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PurposePrior latent class analyses (LCA) have focused on people who were bereaved more than 6 months earlier. Research has yet to examine patterns and correlates of emotional responses in the first few months of bereavement. We examined whether subgroups could be identified among very recently (≤ 6 months) bereaved adults, based on their endorsement of symptoms of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. Associations of class membership with overall disturbed grief, PTSD, and depression—assessed concurrently and at 6 months follow-up—were examined. Furthermore, we examined differences between classes regarding socio-demographics, loss-related, and cognitive behavioural variables.MethodsPGD, PTSD, and depression self-report data from 322 Dutch individuals bereaved ≤ 6 months earlier were subjected to LCA; N = 159 completed the follow-up assessment. Correlates of class membership were examined.ResultsThree classes were identified: a low symptom class (N = 114; 35.4%), a predominantly PGD class (N = 96; 29.8%), and a high symptom class (N = 112; 34.8%). PGD, PTSD, and depression scores (assessed concurrently and at 6 months follow-up) differed significantly between classes, such that low symptom class < predominantly PGD class < high symptom class. Being a woman, younger, more recently bereaved, experiencing deaths of a partner/child and unnatural losses, plus maladaptive cognitions and avoidance behaviours were associated with membership of the pervasive symptom classes.ConclusionIn the first 6 months of bereavement, meaningful subgroups of bereaved people can be distinguished, which highlights the relevance of early detection of people with elevated bereavement-related distress and offering them preventive interventions that foster adaptation to loss.

Five diagnostic criteria sets for pathological grief are currently used in research. Studies evaluating their performance indicate that it is not justified to generalise findings regarding prevalence rates and predictive validity across studies using different diagnostic criteria of pathological grief. We provide recommendations to move the bereavement field forward.

Theoretical and anecdotal work suggests that Prolonged Grief Disorder (PGD) reactions go up and down during the day. However, empirical evidence supporting this claim is lacking. It is also unknown in which context PGD reactions go up and down. Using Experience Sampling Methodology (ESM), we examined whether PGD reactions (ESM-PGD) relate to contextual factors in daily life. For 14 days, five times per day, bereaved adults ( N  = 53; 74% women) rated the intensity of 11 ESM-PGD reactions representing DSM-5-TR PGD symptoms. Using mixed-effect regression analyses, we examined whether contextual factors (i.e., physical and social environments, and time of day) were associated with each ESM-PGD reaction separately. Being away from home compared to being at home was associated with more avoidance. Being alone compared to being in a pleasant social contact was associated with more preoccupation with the loss, intensified feelings that part of oneself died, and increased perception of the loss as unreal. Lastly, a later time of day was related to stronger feelings of loneliness and difficulties moving on. Our findings suggest that ESM-PGD reactions may be context-dependent. This calls for a context-sensitive treatment approach, such as ecological momentary interventions.

According to network theories, mental disorders, including prolonged grief disorder (PGD), comprise networks of dynamically connected symptoms. Examining how prolonged grief symptoms are connected over time could reveal the patterns driving their persistence. This study provides the first empirical investigation of prolonged grief symptom networks using self-reported data on prolonged grief assessed multiple times daily. Adults whose partner, family member, or friend died on average 30 months ago (N = 229, 80 % women, Mage = 51) rated prolonged grief symptom intensity using 11 items (e.g., “In the past three hours, I found myself yearning for him/her”) five times per day for two weeks. We used a two-step multilevel vector autoregressive model to produce between-person, contemporaneous, and temporal networks. In the between-person network, yearning and sadness were the most strongly and positively connected symptoms. In the contemporaneous network, yearning, preoccupation, and sadness formed a cluster of positively connected symptoms. Simultaneously, difficulty reintegrating after the loss, emotional numbness, meaninglessness, and loneliness due to the loss formed another positively connected symptom cluster. In the temporal network, emotional numbness had the greatest positive influence on other prolonged grief symptoms at the subsequent timepoint. We propose that targeting emotional suppression, promoting flexible emotion regulation, and supporting integrated continuing bonds (approach-behaviors) and targeting avoidance of the reality of the loss (avoidance-behaviors) may help people to adapt to loss. •First study to examine dynamic interactions among prolonged grief (PG) symptoms.•Emotional numbness emerged as a central symptom in the temporal network.•People can yearn for the deceased while avoiding facing the reality of the loss.•PG symptoms are different in their between-person, within time points, and temporal connections.

