Explore the vast range of titles available.

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.

Acute grief appears more severe after COVID-19 deaths than natural deaths. Prolonged grief disorder (PGD) also appears prevalent following COVID-19 deaths. Researchers hypothesize that specific loss characteristics and pandemic-related circumstances may precipitate more severe grief following COVID-19 deaths compared to (other) natural deaths. Systematic research on these hypotheses may help identify those most at risk for severe grief reactions, yet it is scant. To compare loss characteristics, loss circumstances, and grief levels among people bereaved due to COVID-19, natural, and unnatural causes. Adults bereaved through COVID-19 (n = 99), natural causes (n = 1006), and unnatural causes (n = 161) completed an online survey. We administered self-report measures of demographic variables (i.e., age, gender), loss characteristics (i.e., time since loss, relationship with the deceased, intensive care admission, expectedness of death), loss circumstances (i.e., saying goodbye appropriately, COVID-19 infection, quarantine, financial setbacks, social support satisfaction, altered funeral arrangements, funeral satisfaction), and prolonged grief symptoms. COVID-19 deaths (vs. other deaths) more often were parental deaths and less often child deaths. COVID-19 deaths (vs. natural deaths) were more often unexpected and characterized by an inability to say goodbye appropriately. People bereaved due to COVID-19 (vs. other deaths) were more often infected and quarantined. COVID-19 deaths (vs. other deaths) more often involved intensive care admission and altered funeral arrangements. COVID-19 deaths yielded higher grief levels than natural deaths (but not unnatural deaths). Expectedness of the death and the inability to say goodbye appropriately explained this effect. Bereavement due to COVID-19 is characterized by a unique set of loss characteristics and circumstances and elevated grief levels. Improving opportunities to say goodbye before and after death (e.g., by means of rituals) may provide an important means to prevent and reduce severe grief following COVID-19 deaths. COVID-19 deaths have unique loss characteristics and circumstances and elicit more severe grief than natural deaths. Death expectedness and the ability to say goodbye appropriately appear important in understanding, preventing and treating grief following COVID-19 deaths.

Prolonged Grief Disorder (PGD) was newly included in the 11th edition of the International Classification of Diseases (ICD-11) and the text revision of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) There is a need to increase our understanding of the prevalence, nature, and risk factors of this condition. Research in this area can be advanced by pooling existing datasets. The MARBLES (Multi-region Archive of Research data on Bereavement and Loss from Empirical Studies) project was initiated to create a consortium of researchers conducting studies on PGD. Its goal is to harmonize and combine data from separate studies into a unified, individual participant data-archive, boosting bereavement research. To date, data from 16,666 bereaved individuals have been compiled from 32 datasets across nine countries. All datasets include data on PGD symptoms and sociodemographic and loss characteristics; most also include data on emotion regulation and concurrent symptoms. For preliminary analyses presented in this paper, data on sociodemographic and loss-related characteristics and on PGD, posttraumatic stress, and depression symptoms were harmonized. Regarding the preliminary analyses, participants' mean age was in their mid-40s, about 70% of the participants were female, one in four participants had lost a partner, and one in four participants experienced an unnatural loss. Analyses (with multiple imputation) indicated that 18.3% met criteria for probable PGD (ICD-11). The MARBLES archive demonstrates that it is feasible to build a FAIR archive of PGD symptom data. Although the archive can already be used to study the prevalence, pathogenesis, and predictors of PGD symptoms and associated emotional problems, it is intended as an evolving resource. Its potential will expand as additional datasets are added and use of the archive grows. Future extensions should prioritize the inclusion of underrepresented groups (e.g. migrants) and currently missing social, cognitive, and neurobiological variables.

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.

