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Background: Violent loss (i.e. loss through homicide, suicide, or accident) is associated with high levels of prolonged grief disorder (PGD). Objective: The current meta-analysis aims at identifying correlates of PGD in adults exposed to violent loss. Method: We conducted a systematic literature search in PsycINFO, PsycARTICLES, PubMed, Web of Science, and Scopus. We used the Pearson correlation coefficient r as an effect size measure and a random effects model was applied to calculate effect sizes. Results: Thirty-seven eligible studies published between 2003 and 2017 (N = 5911) revealed 29 potential correlates. Most studies used a cross-sectional design. Analyses revealed large significant effect sizes for comorbid psychopathology (r = .50-.59), suicidality (r = .41, 95% confidence interval [CI] [.30; .52]), and rumination (r = .42, 95% CI [.31; .52]), while medium effect sizes were found for exposure to traumatic events and factors concerning the relationship to the deceased. Small effect sizes emerged for sociodemographic characteristics, multiple loss, physical symptoms, and religious beliefs. Ten variables did not show a significant association with PGD. Heterogeneity and a small number of studies assessing certain correlates were observed. Conclusions: The associations with psychological disorders may indicate shared mechanisms of psychopathology. Moreover, we recommend that clinicians carefully assess suicidal ideation among individuals with PGD who have been exposed to violent loss. Further research is warranted using longitudinal study designs with large sample sizes to understand the relevance of these factors for the development of PGD.

Background: Studies on mental health following disasters have primarily focused on post-traumatic stress disorder (PTSD), yet severe, enduring, and disabling grief [i.e. complicated grief (CG)] also appears relevant. Objective: The present study examines symptom profiles of PTSD and CG among bereaved Sichuan earthquake survivors 1 year after the disaster. Method: Self-report measures of demographic, disaster, and loss-related characteristics and symptoms of PTSD and CG were administered among 803 survivors (63% women; mean age = 46.7 years). Latent class analysis (LCA) was performed to identify subgroups of people with different PTSD and CG symptom profiles. Results: The LCA demonstrated that a five-class solution yielded the best fit, consisting of a CG class with low PTSD and high CG (N = 208), a combined class with high PTSD and high CG (N = 205), a class with low PTSD and partial CG (N = 145), a class with partial PTSD and CG (N = 136), and a resilient class with low PTSD and CG (N = 108). Being a woman (vs man), losing a child or spouse (vs other), being injured (vs non-injured), and/or having a missing family member (vs non-missing) predicted membership of the CG class compared to other classes. Conclusions: CG appears to be a unique consequence of disasters involving many casualties. Disaster survivors should be screened for CG and provided with appropriate psychological treatment. * Earthquakes elicit post-traumatic stress disorder (PTSD) and complicated grief (CG), but research on CG is still limited.* We performed the first latent class analysis on PTSD and CG among bereaved earthquake survivors.* The analysis demonstrated a five-class solution, which includes a CG class and a resilient class* The results suggest that disaster mental health services should screen for CG and offer CG-specific therapies.

Background: Prolonged grief disorder (PGD) will be newly included in the ICD-11, while a clinically similar diagnosis, persistent complex bereavement disorder (PCBD), has already been added to the DSM-5. Only few studies have evaluated these criteria-sets for prolonged grief. Objective: The aim of this study was to evaluate the ICD-11 accessory symptom threshold and compare the diagnostic performance of the two criteria-sets in treatment-seeking bereaved persons. Method: 113 grief treatment-seeking bereaved persons completed the Interview for Prolonged Grief-13. We used receiver operator characteristic analysis to determine an optimum ICD-11 accessory symptom threshold. We calculated diagnostic rates for PGD and PCBD and examined associations of PGD and PCBD caseness with concurrently assessed psychopathology and prolonged grief symptoms assessed one month later. Results: An ICD-11 threshold of six accessory symptoms distinguished optimally between interview-diagnosed participants with and without prolonged grief. The prevalence of PGD (69%) was significantly higher than that of PCBD (48%) and of PGD with a 6-symptom threshold (47%). PGD caseness was associated with the relation to the deceased, 6-symptom threshold PGD and PCBD caseness with the time since loss. All criteria-sets were linked to concurrent prolonged grief, depression, and general mental distress. PCBD and 6-symptom threshold PGD but not PGD were associated with prolonged grief severity one month later. Conclusions: The results support the validity of PGD and PCBD but, at the same time, they provide further support for differing prevalence rates. Using an empirically determined ICD-11 accessory symptom threshold could prevent the pathologisation of grief reactions.

Background: The ability to adapt to the psychosocial disruptions associated with the refugee experience may influence the course of complicated grief reactions. Objective: We examine these relationships amongst Myanmar refugees relocated to Malaysia who participated in a six-week course of Integrative Adapt Therapy (IAT). Method: Participants (n = 170) included Rohingya, Chin, and Kachin refugees relocated to Malaysia. At baseline and six-week post-treatment, we applied culturally adapted measures to assess symptoms of Prolonged Complex Bereavement Disorder (PCBD) and adaptive capacity to psychosocial disruptions, based on the Adaptive Stress Index (ASI). The ASI comprises five sub-scales of safety/security (ASI-1); bonds and networks (ASI-2); injustice (ASI-3); roles and identity (ASI-4); and existential meaning (ASI-5). Results: Multilevel linear models indicated that the relationship between baseline and posttreatment PCBD symptoms was mediated by the ASI scale scores. Further, ASI scale scores assessed posttreatment mediated the relationship between baseline and posttreatment PCBD symptoms. Mediation of PCBD change was greatest for the ASI II scale representing disrupted bonds and networks. Conclusion: Our findings are consistent with the informing model of IAT in demonstrating that changes in adaptive capacity, and especially in dealing with disrupted bonds and networks, may mediate the process of symptom improvement over the course of therapy. * Our finding supports the core premise of IAT in improving adaptive stress (reflected in the ASI scales) as a potential mechanism through which mental health symptoms can be mitigated with ASI-2 (bonds and networks) exerting the largest effect on PCBD symptoms at follow-up.