The course of symptoms in the first 27 months following bereavement: A latent trajectory analysis of prolonged grief, posttraumatic stress, and depression

Background: Much remains unknown about the course of grief in the early months following bereavement, including the prevalence and timing of a recovery trajectory, whether specific symptoms mark a failure to recover, and the co-occurrence of chronic prolonged grief (PG), posttraumatic stress (PTS) and depression symptoms. Methods: Two hundred fifty-nine participants completed PG, PTS and depression questionnaires up to eleven times every six weeks during the two years post-bereavement. We used Latent Class Growth Mixture Modeling (LCGMM) to identify subgroups of bereaved individuals sharing similar trajectories for each disorder. We used repeated measures ANOVA to evaluate differences in individual symptoms between trajectories. Finally, we investigated to what extent chronic trajectories of these three disorders co-occurred. Results: Three trajectories of PG symptoms emerged: resilient (66.4%), chronic (25.1%) and acute recovery (8.4%). The overall severity and symptom profile of the acute recovery group were indistinguishable from that of the chronic group through 6 months post-bereavement, followed by reduction in PG from 6 to 18 months post-bereavement. Chronic PTS in the first-year post-bereavement tended to co-occur with chronic PG and/or chronic depression. Conclusions: Twenty five percent of those with initial elevations in grief recovered in the period of 6 to 12 months post-bereavement. These findings highlight the clinical importance of severe grief in the initial months following loss, but also suggests caution in diagnosing a grief disorder within the first-year post-bereavement

Post-migration stressors and their association with symptom reduction and non-completion during treatment for traumatic grief in refugees

Background: Resettled refugees exposed to trauma and loss are at risk to develop mental disorders such as posttraumatic stress disorder (PTSD) and persistent complex bereavement disorder (PCBD). Post-migration stressors have been linked to poor mental health and smaller treatment effects. Aim: Our aim was to evaluate reductions in PTSD and PCBD symptoms and to explore the presence of post-migration stressors and their associations with symptom change and non-completion in a traumatic grief focused treatment in a cohort of refugees. Methods: Paired sample t-tests were used to test the significance of the symptom reductions in PTSD and PCBD symptoms during treatment. The presence of post-migration stressors was derived from a qualitative analysis of the patient files. Associations between post-migration stressors and symptom reductions as well as non-completion were calculated. Results: In this uncontrolled study, 81 files of consecutive patients were included. Significant reductions in both PCBD and PTSD symptomatology with medium effect sizes were found. Patients experienced a mean of three different post-migration stressors during the treatment. Undocumented asylum seekers were more likely to be non-completers. Ongoing conflict in the country of origin was associated with smaller PTSD symptom reductions and the total number of post-migration stressors was associated with smaller PCBD symptom reductions. Conclusions: Treatment for resettled refugees for traumatic grief coincides with alleviations in both PCBD and PTSD symptomatology. Specific post-migration stressors were associated with reduced treatment effects and increased non-completion. This is a first step towards well-informed improvements of mental health interventions for resettled refugees

Traumatic grief

Following the death of a loved one, a small yet significant minority of bereaved individuals develops persistent and debilitating symptoms of persistent complexbereavement disorder (PCBD) (also termed prolongedgrief disorder), posttraumatic stress disorder, anddepression. In recent years there has been an increasein treatment options for people for whom loss leads topersistent psychological problems (Boelen, 2016;Djelantik, Smid, Kleber, & Boelen, 2017). The aim ofthis interactive SIG meeting is to share the latestinsights from both a scientific and a clinical perspectivefor the treatment of traumatic grief. We will do this bydiscussing case vignettes and examples from the BriefEclectic Psychotherapy for Traumatic Grief (BEP-TG;Smid et al., 2015). This workshop will be held by ManikDjelantik (psychiatry resident at UMC Utrecht andPhD Candidate at Utrecht University and FoundationCentrum ’45, partner in ARQ National PsychotraumaCentre) and Annemiek de Heus (Clinical Psychologistat PsyQ and trainer of BEP-TG). Both are registered aspsychotrauma therapists at the NtVP and are experienced in assessment and treatment of traumatic grief invarious populations. Together they have conducted aresearch among treatment-seeking bereaved refugees

Early indicators of problematic grief trajectories following bereavement

Background: Little is known about the development of Prolonged Grief Disorder (PGD) symptoms over time in adults. For clinical purposes, it would be useful to have knowledge about early indicators of a problematic grief trajectory. Objective: This study aimed to identify classes of bereaved individuals with similar trajectories of PGD symptoms and to design a provisional screening tool including symptoms predicting membership of classes with problematic grief trajectories. Method: In a Dutch sample of 166 bereaved individuals, we conducted a latent class analysis to identify classes of bereaved individuals with similar trajectories of PGD symptoms between two time points (mean of 6 and 18 months post-loss, respectively). Next, we used Receiver Operating Characteristic (ROC) analyses to examine which symptoms at baseline best predicted membership of classes with problematic grief trajectories. Results: We found four different classes: a class including individuals with persistent high PGD symptoms (class 1, 6%), a class of individuals with persistent moderate PGD symptoms (class 2, 35%), a class of individuals with slightly decreasing moderate PGD symptoms (class 3, 33%) and a class of individuals with persistent low PGD symptoms (class 4, 26%). The endorsement of symptoms 'yearning', 'stunned', 'life is empty' and 'bitterness' as present 'often' during the preceding month at baseline best-predicted membership of class 1 or 2. Conclusions: Two classes of individuals with problematic grief trajectories were identified. Four symptoms were found which could act as early indicators of these two classes in a provisional screening tool

