A systematic review and meta-analysis of correlates of prolonged grief disorder in adults exposed to violent loss

Abstract

Background: Violent loss (i.e. loss through homicide, suicide, or accident) is associated with high levels of prolonged grief disorder (PGD). Objective: The current meta-analysis aims at identifying correlates of PGD in adults exposed to violent loss. Method: We conducted a systematic literature search in PsycINFO, PsycARTICLES, PubMed, Web of Science, and Scopus. We used the Pearson correlation coefficient r as an effect size measure and a random effects model was applied to calculate effect sizes. Results: Thirty-seven eligible studies published between 2003 and 2017 (N = 5911) revealed 29 potential correlates. Most studies used a cross-sectional design. Analyses revealed large significant effect sizes for comorbid psychopathology (r = .50-.59), suicidality (r = .41, 95% confidence interval [CI] [.30; .52]), and rumination (r = .42, 95% CI [.31; .52]), while medium effect sizes were found for exposure to traumatic events and factors concerning the relationship to the deceased. Small effect sizes emerged for sociodemographic characteristics, multiple loss, physical symptoms, and religious beliefs. Ten variables did not show a significant association with PGD. Heterogeneity and a small number of studies assessing certain correlates were observed. Conclusions: The associations with psychological disorders may indicate shared mechanisms of psychopathology. Moreover, we recommend that clinicians carefully assess suicidal ideation among individuals with PGD who have been exposed to violent loss. Further research is warranted using longitudinal study designs with large sample sizes to understand the relevance of these factors for the development of PGD. Una revisión sistemática y metanálisis de los correlatos de duelo prolongado en adultos expuestos a pérdidas violentas Antecedentes y objetivos: La pérdida violenta (ej. pérdida por homicidio, suicidio, accidente) está asociada con niveles elevados de trastorno por duelo prolongado (PGD, por sus siglas en inglés). El objetivo del metanálisis actual es identificar los correlatos del PGD en adultos expuestos a pérdidas violentas. Método: Condujimos una búsqueda sistemática de literatura en PsycINFO, PsycARTICLES, PubMed, Web of Science y Scopus. Usamos el coeficiente r de correlación de Pearson como medición del tamaño del efecto de la muestra y se aplicó el modelo de efectos aleatorios (REM) para calcular los tamaños del efecto. Resultados: Treinta y siete estudios elegibles publicados entre el año 2003 y 2017 (N=5911) revelaron 29 correlatos potenciales. La mayoría de los estudios usaron un diseño transversal. Los análisis revelaron tamaños del efecto significativamente grandes para comorbilidad psicopatológica (r= .50-.59), suicidalidad (r=. 41, 95% IC[.30; .52]) y rumiación (r=.42, [.31; .52]), mientras que los tamaños del efecto medianos fueron encontrados para exposición a eventos traumáticos y factores concernientes a la relación del deceso. Los tamaños del efecto pequeños emergieron en las características sociodemográficas, pérdidas múltiples, síntomas físicos y ...

A decennial review of psychotraumatology: what did we learn and where are we going?

“…What we do not know is how the neurobiological (Lanius & Olff, 2017), psychological (Baekkelund, Frewen, Lanius, Ottesen Berg, & Arnevik, 2018;Schafer, Becker, King, Horsch, & Michael, 2019), affective (Strøm, Aakvaag, Birkeland, Felix, & Thoresen, 2018), and relational (Heeke, Kampisiou, Niemeyer, & Knaevelsrud, 2019;van Dijke, Hopman, & Ford, 2018) alterations associated with different forms, durations, and structures (Armour, Fried, & Olff, 2017;Murphy, Elklit, Dokkedahl, & Shevlin, 2018) of psychotrauma exposure (and reexposure) emerge and take different courses or trajectories across the lifespanand across generations (Burnette & Cannon, 2014;Crombach & Bambonye, 2015;Schick, Morina, Klaghofer, Schnyder, & Muller, 2013). Biopsychosocial mechanisms and processes involved in the long-term adverse impact of childhood trauma over decades into mid-life and old age (Glück, Knefel, Tran, & Lueger-Schuster, 2016) and across generations (Kuffer, Thoma, & Maercker, 2016) have been preliminarily conceptualized but remain understudied.…”

Sounds of silence. The “special grief” of drug-death bereaved parents: a qualitative study

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Symptoms of prolonged grief, posttraumatic stress, and depression in recently bereaved people: symptom profiles, predictive value, and cognitive behavioural correlates

“…A minority of approximately 10% of bereaved individuals is plagued by persistent and disabling distress [1,2]. This distress may manifest in symptoms of prolonged grief disorder (PGD; 3) or persistent complex bereavement disorder (PCBD) as included in DSM-5 [4]-including yearning, difficulties in accepting the loss, and moving on without the lost personas well as depression, posttraumatic stress disorder (PTSD), other anxiety disorders, and suicidal ideation that are frequently comorbid with PGD/PCBD [5,6].…”

“…There is gradually growing knowledge about risk factors for poor bereavement outcome. Research has shown that disturbed grief is associated with loss of closer loved ones, losses due to unnatural/violent causes, limited social support, and personality features of insecure attachment and elevated neuroticism [5,7]. Yet, there is a need to enhance knowledge about risk factors.…”

“…Yet, there is a need to enhance knowledge about risk factors. For instance, inconsistencies in research findings have been observed [5,7]. These may be due to differences in study methods and samples and stress the importance of additional risk factor research.…”