Predictors of Complicated Grief: A Systematic Review of Empirical Studies

Abstract

A systematic review of the literature on predictors of complicated grief (CG) was undertaken with the aim of clarifying the current knowledge and to inform future planning and work in CG following bereavement. Predictors of CG prior to the death include previous loss, exposure to trauma, a previous psychiatric history, attachment style, and the relationship to the deceased. Factors associated with the death include violent death, the quality of the caregiving or dying experience, close kinship relationship to the deceased, marital closeness and dependency, and lack of preparation for the death. Perceived social support played a key role after death, along with cognitive appraisals and high distress at the time of the death. Inconsistent definitions of CG and measurement tools were noted in the earlier studies reviewed. Limitations identified in the studies included use of cross-sectional designs, heterogeneous samples, high attrition, demographic differences between cases and controls, differences in length of time since death, and differences in types of death experienced. Notwithstanding these limitations, some consistent findings have emerged. Further research into conceptualizations of CG in terms of attachment theory and constructivist and cognitive-behavioral concepts of finding purpose and meaning after bereavement is warranted.

Prolonged grief symptomatology following violent loss: the mediating role of meaning

“…Burke & Neimeyer, 2013; Lobb et al, 2010), violent loss was not significantly correlated with PGD, the total GMRI score, the valuing life GMRI factor, the personal growth GMRI factor, or the emptiness and meaninglessness GMRI factor. However, violent loss was significantly correlated with the sense of peace and continuing bonds factors of the GMRI.…”

“…Alternatively, it may be that negative meaning becomes maladaptive among mourners who have trait-level dispositions toward negative cognition, such as those who demonstrate high levels of neuroticism and anxious attachment. In fact, both of these traits have received considerable empirical support as risk factors for PGD (Burke & Neimeyer, 2013; Lobb et al, 2010). Thus, the emptiness and meaninglessness theme may be relevant to poor adaptation following violent loss if the griever demonstrates anxious attachment and/or neuroticism.…”

“…Thus, the emptiness and meaninglessness theme may be relevant to poor adaptation following violent loss if the griever demonstrates anxious attachment and/or neuroticism. Indeed, scholarship suggests that risk factors are likely to moderate each other’s effect on the grief experience in a manner that exacerbates symptoms of PGD beyond the influence of any one risk factor (Burke & Neimeyer, 2013; Lobb et al, 2010; Stroebe, Folkman, Hansson, & Schut, 2006). Future studies examining the aetiology of PGD would benefit from testing the empirical validity of these various scenarios.…”

Social support and psychological well-being as possible predictors of complicated grief in a cross-section of people in mourning. [Apoyo social y bienestar psicológico como posibles predictores de estado de duelo complicado en poblac de personas en duelo]

“…Thus, social support (SS) counted on by a person in mourning, may be a matter of much importance in the early stages, of softening and cushioning the impact of the death of a loved one (damping effect), as well as in the final stages of assisting the improvement and recovery of the bereaved (recovery effect) (Lobb et al, 2010;Mancini, Prati & Bonanno, 2011;Stroebe, Wech, Stroebe & Abakoumkin, 2005).…”

The effect of caring on post-bereavement outcome: Research gaps and practice priorities

“…Despite approximately 10 to 20% of bereaved individuals demonstrating persistent psychiatric difficulties, 38,39 formal services and supports available to family caregivers pre-and post-bereavement in Australia, the United Kingdom, and the United States struggle with how to use their limited resources to deliver best-practice bereavement support. [40][41][42][43][44] For instance, a survey of Australian palliative care services 43 determined that, although 95% (of 236 services) offered some form of bereavement support, the variability between services resulted from a "lack of clear evidence to guide development and allocation of bereavement programs in palliative care" (p. 230).…”