/slow recovery or chronic grief was female gender, previous depressive symptoms, and intrusion and avoidance symptoms. Conclusion: The findings highlights the difficult grief process and slow recovery that characterizes the majority of close family members bereaved by a terror-incident. Community mental health programs should strive for both early outreach and long-term follow-up after such incidents.

Comorbid Prolonged Grief, PTSD, and Depression Trajectories for Bereaved Family Surrogates

“…Perhaps PGD recovery could not be detected by the infrequent yearly assessment . Our recovery trajectory was also significantly less severe than the chronic trajectory from 6 to 24 months after the death, differing from the study by Djelantik and colleagues but consistent with other studies …”

“…33 Our recovery trajectory was also significantly less severe than the chronic trajectory from 6 to 24 months after the death, differing from the study by Djelantik and colleagues 34 but consistent with other studies. 12,13,15,16 The delayed-onset trajectory identified for PTSD symptoms in our study was unique to our study. Beyond bereavement literature, a relapse or delayed-onset trajectory was reported among US military personnel 29 and children surviving a natural disaster 30 for PTSD and depressive symptoms, and among adult spouses of veterans who had experienced trauma 21 for PTSD symptoms.…”

Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial

“…Offering early treatments for disturbed grief is relevant for several reasons. First, research has shown that acute grief, PTSD, and depression symptoms in the early months after a loss are one of the strongest predictors for clinically relevant disturbed grief, PTSD, and depression levels later in time ( Boelen & Lenferink, 2020 , 2022 ; Bonanno & Malgaroli, 2020 ; Kristensen et al, 2020 ; Lenferink et al, 2020a ; Nielsen et al, 2019 ; Sveen et al, 2018 ). For instance, Boelen and Lenferink (2022) found that people who met (versus did not meet) probable PGD criteria 4 months post-loss were 32 times more likely to meet probable PGD criteria 1 year later.…”

Prolonged grief, post-traumatic stress, and functional impairment in parents and siblings 8 years after the 2011 Utøya terror attack

“…These results suggest that PG and PTS symptom levels reduces over time. Moreover, Kristensen et al ( 2020 ) reported the mean PG symptom levels on the ICG as 37.52 at 18 months (T1), 34.49 at 28 months (T2) and 32.46 at 40 months (T3) after the attack. These findings are comparable to our study ( M = 30.71), which suggests that the level of prolonged grief remains relatively stable by 40 months.…”