Trajectories of complicated grief

Abstract

-Background and Objectives:In the discussion of apparent similarities between symptoms of grief and depression, research and theory have often confounded these two constructs because, as a construct, grief is distinct from depression and because these two constructs may have distinct trajectories. This study examines the trajectories of complicated grief and associated risks and the relationship between trajectories of complicated grief and depression.Design: Longitudinal. Setting: Intervention methods for enhancing family caregiving for persons with dementia. Participants: A total of 221 participants of the Resources for Enhancing Alzheimer's Caregiver Health project.Measurement: The Inventory of Complicated Grief. Results:The results based on group-based mixture modeling identify two distinct trajectories of grief (persistently high and low) and three distinct trajectories of depression (persistently high, moderate, and low). There were significant differences between the proportion of grief trajectory membership and that of depression trajectory membership, indicating distinct patterns over time.Conclusions: Noteworthy is the significant difference between the proportion of grief trajectory membership and that of depression trajectory membership, indicating differences in distinct patterns over time.

Distinctiveness of prolonged‐grief‐disorder‐ and depressive‐symptom trajectories in the first 2 years of bereavement for family caregivers of terminally ill cancer patients

“…Endurance, transient‐reaction, resilience, and prolonged‐symptomatic trajectories were identified for both PGD and depressive symptoms, whereas symptom trajectories of potential recurrence and chronic distress were uniquely identified for PGD and MDD, respectively. In addition, despite endurance and transient‐reaction trajectories conjointly comprising the most prevalent trajectories for PGD 16‐19 and depressive (see systematic review) 35 symptoms as reported, prevalence rankings of the other trajectories differed between PGD and depressive symptoms (Table 2). The prolonged‐symptomatic trajectory was the third and the least prevalent trajectories for depressive and PGD symptoms, respectively.…”

“…Construct distinctiveness of PGD and MDD has been established by confirmatory factor analysis, 12 bifactor analysis, 13 incremental validity testing for PGD's significantly increasing the explained variance in quality of life above MDD, 14 and lower‐level mediation analysis to show that change in each construct predicts a considerably different amount of change in the variance of the other construct 15 . However, no research has yet compared how well the patterns of change (trajectories) for PGD and MDD symptoms synchronize during bereavement, despite the importance of the temporal frame in defining PGD and MDD, the well‐observed phenomenon that grief‐related distress symptoms resolve over time, 5,8 and the heterogeneity of grief reactions as shown by individually identified distinct symptom trajectories for PGD 8,16‐19 and MDD 16,20‐26 . Furthermore, among studies that identified distinct PGD‐ or MDD‐symptom trajectories, few covered early and late bereavement (1 or 3 months 8,18,22,24,25 and >18 months 16,18,25,26 post‐loss, respectively).…”

“…However, no research has yet compared how well the patterns of change (trajectories) for PGD and MDD symptoms synchronize during bereavement, despite the importance of the temporal frame in defining PGD and MDD, the well‐observed phenomenon that grief‐related distress symptoms resolve over time, 5,8 and the heterogeneity of grief reactions as shown by individually identified distinct symptom trajectories for PGD 8,16‐19 and MDD 16,20‐26 . Furthermore, among studies that identified distinct PGD‐ or MDD‐symptom trajectories, few covered early and late bereavement (1 or 3 months 8,18,22,24,25 and >18 months 16,18,25,26 post‐loss, respectively). Therefore, the purpose of this study was to investigate the construct distinctiveness of PGD and MDD by simultaneously identifying and examining the similarities and differences of bereaved caregivers' symptom trajectories from immediately post‐loss through 2 years later.…”

Trajectories of prolonged grief one to six years after a natural disaster

“…There is a lack of longitudinal studies that examine distinct patterns of grief in disaster-bereaved individuals and factors predicting the different trajectories. To date, two studies [24, 25] have examined different patterns of problematic grief over time after the loss due to natural causes. Djelantik et al [24] found four trajectories of PGD symptoms in bereaved individuals, using two time points, 6 and 18 months post loss: a persistent high PGD symptom-trajectory, a persistent moderate, a decreasing moderate and a persistent low PGD symptom-trajectory.…”

“…In the study, the majority (90%) of individuals had lost a loved one due to a natural cause. In a similar study with one additional assessment at 12 months, Nam [25] identified two trajectories, a persistent high and a persistent low grief trajectory, in a sample of individuals who had lost a relative in dementia, mainly spouses.…”