Networks of loss: Relationships among symptoms of prolonged grief following spousal and parental loss.

Abstract

The death of a loved one can trigger a range of emotional, behavioural, motivational and cognitive reactions collectively labelled as “grief”. There has been a recent resurgence of empirical interest in grief reactions, and there is now a general consensus that 7%–10% of bereaved individuals experience intense and chronic reactions termed Prolonged Grief (PG). However, there is ongoing debate about how best to conceptualise the construct. Recent studies have advanced this debate by applying a network, or causal systems approach. Whereas traditional views of psychopathology posit symptoms of disorders reflect the independent actions of latent entities, the network approach argues that the symptoms themselves interact to give rise to the disorder. A network conceptualisation offers novel approaches to studying the mechanisms that contribute to PG. To date, however, research has focussed only on spousal loss and only used a single archival data set. Therefore, in this paper we apply network analysis to examine relationships among PG symptoms in samples of individuals bereaved by loss of a spouse (Study 1, N=193) and a parent (Study 2, N=180). Participants completed the PG-13 and a measure of depression. A comparison test suggested the networks produced from each sample were not reliably different. The strongest link in both networks was between yearning and emotional pain. Meaninglessness was relatively central, whereas avoidance was peripheral in both networks. Findings are discussed with reference to theoretical models and the potential benefits a network approach may hold for understanding relationships between symptoms of PG.

A Network Approach to Understanding Quality of Life Impairments in Prolonged Grief Disorder

“…This study used network analysis to explore this issue. Consistent with previous studies, we observed that the symptoms of PGD formed a network of nodes connected by positive edges (Maccallum et al., ; Robinaugh et al., , ). This indicated that the node values were positively associated, independent of other nodes within the network.…”

“…Notwithstanding these issues, the results of this analysis share features with previous network analyses of PGD (Maccallum et al., ) and PCBD (Malgaroli et al., ; Robinaugh et al., ). There was a strong positive edge between emotional pain and yearning, and links between meaninglessness and numbness and meaninglessness and difficulties reengaging were found to be stronger than many other in the network (see Supplementary Figure S1).…”

“…This precluded splitting the sample to undertake investigation of potential factors that may have impacted network associations, such as relationship of the deceased, nature of the loss, or gender, or including additional nodes that represented common comorbid conditions, such as depression. Prior studies have suggested that differences based on relationship to the deceased may be minimal (Maccallum et al., ). Future research undertaken with larger samples sizes will enable further exploration of this these issues.…”

“…Accordingly, in this study, we constructed networks composed of nodes that represent the symptoms of PGD and the four QoL domains. Based on prior network analyses of PGD, we expected emotional pain and meaninglessness to emerge as the most central and well-connected nodes (Maccallum et al, 2017;Robinaugh et al, 2014;Robinaugh, Millner, & McNally, 2016). For similar reasons, we expected that avoidance of reminders would be relatively peripheral.…”

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

“…Specifically, “loneliness” was found to activate other symptoms through its association with loss [49] and to connect to risk factors, such as lack of instrumental social support [48]. Maccallum et al [50] analyzed the networks of depressive and complicated grief symptoms regarding 2 different types of losses (i.e., death of a spouse or a parent) in general population. The results showed that both types of losses produced very similar networks in which the strongest connection is the link between yearning and emotional pain.…”