Prolonged Grief Disorder (PGD) is a new stress-related disorder included in both the ICD-11 and DSM-5-TR. It is characterised by persistent longing for and preoccupation with the deceased, accompanied by associated emotional symptoms. The Aarhus Prolonged Grief Disorder scale (A-PGDs) is a self-report measure based on these diagnostic criteria. A clinically validated straightforward scoring method may increase its clinical utility. This study aimed to establish a scoring procedure for identifying probable ICD-11 and DSM-5-TR PGD cases using the A-PGDs. Specifically, we sought to develop a two-step approach requiring endorsement of core symptoms and exceeding a cut-off score on associated symptoms. Participants included bereaved adults (  = 122; 89.9% female) experiencing grief-related difficulties more than six months post loss. Optimal item thresholds for core symptoms were identified, and receiver operator characteristic (ROC) curve analyses determined the optimal cut-off score for associated symptoms. The Aarhus Structured Clinical Interview (A-PGDi) served as the gold standard. Endorsing core symptoms at a threshold of ≥3 identified 81.1% (  = 99) of participants. For these individuals, a cut-off score of ≥27 on the associated symptom items produced sensitivity and specificity of 80% and 61%, respectively, for ICD-11 PGD, and a cut-off score of ≥29 produced sensitivity and specificity of 81% and 66%, respectively, for DSM-5-TR PGD. Using the full two-step method, sensitivity and specificity were 80% and 70% for ICD-11 PGD, and 78% and 74% for DSM-5-TR PGD. Prevalence estimates were 34.4% for probable ICD-11 PGD and 36.0% for DSM-5-TR PGD. This two-step scoring method provides a simple, easy-to-use approach for clinicians to identify probable PGD cases.

Prolonged Grief Disorder (PGD) is a new disorder. A structured clinical interview for ICD-11 and DSM-5-TR PGD is a necessary tool in diagnosing PGD needed as PGD is implemented as a mental disorder in health services across the world. This study developed and validated The Aarhus PGD Interview (A-PGDi) to provide clinicians with free access to a valid method to diagnose PGD in alignment with recent diagnostic requirements in ICD-11 and DSM-5-TR and to training materials. The A-PGDi was developed in close collaboration between scientists, clinicians, and bereaved individuals. First, all PGD-symptoms underwent two rounds of item-formulations by clinicians and researchers. Then, a first version of the A-PGDi was tested in a group of bereaved adults with PGD symptoms, who were interviewed about the A-PGDi. The A-PGDi was refined according to their responses, piloted in 13 bereaved adults and further refined to its final version. The validity of A-PGDi was then tested with clinical interviews for PGD, PTSD, depression, and anxiety performed by carefully trained clinical interviewers in a sample of 124 bereaved adults (mean age 47 years (range 19-83 years); 85% female). Benchmarked against a self-report measure of PGD and moderate to substantial inter-diagnostic agreement between ICD-11 and DSM-5-TR diagnoses the A-PGDi had sufficient content validity. Significant relations between PGD-diagnosis and other mental disorders estimated with clinical interviews and self-report scales and moderate to substantial inter-diagnostic and test-retest agreement indicated sufficient criterion validity and reliability. small non-probability sample with PGD symptoms; self-identified for participation; mostly female. The results indicate that A-PGDi with some limitations is a valid structured clinical interview for diagnosing both ICD-11 and DSM-5-TR PGD that is relevant to administer in mental health settings to ensure correct diagnostics and the most helpful treatment plan for people with PGD.

