Looking beyond the mean in grief trajectories: A prospective, population-based cohort study

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

“…However, no identical PGD‐symptom trajectories have been identified 16‐19 . PGD‐symptom trajectories were identified similar to our trajectories identified as endurance, 16‐19 resilience, 18 prolonged symptomatic, 17,18 and chronically distressed, 19 but labeled differently, that is, resilience, 18 low grief, 16,19 persistent low/moderate PGD symptoms, 17 moderate‐decreasing grief, 19 and decreasing moderate PGD symptoms, 17 acute‐recovery, 18 moderate‐improving, 18 moderate‐stable, 18 and persistently high PGD symptoms, 17 and high grief, 19 respectively. We intentionally used “endurance” to define a group of bereaved caregivers who not only withstood the hardship of bereavement, but also maintained psychological well‐being throughout their first 2 years of bereavement despite losing a beloved.…”

“…A delayed trajectory was pre‐defined (not empirically identified by advanced statistics like LCGA) 8 as meeting the symptom criteria for PGD at 6 to 12 months, but not at 0 to 6 months post‐loss; the timing for new onset of PGD was different from that for our identified potential‐recurrence trajectory. Late‐grief and high‐decreasing trajectories were characterized as low‐level pre‐loss PGD symptoms that rose 6 months post‐loss and gradually increased over the first 3 years of bereavement and a very high level of pre‐loss PGD symptoms that gradually declined after the patient's death, respectively 19 . PGD symptoms in that study were measured only 6 months and 3 years post‐loss 19 .…”

“…Endurance, transient‐reaction, resilience, and prolonged‐symptomatic trajectories were identified for both PGD and depressive symptoms, whereas symptom trajectories of potential recurrence and chronic distress were uniquely identified for PGD and MDD, respectively. In addition, despite endurance and transient‐reaction trajectories conjointly comprising the most prevalent trajectories for PGD 16‐19 and depressive (see systematic review) 35 symptoms as reported, prevalence rankings of the other trajectories differed between PGD and depressive symptoms (Table 2). The prolonged‐symptomatic trajectory was the third and the least prevalent trajectories for depressive and PGD symptoms, respectively.…”

“…Construct distinctiveness of PGD and MDD has been established by confirmatory factor analysis, 12 bifactor analysis, 13 incremental validity testing for PGD's significantly increasing the explained variance in quality of life above MDD, 14 and lower‐level mediation analysis to show that change in each construct predicts a considerably different amount of change in the variance of the other construct 15 . However, no research has yet compared how well the patterns of change (trajectories) for PGD and MDD symptoms synchronize during bereavement, despite the importance of the temporal frame in defining PGD and MDD, the well‐observed phenomenon that grief‐related distress symptoms resolve over time, 5,8 and the heterogeneity of grief reactions as shown by individually identified distinct symptom trajectories for PGD 8,16‐19 and MDD 16,20‐26 . Furthermore, among studies that identified distinct PGD‐ or MDD‐symptom trajectories, few covered early and late bereavement (1 or 3 months 8,18,22,24,25 and >18 months 16,18,25,26 post‐loss, respectively).…”

Predictive factors for differential changes in grief symptoms following group bereavement intervention for Chinese widowed older adults

“…Spousal bereavement is a common but stressful life experience for older adults. In the Chinese population, widowed adults have a high risk of prolonged grief disorder (PGD; He et al, ), a syndrome of pervasive distressing grief symptoms in excess of 6‐month duration after the death of a loved one in some cultures (Maercker et al, ; Nielsen, Carlsen, Neergaard, Bidstrup, & Guldin, ). Compared with younger bereaved persons, older adults manifest an elevated risk of suffering from PGD (Simon, ).…”