Early grief reactions have been hypothesized to fluctuate within persons and to be one of the strongest predictors of Prolonged Grief Disorder (PGD). Experience Sampling Methodology (ESM) offers an opportunity to examine (early) PGD dynamics in daily contexts. For this, however, a brief and valid ESM scale is needed to accurately assess PGD symptoms in everyday life. We investigated the psychometric properties of ESM items developed to assess momentary prolonged grief symptoms in daily life (ESM-PGD). Additionally, we aimed to create a valid brief scale for future ESM studies. Bereaved adults (N = 169) whose loved ones died 3–6 months earlier completed 11 ESM-PGD items based on 10 PGD symptoms, as defined in DSM-5-TR, five times a day for 14 consecutive days at semi-random intervals. We performed multilevel confirmatory factor analysis (MCFA), calculated root-mean-square of successive differences (RMSSD) and intraclass correlations (ICC), and conducted correlational analyses of ESM-PGD items with related mental health symptoms (e.g., depression) to identify the best-performing items. MCFA confirmed that the hypothesized one-factor model fits the data well with good composite reliability at the between- and within-person levels. All ESM-PGD items were able to distinguish between people with and without early PGD. Examination of within-person level factor loadings, ICCs and RMSSDs revealed that not all ESM-PGD items were able to capture fluctuations of momentary PGD symptoms. The best-performing items were selected, resulting in a valid 2-item Prolonged Grief Symptoms – Short Ecological Assessment (PGS-SEA) scale for assessing PGD in daily life to facilitate ESM-research on PGD. •We evaluated the psychometric properties of 11 ESM items developed to assess PGD.•Sadness and yearning items performed best across multiple indices.•These items formed the PGS-SEA, a scale assessing PGD symptoms in daily life.

Background Parents who experience the death of a child may develop a range of mental health problems including insomnia and prolonged grief disorder (PGD). Insomnia symptoms predict worsening of prolonged grief symptoms and persons with more chronic insomnia trajectories may be at risk of developing PGD. However, it remains to be established when prolonged grief and insomnia symptomatology co-occur and which potential risk factors heighten the risk of comorbid insomnia and prolonged grief. Methods To address these questions, we conducted a cross-sectional, registry-based survey study involving 225 Swedish parents who lost a child to cancer 1–5 years ago. We assessed sociodemographic and loss-related characteristics, self-rated health, grief rumination, and depressive, posttraumatic stress, prolonged grief, and insomnia symptoms. Results A latent class analysis yielded a three-class solution, including a resilient class ( n  = 58, 25.9%), characterized by predominantly low to moderate odds of insomnia and prolonged grief symptoms, a prolonged grief class ( n  = 75, 33.1%), characterized by moderate to high probability of prolonged grief symptoms and low to moderate probability of insomnia symptoms, and a comorbid prolonged grief/insomnia class ( n  = 92, 41.0%), characterized by predominantly high odds of prolonged grief and insomnia symptoms. Univariate analyses of covariates demonstrated that self-rated health, grief rumination, depressive, posttraumatic stress, prolonged grief, and insomnia symptoms differed across classes. The resilient class demonstrated the lowest levels of these covariates, the prolonged grief class higher levels, and the prolonged grief/insomnia class the highest levels. Results for sociodemographic and loss-related variables were less consistent. Multivariate analyses including all covariates simultaneously identified older age and grief rumination variables uniquely distinguishing two or more latent classes. Conclusions Results confirm that bereaved parents are at risk of experiencing comorbid insomnia and prolonged grief. However, substantive subgroups of this population report prolonged grief symptoms without severe insomnia symptoms or demonstrate resilience. Older age of the parent and rumination emerged as potential risk factors for co-occurring severe insomnia and prolonged grief symptoms. Rumination may be a key target for interventions for bereaved parents experiencing these mental health problems. Clinical trial number Not applicable.

Non-fatal traffic accidents may give rise to mental health problems, including posttraumatic stress (PTS) and depression. Clinical evidence suggests that victims may also experience grief reactions associated with the sudden changes and losses caused by such accidents. The aim of this study was to examine whether there are unique patterns of symptoms of PTS, depression, and grief among victims of non-fatal traffic accidents. We also investigated associations of emerging symptom patterns with sociodemographic variables and characteristics of the accident, and with transdiagnostic variables, including self-efficacy, difficulties in emotion regulation, and trauma rumination. Participants (N = 328, M age = 32.6, SD age = 17.5 years, 66% female) completed self-report measures tapping the study variables. Using latent class analysis (including symptoms of PTS, depression, and grief), three classes were identified: a no symptoms class (Class 1; 59.1%), a moderate PTS and grief class (Class 2; 23.1%), and a severe symptoms class (Class 3; 17.7%). Summed symptom scores and functional impairment were lowest in Class 1, higher in Class 2, and highest in Class 3. Psychological variables were similarly ordered with the healthiest scores in Class 1, poorer scores in Class 2, and the worst scores in Class 3. Different sociodemographic and accident related variables differentiated between classes, including age, education, and time since the accident. In a regression including all significant univariate predictors, trauma rumination differentiated Class 2 from Class 1, all three psychological variables differentiated Class 3 from Class 1, and difficulties with emotion regulation and trauma rumination differentiated Class 3 from Class 2. This study demonstrates that most people respond resiliently to non-fatal traffic accident. Yet, approximately one in three victims experiences moderate to severe mental health symptoms. Increasing PTS coincided with similarly increasing grief, indicating that grief may be considered in interventions for victims of traffic accidents. Trauma rumination strongly predicted class membership and appears a critical treatment target to alleviate distress.

