Coping strategies as a causal mediator of the effect of loss-related memory characteristics and negative loss-related appraisals on symptoms of PGD, PTSD and depression

Abstract

Background Psychological models of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) make predictions about the role of unhelpful coping strategies in maintaining difficulties by blocking self-correction of negative appraisals and memory integration following stressful life events like bereavement. However, few studies have tested these predictions directly. Method We used counterfactually based causal mediation to assess whether unhelpful coping strategies mediated the relationship between (1) loss-related memory characteristics and/or (2) negative grief-related appraisals and symptoms of PGD, PTSD and depression using a three-wave longitudinal sample (N = 275). Appraisals and memory characteristics were measured at time point 1, unhelpful coping strategies at T2, and symptom variables at T3. Additionally, multiple mediation analyses within a structural equation modelling (SEM) framework assessed which types of coping strategies differentially mediated symptoms of PGD, PTSD and depression. Results Coping strategies mediated the relationship between negative appraisals and memory characteristics and symptoms of PGD, PTSD and depression after adjusting for demographics and loss characteristics. Sensitivity analyses suggested that these results were most robust for PGD, followed by PTSD and then depression. Multiple mediation analyses suggested that all four subscales (avoidance, proximity seeking, loss rumination and injustice rumination) individually mediated the effect of memory characteristics and appraisals on PGD. Conclusions These results suggest that core predictions of the cognitive model for PTSD and the cognitive behavioural model of PGD are useful in predicting symptoms of post-loss mental health problems in the first 12–18 months after loss. Targeting unhelpful coping strategies is likely to reduce symptoms of PGD, PTSD and depression.

La eficacia de la terapia cognitivo-conductual para el duelo prolongado

“…Junto a estos datos, otros predictores ya abordados serían tener mayor edad -por el elevado riesgo de sufrir declive cognitivo o aislamiento social- (35) ; intervenciones de corta duración (36) ; o la evitación como estrategia de afrontamiento -aunque desadaptativa- (37) , pues limitaría la involucración en el proceso, y, por tanto, los resultados óptimos. Por último, presentar elevados niveles de autoculpabilización por la pérdida también restringiría los resultados, dado que, en sí, representa una de las razones nucleares que conducen al DP (34) .…”

“Suddenly Feeling Dark”: A Qualitative Study on the Experiences of Nurses Facing Coworker Death During the COVID-19 Pandemic

“…Coping developed by nurses may be seen as an effort to reduce the adverse effects of emotional problems. However, unhelpful coping strategies can exacerbate emotional distress (Smith & Ehlers, 2023). Thus, nurses must learn to accept their loss and implement self-control.…”

Psychometric Characteristics of the Oxford Grief Memory Characteristics Scale and Its Relationship With Symptoms of ICD-11 and DSM-5-TR Prolonged Grief Disorder

“…This pattern of results would be expected by psychological models of PGD (6, 8) that aim to explain the persistence of grief symptoms beyond the initial months of grieving, where most people will have frequent memories of the death and the deceased together with feelings of loss and grief. People for whom grief does not resolve naturally are thought to differ from those who adapt to their loss by several factors that maintain their symptoms, including memory characteristics, appraisals, social disconnection and unhelpful coping strategies (49)(50)(51)(52)(53)67).…”