Bereavement Issues and Prolonged Grief Disorder: A Global Perspective

Abstract

The death of a loved one – bereavement – is a universal experience that marks the human mental health condition. Grief – the cognitive, emotional, and behavioral responses to bereavement – is thus experienced by virtually everyone at some point in life, while mourning is a process through which grievers come to terms with the loss envisioning life without the deceased. Although distress subsides over time among most bereaved individuals, a minority will develop a condition recently identified as prolonged grief disorder (PGD). The present review provides a global perspective on bereavement, grief reactions, and PGD. Although the loss of a loved one and grief reactions are in general experienced consistently across different cultures, differences and variations in their expression may exist across cultures. Especially within specific populations that may be more at risk for PGD, possibly due to risk factors associated with the mechanisms of loss (e.g., refugees, migrants, and conflict survivors). The diagnostic criteria for PGD are mostly based on Western grieving populations, and cultural adaptations of PGD treatments are limited. Therefore, cross-cultural development and validation of PGD screening/assessment is critical to support future research on grief reactions and PGD, especially in non-Western contexts, and concerning the potential future global changes and challenges that appear to have a major impact on PGD. More transcultural research on PGD is needed to contextualize and will lead to culture-bound symptom identification of PGD, and the adaptation of current treatment protocols, which may ultimately improve health at the individual level, and health-care systems.

Prolonged grief disorder symptomology in three African countries: A network analysis and comparison

“…This study offers a significant insight into Prolonged Grief Disorder (PGD) using a non-Western, gender-balanced sample, highlighting PGD's global relevance and its impact on previously underrepresented groups in grief research (Hilberdink et al, 2023;Maccallum et al, 2023).…”

“…Bereavement, the death of a loved one, is a common and universal stressor, often leading to a grieving process marked by loss, yearning and sadness (Hall, 2014 ; Hilberdink et al, 2023 ). While most people adapt over time, some experience disordered chronic and complex grief reactions persisting beyond typical cultural bereavement periods (Bonanno et al, 2002 ).…”

“…PGD is distinguished from typical acute grief, characterised by resolution within 6 months and by symptoms like sadness, sleep issues and emotional reactivity (Bonanno and Malgaroli, 2020 ; Mughal et al, 2022 ). Typical grief expressions, however, vary culturally (Hilberdink et al, 2023 ). For example, some African cultures view grief differently, with individuals comforted by the belief in the continued presence of the deceased’s spirit (Njue et al, 2015 ).…”

“…For example, some African cultures view grief differently, with individuals comforted by the belief in the continued presence of the deceased’s spirit (Njue et al, 2015 ). Persistent feelings of grief and yearning may therefore be less distressing to individuals based on cultural expectations and norms, contributing to findings that PGD prevalence is elevated in westernised contexts compared to the relative symptom burden reported in the global south (Ben-Ezra et al, 2020 ; Hilberdink et al, 2023 ). PGD has context-specific considerations for symptoms and functioning (Maciejewski et al, 2016 ), necessitating culturally sensitive diagnostic criteria (Maercker and Eberle, 2022 ).…”

Everything Everywhere All at Once? Identifying Exposures and Outcomes that Matter to Families within and beyond the Intensive Care Unit

“…Future research is needed to disentangle the relationships among specific stress events, moderators, and family member outcomes, thus informing the interventions that can be targeted to the specific stressors and the study designs that can target the relevant outcomes. For example, investigations of the impact of bereavement after the death of a loved one during or after a critical illness requires extended longitudinal follow-up, as outcomes assessed at 6 months are inherently unable to distinguish between prolonged grief disorder versus a “normal” grief reaction after the loss of a loved one ( 14 , 15 ).…”