Latent trajectories of DSM-5-TR-based Prolonged Grief Disorder: findings from a data pooling project MARBLES

Abstract

Background: With the release of the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR), criteria for Prolonged Grief Disorder (PGD) were included. This necessitates studying grief trajectories based on these criteria. Objective: This is the first study examining latent trajectories of DSM-5-TR-based PGD symptom levels and testing whether specific risk factors (e.g. cause of death) predicted PGD trajectories. Method: We evaluated latent DSM-5-TR PGD trajectories using pooled existing data collected at 6–12, 13–24, and 25–60 months post-loss in Danish and Dutch bereaved adults ( N = 398). Latent Growth Mixture Modelling (LGMM) was employed to determine the trajectories. Multinomial logistic regression analyses were used to examine which risk factors predicted class membership. Results: The four-class LGMM solution with a quadratic term was best-fitting the data. This solution represented four trajectories: High stable PGD (6%), High PGD quick recovery (10%), High PGD slow recovery (35%), and Low PGD symptoms (49%). Participants with a higher educational level were more likely to be assigned to the Low PGD symptoms trajectory compared to High stable PGD and High PGD slow recovery trajectories. Unnatural causes of death increased the likelihood of being in the High stable PGD and High PGD slow recovery trajectories compared to the Low PGD symptoms trajectory. Conclusions: Consistent with prior research, the Low PGD symptoms trajectory was the most common. A significant minority experienced high and stable levels of PGD within five years after the loss. About one-third of participants experienced high acute grief levels that decreased slowly; how slow decreasing symptoms relate to an individual’s functioning requires further attention. This study demonstrates that a significant minority of bereaved people develop acute PGD symptomatology that does not diminish within five years post-loss, emphasizing the need for early screening for PGD to prevent long-lasting complaints.

Sex and gender in psychotrauma research

“…Men, 7. Women 12 qualitative or quantitative empirical study using child or adult clinical or non-clinical samples and presented CPTSD separated by gender or sex, or in one gender or sex only Yes Mellor et al ( 2021 ) Systematic review Gender (male, female); how measured is not explicitely stated 13 empirical studies in refugee and displaced treatment seeking or general populations No Nordström et al ( 2022 ) Cross-sectional (based on the fourth data collection eight years after the Utøya terror attack) Gender (male, female) 88 bereaved parents and 34 siblings aged 19 and above (59.8% female, Norway) Yes Pociunaite et al ( 2023 ) Longitudinal data from the data-archive of the Measurement Archive of Reactions to Bereavement from Longitudinal European Studies (MARBLES) project Gender (male, female) 398 bereaved adults (64.2% female, Denmark & The Netherlands) No Rasmusson et al ( 2018 ) Cross-sectional Gender (male, female) 112 patients in treatment for substance use disorders and 112 matched controls with mild to moderate mental health disorders (each group 43.8% female, Norway) Yes Schenker et al ( 2023 ) Cross-sectional Sex, biologically (use both male, female and men, women; none of the participants indicated their sex as ‘other’) 41 non-treatment seeking, trauma exposed young adults aged 18–50 years (75.6% female, Australia) Yes Søegaard et al ( 2021 ) Cross-sectional Self-reported gender (men, women) 110 traumatized patients attending a mental health outpatient clinic (61.8% female, Norway) Yes Stelzer et al ( 2019 ) Cross-sectional Gender (men, women) 50 bereaved widow(er)s and parents (58% female; USA) ...…”

“…Pociunaite et al ( 2023 ) expected gender differences in latent DSM-5-TR PGD trajectories with female showing an increased likelihood of belonging to trajectories that experienced more severe PGD. In contrast to many other studies, gender did not have a role in predicting the different trajectories of PGD symptoms levels within the first five years after loss in their sample of bereaved adults, possibly due to the increase of Type II error due to the overrepresentation of women in the sample.…”

Trajectories of DSM-5-TR Prolonged Grief Disorder Severity in the First Two Years After Loss During the COVID-19 Pandemic

“…Latent trajectory studies can be used to examine the course of grief symptoms over time and to identify subgroups with different courses. Prior latent trajectory studies on PGD demonstrated that differences exist in the course of grief reactions after loss (e.g., Mørk et al, 2023;Pociunaite et al, 2023). Therefore, latent trajectory studies are an important extension of the majority of research in the field (e.g., Djelantik et al, 2020;Kokou-Kpolou et al, 2020b;Komischke-Konnerup et al, 2021;Lundorff et al, 2017), which is dominated by examining means of symptom-levels or the presence/absence of a psychological disorder.…”

“…To the best of our knowledge, ten latent trajectory studies explored PGD trajectories (Bonanno & Malgaroli, 2020;Djelantik et al, 2022;Kristensen et al, 2020;Lenferink et al, 2020;Lundorff et al, 2020;Mørk et al, 2023;Nielsen et al, 2019;Pociunaite et al, 2023;Smith & Ehlers, 2020;Sveen et al, 2018). Most studies identified three PGD trajectories (Bonanno & Malgaroli, 2020;Djelantik et al, 2022;Kristensen et al, 2020;Mørk et al, 2023;Sveen et al, 2018), followed by four (Lundorff et al, 2020;Nielsen et al, 2019;Pociunaite et al, 2023;Smith & Ehlers, 2020), five (Bonanno & Malgaroli, 2020;Nielsen et al, 2019), or two trajectories (Lenferink et al, 2020). Despite differences in the number of TRAJECTORIES OF PROLONGED GRIEF DISORDER 6 trajectories, there are several similarities in the trajectory characteristics among studies.…”

“…It is also notable that, thus far, only one study has examined latent trajectories of PGD severity based on DSM-5-TR criteria in bereaved people (Pociunaite et al, 2023). However, this study also has limitations because not all PGD criteria could be measured since existing data from previous studies were used before the DSM-5-TR was published.…”