Distinctiveness of prolonged‐grief‐disorder‐ and depressive‐symptom trajectories in the first 2 years of bereavement for family caregivers of terminally ill cancer patients

Abstract

Objective: Grief reactions in bereaved caregivers of cancer patients have been identified individually as distinct prolonged grief disorder (PGD)-and major depressive disorder (MDD)-symptom trajectories, but no research has examined whether the patterns of change (trajectories) for PGD and MDD symptoms synchronize during bereavement. We conducted a secondary analysis study to investigate the construct distinctiveness of PGD and MDD by simultaneously identifying and examining similarities and differences between bereaved caregivers' PGD-and depressive-symptom trajectories from immediately post-loss through 2 years later. Methods: PGD and depressive symptoms were measured for 849 cancer patients' caregivers over their first 2 years of bereavement using 11 grief-symptom items of the prolonged grief-13 scale (PG-11) and the center for epidemiologic studies-depression (CES-D) scale, respectively. PGD-and depressive-symptom trajectories were identified using latent class growth analysis with continuous latent-class indicators (total PG-11 and CES-D scores). Concordance of caregiver participants' membership in PGD-and depressive-symptom trajectories was examined by a percentage and a kappa value. Results: Five distinct symptom trajectories were identified for both PGD and MDD, with four shared trajectories (endurance, transient-reaction, resilience, and prolongedsymptomatic) having different prevalence rankings. Nonetheless, unique trajectories were identified for PGD (potential recurrence) and depressive symptoms (chronically distressed), respectively. Concordance between membership in PGD-and depressivesymptom trajectories was moderate (61.3%, kappa [95% CI]: 0.49 [0.44, 0.53]). Conclusion: PGD and MDD are related but distinct constructs indicated by the unique trajectories identified for each, different prevalence rankings for PGD-and depressive-symptom trajectories, and moderate concordance between membership in PGD-and depressive-symptom trajectories, respectively.

Prolonged grief disorder and depression are distinguishable syndromes: A latent transition analysis for bereaved family caregivers of cancer patients

“…Therefore, the aim of this study was to examine distinct symptom states based on the presence of PGD and depressive symptoms to validate the construct distinctiveness of PGD and MDD for family caregivers of terminally ill cancer patients over their first 2 years of bereavement. This may extend our previous understanding about PGD and MDD as distinct constructs by confirmatory bifactor modeling, 13 lower‐level mediation analysis, 15 and latent class growth analysis 16 …”

“…This secondary‐analysis study re‐examined data from three longitudinal studies that explored the relationships of end‐of‐life caregiving and an advanced care‐planning intervention with family caregivers' depressive symptoms and PGD before and after their loved one's death 16 . The current study used the same sample as our previous works 16 .…”

“…This secondary‐analysis study re‐examined data from three longitudinal studies that explored the relationships of end‐of‐life caregiving and an advanced care‐planning intervention with family caregivers' depressive symptoms and PGD before and after their loved one's death 16 . The current study used the same sample as our previous works 16 . Detailed information has been reported on subject recruitment, follow‐up surveys while providing end‐of‐life caregiving and during bereavement, and no significant differences in PGD and depressive symptoms among combined samples over the first 2 bereavement years 16 .…”

Emerging experience with selected new categories in the ICD‐11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

“…Further studies, particularly those with larger sample sizes or longer‐term time frames, have observed distinct trajectories in which most people are resilient to the effects of bereavement, a smaller but significant proportion have grief symptoms improving over time, others have moderate and persistent symptoms, and a smaller group exhibits high levels of grief symptoms that do not improve over time (i.e., prolonged grief) 91,92 . It appears that, whereas prolonged grief disorder and depression follow some of the same trajectories after bereavement, there are also trajectories unique to each 93 . Another study found that the ICD‐11 prolonged grief disorder construct is more consistent with the observed patterns than “persistent complex bereavement disorder” as described in the DSM‐5 research appendix 94 .…”

Association between Family Caregivers' Satisfaction with Care for Terminal Cancer Patients and Quality of Life of the Bereaved Family: A Prospective Pre- and Postloss Study

“…Several assessment points are necessary to capture changes in mental health status. 5 , 30 Finally, grief and depressive symptoms were assessed by self-reported instruments, and the family caregivers were not clinically diagnosed with depression.…”