Prolonged Grief Disorder (PGD) affects a significant minority of bereaved individuals, leading to persistent emotional distress and functional impairment for six months or more. While cognitive behavioural therapy (CBT) with a grief specific focus is effective, access is limited due to the resource demands of in-person therapy. Guided digital therapies offer a promising alternative, but research on their use in the UK remains limited. This study aimed to develop a guided digital therapy for PGD using a co-production approach that engaged both individuals with relevant lived experience and professionals specialising in grief-related mental health. The goal was to design a user-centred, evidence-informed intervention to improve access to PGD treatment. The development process followed a multi-stage approach. First, rapid literature reviews were conducted to assess existing evidence on in-person and digital therapies for PGD. Second, qualitative interviews were held with stakeholders, including individuals with lived experience of PGD and professionals in grief and/or digital interventions. The interviews gathered opinions on intervention content, structure, and delivery. Inductive thematic analysis was used to identify key themes, which informed the intervention design. Five key themes emerged: (1) acceptability of digital interventions for PGD, (2) challenges in adjusting to loss and finding meaning, (3) optimal timing for therapy, (4) the need for simplicity in intervention delivery, and (5) strategies for effective user engagement. These insights guided the development of a practical, accessible, and engaging intervention. The co-production process led to the development of a guided digital therapy for PGD, incorporating perspectives from both individuals with lived experience and professionals. This study highlights the importance of cultural sensitivity, user engagement, and simplicity in digital intervention design. Findings will inform the next steps in evaluating and refining the intervention to enhance access to PGD treatment in the UK and beyond.

Bereavement may lead to heterogeneous psychological responses, including prolonged grief disorder (PGD), depression, and psychotic-like experiences (PLEs). Individuals' attitudes toward death may play a significant role in bereavement adjustment. This study aimed to identify latent subgroups of bereaved Chinese college students based on their symptom endorsement of PGD, depression, and PLEs, and to examine the predictive role of five specific death attitudes - fear of death, death avoidance, neutral acceptance, approach acceptance, and escape acceptance - on class membership over time. At baseline, 366 bereaved college students completed measures of PGD, depression, PLEs, and death attitudes. Of these, 159 (43.4%) completed the six-month follow-up survey. Latent class analysis was conducted to identify subgroups, and multinomial logistic regression was used to explore predictors of class membership at follow-up. A three-class solution was identified as optimal among the retained participants: a Resilient class, a Moderate Symptoms with Elevated Delusions Class and a High Symptom Class. Compared to those in the High Symptom Class, students in the Resilient Class were more likely to report better physical health and to have experienced a non-violent loss. Furthermore, higher levels of fear of death and escape acceptance at baseline significantly predicted membership in High Symptom Class six months later. Bereaved college students exhibited distinct symptom profiles, with a small subgroup experiencing severe comorbid symptoms of grief, depression, and PLEs. Death attitudes were important predictors of class membership. Although the high attrition rate and differences between retained participants and dropouts warrant caution in generalising the findings, the results underscore the importance of early identification and tailored interventions for bereaved college students. Interventions targeting maladaptive death attitudes, particularly fear of death and escape acceptance, may represent an effective strategy to promote adaptive bereavement adjustment.

Background: Due to its high death toll and measures to curb the pandemic, COVID-19 has affected grieving experiences and may contribute to risk factors for Prolonged Grief Disorder (PGD). Persons at risk for PGD often seek support from grief counselling. Objective: To explore whether pandemic-associated risk factors have become more important topics in counselling in a mixed-method design. Method: German grief counsellors (n = 93) rated whether pre-defined risk factors had become more important in grief counselling and indicated additional important themes in an open format. Results: The counsellors indicated that all pre-defined risk factors had become more important, though differing significantly in their frequency. Most frequently endorsed risk factors were lack of social support, limited possibilities to accompany a dying loved one and absence of traditional grief rituals. Qualitative analysis identified three additional themes: the societal impact of the pandemic, its impact on bereavement support and health care, and a chance for personal growth. Conclusions: The pandemic has affected bereavement experiences and grief counselling. Counsellors should monitor grief processes and specific risk factors to provide the best possible care for bereaved people when needed. Pandemic-associated risk factors for PGD have become more important topics in grief counselling during COVID-19. Risk factors include especially a lack of social support, limited possibility to accompany a dying significant other and absence of traditional grief rituals. Future research is needed to investigate whether monitoring and addressing these risk factors can improve bereavement care.

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.