The longitudinal association between symptoms of posttraumatic stress and complicated grief: A random intercepts cross-lag analysis.

Abstract

Objective: Knowledge about the temporal relationship between disturbed grief and symptoms of posttraumatic stress disorder (PTSD) may have important implications for clinicians working with bereaved trauma survivors. We aimed to investigate the longitudinal association between symptoms of complicated grief and PTSD in a bereaved trauma-exposed sample. Method: In total, 275 bereaved survivors (M age = 19.3, SD = 4.6 years; 47.3% females) of the 2011 massacre on Utøya Island, Norway, participated in semistructured interviews 4-5 months (Time 1 [T1]), 14-15 months (Time 2 [T2]), and 30-32 months (Time 3 [T3]) posttrauma. Complicated grief was measured using the Brief Grief Questionnaire, and posttraumatic stress reactions using the University of California at Los Angeles PTSD Reaction Index. To explore associations between symptoms of complicated grief and PTSD over time, we used a random intercepts cross-lagged panel model. Results: The participants had lost a close friend (n = 256) and/or a family member/partner (n = 19) in the attack. We found a strong correlation between stable individual differences in symptoms of complicated grief and PTSD across the three time-points. PTSD symptoms at T2 predicted complicated grief reactions at T3, but not vice versa. Conclusion: Findings suggest that targeting PTSD symptoms among trauma-exposed bereaved may hinder later development of complicated grief. Clinical Impact StatementWe found a strong, positive association between symptoms of complicated grief and posttraumatic stress disorder (PTSD). PTSD symptoms predicted complicated grief reactions at a subsequent time point, but not vice versa. Our findings suggests that targeting PTSD symptoms may hinder later development of complicated grief.

How symptoms of prolonged grief disorder, posttraumatic stress disorder, and depression relate to each other for grieving ICU families during the first two years of bereavement

“…PGD symptoms consistently preceded PTSD symptoms over the first 2 bereavement years (Fig. 2 ), consistent with three previous studies [ 19 , 20 , 22 ]. Separation distress [ 37 , 38 ] and stress sensitization theory [ 43 ], as described above, may similarly explain why PGD symptoms consistently predicted heightened PTSD symptoms.…”

“…We observed that symptoms of PTSD predicted subsequent PGD symptoms beyond the first bereavement year, consistent with the report for survivors of a terrorist attack [ 20 ]. A meta-analysis indicated the prevalence of PGD is much higher (49% [95% confidence interval (CI) 33.6, 65.4]) in people bereaved by unnatural or traumatic deaths [ 47 ] than by losses primarily due to diseases (9.8% [95% CI 6.8–14.0]) [ 48 ].…”

“…Further, PGD is defined as a spectrum of grief symptoms occurring at least 6 months after the death as per the minimum duration criterion [ 23 ]. Assessments made earlier (1–4 [ 22 ] or 4–5 [ 20 ] months post-loss) may invalidate the PGD assessment. Therefore, the purpose of this study was to establish an appropriate time interval reflecting the PGD duration criterion and longitudinally determine the temporal reciprocal relationships between symptoms of PGD, PTSD, and depression among ICU family surrogates during their first 2 bereavement years to determine a potential mechanism of comorbidity.…”

“…Identifying psychological distress promptly in the preceding period and targeting it with appropriate symptom management may block subsequent development/exacerbation of long-lasting comorbid psychological distress and functional impairment. Yet, knowledge about temporal relationships between PGD, PTSD, and depression is limited with most of the focus on PTSD and depression [10][11][12][13][14][15][16], less on PGD and PTSD [17][18][19][20], and least on PGD and depression [19,21,22]. Only one study [19] was found to explore the temporal relationships between PGD, PTSD, and depression simultaneously following traumatic losses from an airplane crash.…”

DSM-5-TR prolonged grief disorder and DSM-5 posttraumatic stress disorder are related, yet distinct: confirmatory factor analyses in traumatically bereaved people

“…r = .76; Boelen, van Denderen, & de Keijser, 2016 ), people exposed to disaster/terror attack (i.e. r = ≥ .79 ≤ .88 across four time-points; Lenferink et al, 2019 ; r = ≥ .57 ≤ .65 across three time-points; Glad, Stensland, Czajkowksi, Boelen, & Dyb, 2021 ), and internally displaced people (i.e. r = .50; Heeke, Stammel, & Knaevelsrud, 2015 ).…”