When Grief Becomes Complicated: Development of Psychopathological Distress in The Years After a Loss

What is it about?

In The Aarhus Bereavement Study (TABstudy, Unit for Bereavement Research, Aarhus University) we followed more than 1000 Danish bereaved individuals throughout the first two years after their loss. Our aim in this study was to better understand how mental health issues such as Prolonged Grief Disorder (PGD), Post-Traumatic Stress Disorder (PTSD), and depression relate to each other after the loss of a close person. Our results suggest that there were large differences in symptom levels of PGD, PTSD, and depression between bereaved individuals. We found that most individuals coped well with their loss with few symptoms of these disorders, but some experienced persisting high symptom levels across the 2 first years after their loss. We also found that initial high levels of preliminary PGD symptoms at 2 months post-loss may pose a risk for later development or intensification of symptoms of PGD, PTSD, and depression. That is, if a person has high levels of PGD symptoms 2 months after the loss, there is a significant risk, that this person will have problems with PGD, PTSD, and/or depression in the longer run. This finding was particularly interesting as the diagnostic criteria for PGD include a time criterion of symptom presence at least 6 months post-loss according to the ICD-11 diagnostic manual and at least 12 months post-loss according to the DSM-5-TR manual, while depression and PTSD can be diagnosed and treated within this period. Our results could be taken to suggest that early identification and treatment of PGD symptoms could be important in preventing later development or intensification of depression, PTSD, and PGD. Finally, we found that symptoms of PGD, PTSD, and depression often occurred together and that the relationship between these syndromes within bereaved individuals became increasingly intertwined over time. Across the two years after the loss, 62-66 % of the participants with PGD symptoms also had symptoms of PTSD, depression, or both. Together, the results suggest complex and closely connected development patterns of PGD, PTSD, and depression in bereaved individuals with complicated grief reactions. The results were similar across bereaved individuals who lost a spouse or a parent.

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Photo by Jonatán Becerra on Unsplash

Photo by Jonatán Becerra on Unsplash

Why is it important?

PGD is a new psychiatric diagnosis that mental health professionals need to consider along with other well-known psychiatric diagnoses such as depression and PTSD. A nuanced understanding of how mental health problems develop within bereaved individuals over time could potentially lead to better identification and treatment of those who are in need. For example, who to treat when, what symptoms should be targeted first in treatment to hinder the development of additional psychopathology, and if transdiagnostic psychotherapeutic treatments are needed for this population.

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