The Temporal Relationship Between Change in Symptoms of Prolonged Grief and Posttraumatic Stress Following Old Age Spousal Bereavement

Abstract

Background High levels of prolonged grief symptoms (PGS) and posttraumatic stress symptoms (PTS) are relatively common following bereavement. The two types of bereavement complications share some but not all of the same features. Little research has studied which of the two precedes the other following the death of a loved one. The purpose of this study was to examine the temporal relationship between change in PGS and PTS during the first 4 years following old age spousal loss. Methods Participants were 237 Danes (40% male; mean age = 73 years, SD = 4.4; range 65–81) who during the year of 2006 lost their spouse. Participants completed self‐report questionnaires at 6 months (n = 237), 13 months (n = 198), 18 months (n = 192), and 48 months (n = 213) post loss. Main outcome measures were Inventory of Complicated Grief—Revised and the Harvard Trauma Questionnaire. Results Lower level mediation analyses were performed. Results indicated that PGS mediated 83% of the relationship between time and PTS, whereas PTS only mediated 17% of the relationship between time and PGS. These results suggest that changes in PGS mediated changes in PTS following spousal bereavement to a greater extent than vice versa. Conclusions The findings in the present study indicate that changes in PGS may precede and potentially directly impact changes in PTS following bereavement. This tentative conclusion points to the potential value of targeting PGS in psychological interventions at an early point in the long‐term perspective following old age spousal bereavement.

Symptoms of prolonged grief and major depressive disorders: Distinctiveness and temporal relationship in the first 2 years of bereavement for family caregivers of terminally ill cancer patients

“…If both models for examining the mediation effects of PGD and depressive symptoms are confirmed, the amounts of variance explained by the two mediation variables (PGD symptoms or depressive symptoms) would indicate the similarity or distinctiveness of the two constructs. If they are the same, their relationship should be bidirectional, indicated by approximately the same amount of change in variance in one construct being explained by the other construct …”

“…Lower‐level mediation analysis differs from upper‐level mediation analysis, which aims to investigate between‐group differences (eg, in gender or age) . If PGD and MDD are expressions of the same latent concept, these constructs will have a bidirectional relationship, in which change in each construct will predict about the same change in the other construct's variance . In contrast, if the two constructs are different, lower‐level mediation analysis will reveal that changes in each construct predict a considerably different amount of change in the variance of the other construct …”

“…Furthermore, caregivers with PGD symptoms also have significant depressive symptoms . However, no studies have explicitly explored the temporal relationship of these two constructs, despite such a relationship being established for symptoms of PGD and posttraumatic stress disorder (PTSD) following bereavement . Indeed, PGD symptoms were shown to precipitate PTSD symptoms following bereavement rather than vice versa .…”

“…However, no studies have explicitly explored the temporal relationship of these two constructs, despite such a relationship being established for symptoms of PGD and posttraumatic stress disorder (PTSD) following bereavement . Indeed, PGD symptoms were shown to precipitate PTSD symptoms following bereavement rather than vice versa . Information on the temporal relationship between PGD and MDD is important to guide development of effective interventions to avoid the subsequent emotional disorder.…”

“…Information on the temporal relationship between PGD and MDD is important to guide development of effective interventions to avoid the subsequent emotional disorder. The temporal relationship of PGD and MDD during bereavement can be examined by a lagged approach in lower‐level mediation analysis (ie, depressive symptoms measured in the previous wave of assessment might mediate current PGD symptoms or vice versa). A lagged approach can directly establish a chronological order, despite reducing statistical power by sacrificing one time point .…”