Prolonged grief disorder (PGD) is included in the Diagnostic and Statistical Manual of Mental Disorders text-revised fifth edition (DSM-5-TR) and in the International Classification of Diseases Eleventh Edition (ICD-11). While PGD screening instruments exist for adults, these instruments are not applicable to children. Caretakers play a crucial role in screening for PGD in children. We evaluated the psychometric properties of the Traumatic Grief Inventory-Kids-Caregiver-Report (TGI-K-CR) to screen for DSM-5-TR and ICD-11 PGD in children. On a website with information about grief, 196 Dutch caregivers (82% woman; age = 44) completed questions about their own and their child's (47% girls; age = 11; 44% lost a parent) background and loss-related characteristics (77% of deaths resulted from illness). Caregivers completed the TGI-K-CR and a self-report measure about their own PGD intensity. Factor structure and internal consistency of DSM-5-TR and ICD-11 PGD items were examined separately. T-tests and correlation analyses examined whether caregiver-ratings of PGD intensity in children differed as a function of background- and loss-related characteristics. Provisional cut-offs for both criteria sets were determined. Confirmatory factor analyses showed support for two distinct, but related, factors for DSM-5-TR and ICD-11 PGD items. We found strong internal consistency (  = .85 for DSM-5-TR;  = .87 for ICD-11), while some factor loadings were poor. In support of known-groups validity, DSM-5-TR and ICD-11 PGD intensity were higher in children when caregivers reported higher PGD intensity for themselves and when deaths occurred more recently. ROC analyses showed optimal cut-off scores of ≥46 and ≥52 to determine probable caseness for DSM-5-TR and ICD-11 PGD, respectively, when summing all 16 items. The psychometric properties of the TGI-K-CR seem promising, but more research among larger samples is needed. This caregiver screening tool for PGD in children (aged 8-18) may advance child bereavement research and care.

Content overlap analyses showed moderate overlap between symptoms of PGD per DSM-5-TR and ICD-11 and between these diagnoses and prior criteria sets. We should establish when new criteria sets for PGD behave similarly or differently. Convergence of PGD criteria sets is needed. The International Classification of Diseases eleventh edition (ICD-11) has recently included prolonged grief disorder (PGD), a diagnosis characterized by severe, persistent, and disabling grief. The text revision of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5-TR) is scheduled to include a similar but distinct diagnosis, also termed PGD. Concerns have been raised that these new diagnoses are qualitatively different from both prior proposed diagnoses for pathological grief and each other, which may affect the generalizability of findings obtained with different criteria sets. We conducted a content overlap analysis of PGD ICD-11 , PGD DSM-5-TR , and previous proposals for pathological grief diagnoses (i.e. PGD 2009; complicated grief (CG), PGD ICD-11 beta draft, persistent complex bereavement disorder (PCBD) per DSM-5). Using the Jaccard's Index, we established the degree of content overlap between core and accessory symptoms of PGD ICD-11 , PGD DSM-5-TR , and prior proposals for pathological grief diagnoses. Main findings are that PGD ICD-11 and PGD DSM-5-TR showed moderate content overlap with each other and with most prior proposed diagnoses for pathological grief. PGD ICD-11 and PGD DSM-5-TR showed the strongest content overlap with their direct predecessors, PGD ICD-11 beta draft and PCBD, respectively. Limited content overlap between PGD ICD-11 and PGD DSM-5-TR and preceding criteria sets may threaten generalizability of past research on phenomenological characteristics of pathological grief to current criteria sets. Similarly, findings obtained with instruments to assess PGD ICD-11 may not generalize to PGD DSM-5-TR and vice versa. Researchers should aim to determine under which circumstances criteria sets for PGD yield similar or distinct characteristics. Convergence of criteria sets for PGD remains an important goal for the future.

Background: The disappearance of a significant person is an ambiguous loss due to the persistent uncertainty about the whereabouts of the person. Measures specifically capturing the psychological consequences of ambiguous loss are lacking. Therefore, this study aimed to develop the Ambiguous Loss Inventory Plus (ALI+) and evaluated its suitability for use with relatives of missing persons. Methods: ALI+ items were generated based on established measures for prolonged grief symptoms and literature on psychological responses to ambiguous loss. Eight relatives of missing persons (three refugees, five non-refugees) and seven international experts on ambiguous loss rated all items in terms of understandability and relevance on a scale from 1 (not at all) to 5 (very well). Results: On average, the comprehensibility of the items was rated as high (all items ≥ 3.7). Likewise, all items were rated as relevant for the assessment of common responses to the disappearance of a loved one. Only minor changes were made to the wording of the items based on the experts’ feedback. Conclusions: These descriptive results indicate that the ALI+ seems to cover the intended concept, thus showing promising face and content validity. However, further psychometric evaluations of the ALI+ are needed.