Early indicators of problematic grief trajectories following bereavement

Background: Little is known about the development of Prolonged Grief Disorder (PGD) symptoms over time in adults. For clinical purposes, it would be useful to have knowledge about early indicators of a problematic grief trajectory. Objective: This study aimed to identify classes of bereaved individuals with similar trajectories of PGD symptoms and to design a provisional screening tool including symptoms predicting membership of classes with problematic grief trajectories. Method: In a Dutch sample of 166 bereaved individuals, we conducted a latent class analysis to identify classes of bereaved individuals with similar trajectories of PGD symptoms between two time points (mean of 6 and 18 months post-loss, respectively). Next, we used Receiver Operating Characteristic (ROC) analyses to examine which symptoms at baseline best predicted membership of classes with problematic grief trajectories. Results: We found four different classes: a class including individuals with persistent high PGD symptoms (class 1, 6%), a class of individuals with persistent moderate PGD symptoms (class 2, 35%), a class of individuals with slightly decreasing moderate PGD symptoms (class 3, 33%) and a class of individuals with persistent low PGD symptoms (class 4, 26%). The endorsement of symptoms 'yearning', 'stunned', 'life is empty' and 'bitterness' as present 'often' during the preceding month at baseline best-predicted membership of class 1 or 2. Conclusions: Two classes of individuals with problematic grief trajectories were identified. Four symptoms were found which could act as early indicators of these two classes in a provisional screening tool

Prevalence matters : The influence of socio-demographic and loss-related variables on the development of prolonged grief disorder

A meta-analysis is currently being conducted on pro-longed grief disorder (PGD) following unnatural losses.Preliminary results indicate a much higher prevalencethan the prevalence of PGD following natural losses. Inaddition, other loss-related variables may be associatedwith PGD prevalence. This symposium aims to illustratethe clinical implications of these‘prevalence matters’bypresenting two studies of large help-seeking samples ofbereaved individuals. The first study is based on datafrom 942 Western homicidally bereaved individuals. Thesecond study examined data from 2404 Arabic speakingbereaved individuals. The third study introduces a cultu-rally-sensitive online assessment measure of PGD forSwiss, Japanese and Chinese bereaved individuals

Early indicators of a problematic grief trajectory following bereavement

Background: For clinical purposes, it would be useful to have knowledge of early indicators of problematic PGD trajectories. Objective: The aim of this study was to identify classes of bereaved individuals with similar trajectories of PGD symptoms and to identify symptoms predicting the classes with a problematic grief trajectory. Method: Using data from 166 Dutch bereaved individuals, we conducted a latent class analysis to identify classes of bereaved individuals with similar trajectories of PGD symptoms between two time points (six and 18 months, respectively). Next, we used Receiver Operating Characteristic (ROC) analysis to examine which early symptoms best predicted membership of a class with a problematic grief trajectory. Results: We found two classes with a problematic grief trajectory in adults over the first two years after a loss. Daily endorsement of yearning, feeling stunned, anger and/or feeling that life is empty could act as early indicators of these two classes. Conclusions: This first study about early indicators of problematic grief trajectories among adults will help caregivers to identify bereaved individuals at risk for developing psychopathology

Do prolonged grief disorder symptoms predict post-traumatic stress disorder symptoms following bereavement? : A cross-lagged analysis

BACKGROUND: Bereavement can precipitate different forms of psychopathology, including prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD) symptoms. How these symptoms influence each other is unclear. The aim of this study was to examine the temporal relationship of symptoms of PGD and PTSD following bereavement. METHODS: We included 204 individuals, confronted with the loss of a loved one within the past year, who completed self-report measures of PGD and PTSD and again completed these measures one year later. We conducted a cross-lagged analysis to explore cross-lagged and autoregressive relationships. RESULTS: A significant cross-lagged relationship was found between PGD symptoms at time point 1 (T1) and PTSD symptoms at time point 2 (T2) (β=0.270, p<0.001). Furthermore, PGD symptoms at T1 predicted PGD symptoms at T2 and PTSD symptoms at predicted PTSD symptoms at T2 (β=0.617 and β=0.458, ps<0.001, respectively). In addition, PGD and PTSD symptoms were significantly correlated on both time points. CONCLUSIONS: We found that PGD symptoms predict PTSD symptoms after a loss. Potentially, this could help to design new strategies and interventions for bereaved individuals. Additionally, PGD symptom levels predicted PGD symptom levels one year later, independently of the PTSD levels. This finding adds to the accumulating evidence that PGD is a distinct disorder