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Disturbed grief, operationalized as persistent complex bereavement disorder (PCBD), correlates with yet differs from posttraumatic stress disorder (PTSD) and depression symptoms. However, knowledge about temporal associations among these symptoms is limited. We aimed to enhance our understanding of the etiology of loss-related distress by examining temporal associations among PCBD, PTSD, and depression symptom levels. Dutch people (N= 172) who lost significant other(s) in a plane disaster completed questionnaires for PCBD, PTSD, and depression 11, 22, 31, and 42 months after the disaster. Cross-lagged analyses revealed that changes in PCBD symptom levels have a greater impact on changes in symptom levels of PTSD and depression than vice versa. Our findings contradict the notion that PTSD and depression symptoms should be addressed before grief in treatment. Pending replication of our findings in clinical samples, we tentatively conclude that screening and treatment of grief symptoms has potential value in preventing long-lasting distress.

ABSTRACTBackground:The FAIR data principles aim to make scientific data more Findable, Accessible, Interoperable, and Reusable. In the field of traumatic stress research, FAIR data practices can help accelerate scientific advances to improve clinical practice and can reduce participant burden. Previous studies have identified factors that influence data sharing and re-use among scientists, such as normative pressure, perceived career benefit, scholarly altruism, and availability of data repositories. No prior study has examined researcher views and practices regarding data sharing and re-use in the traumatic stress field.Objective:To investigate the perspectives and practices of traumatic stress researchers around the world concerning data sharing, re-use, and the implementation of FAIR data principles in order to inform development of a FAIR Data Toolkit for traumatic stress researchers.Method:A total of 222 researchers from 28 countries participated in an online survey available in seven languages, assessing their views on data sharing and re-use, current practices, and potential facilitators and barriers to adopting FAIR data principles.Results:The majority of participants held a positive outlook towards data sharing and re-use, endorsing strong scholarly altruism, ethical considerations supporting data sharing, and perceiving data re-use as advantageous for improving research quality and advancing the field. Results were largely consistent with prior surveys of scientists across a wide range of disciplines. A significant proportion of respondents reported instances of data sharing and re-use, but gold standard practices such as formally depositing data in established repositories were reported as infrequent. The study identifies potential barriers such as time constraints, funding, and familiarity with FAIR principles.Conclusions:These results carry crucial implications for promoting change and devising a FAIR Data Toolkit tailored for traumatic stress researchers, emphasizing aspects such as study planning, data preservation, metadata standardization, endorsing data re-use, and establishing metrics to assess scientific and societal impact.

ABSTRACTBackground:With the release of the text revision of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR), criteria for Prolonged Grief Disorder (PGD) were included. This necessitates studying grief trajectories based on these criteria.Objective:This is the first study examining latent trajectories of DSM-5-TR-based PGD symptom levels and testing whether specific risk factors (e.g. cause of death) predicted PGD trajectories.Method:We evaluated latent DSM-5-TR PGD trajectories using pooled existing data collected at 6–12, 13–24, and 25–60 months post-loss in Danish and Dutch bereaved adults (N = 398). Latent Growth Mixture Modelling (LGMM) was employed to determine the trajectories. Multinomial logistic regression analyses were used to examine which risk factors predicted class membership.Results:The four-class LGMM solution with a quadratic term was best-fitting the data. This solution represented four trajectories: High stable PGD (6%), High PGD quick recovery (10%), High PGD slow recovery (35%), and Low PGD symptoms (49%). Participants with a higher educational level were more likely to be assigned to the Low PGD symptoms trajectory compared to High stable PGD and High PGD slow recovery trajectories. Unnatural causes of death increased the likelihood of being in the High stable PGD and High PGD slow recovery trajectories compared to the Low PGD symptoms trajectory.Conclusions:Consistent with prior research, the Low PGD symptoms trajectory was the most common. A significant minority experienced high and stable levels of PGD within five years after the loss. About one-third of participants experienced high acute grief levels that decreased slowly; how slow decreasing symptoms relate to an individual’s functioning requires further attention. This study demonstrates that a significant minority of bereaved people develop acute PGD symptomatology that does not diminish within five years post-loss, emphasizing the need for early screening for PGD to prevent long-lasting complaints.

ABSTRACTBackgroundThe 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.ObjectiveWe conducted a content overlap analysis of PGDICD-11, PGDDSM-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).MethodsUsing the Jaccard’s Index, we established the degree of content overlap between core and accessory symptoms of PGDICD-11, PGDDSM-5-TR, and prior proposals for pathological grief diagnoses.ResultsMain findings are that PGDICD-11and PGDDSM-5-TRshowed moderate content overlap with each other and with most prior proposed diagnoses for pathological grief. PGDICD-11and PGDDSM-5-TRshowed the strongest content overlap with their direct predecessors, PGDICD-11 beta draftand PCBD, respectively.ConclusionsLimited content overlap between PGDICD-11and PGDDSM-5-TRand 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 PGDICD-11may not generalize to PGDDSM-5-TRand 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.

ABSTRACTBackground: After a potentially traumatic event (PTE), children often show symptoms of acute stress disorder (ASD), which may evolve into posttraumatic stress (PTS) disorder. A growing body of literature has employed latent class analysis (LCA) to disentangle the complex structure underlying PTS symptomatology, distinguishing between homogeneous subgroups based on PTS presentations. So far, little is known about subgroups or classes of ASD reactions in trauma-exposed children.Objective: Our study aimed to identify latent classes of ASD symptoms in children exposed to a single-incident PTE and to identify predictors of class membership (gender, age, cultural background, parental education, trauma type, and trauma history).Method: A sample of 2287 children and adolescents (5–18 years) was derived from the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive, an international archive including studies from the USA, UK, Australia, and Switzerland. LCA was used to determine distinct subgroups based on ASD symptoms. Predictors of class membership were examined using a three-step approach.Results: Our LCA yielded a three-class solution: low (42%), intermediate (43%) and high (15%) ASD symptom severity that differed in terms of impairment and number of endorsed ASD symptoms. Compared to the low symptoms class, children in the intermediate or high severity class were more likely to be of female gender, be younger of age, have parents who had not completed secondary education, and be exposed to a road traffic accident or interpersonal violence (vs. an unintentional injury).Conclusions: These findings provide new information on children at risk for ASD after single-incident trauma, based on a unique set of international data. Classifying children based on latent symptom profiles helps to identify target groups for prevention and intervention after exposure to a PTE.

ABSTRACTBackground: 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.

ABSTRACTBackground: The disappearance of a loved one is a unique type of loss, also termed ‘ambiguous loss’, which may heighten the risk for developing prolonged grief (PG), depression, and posttraumatic stress (PTS) symptoms. Little is known about protective and risk factors for psychopathology among relatives of missing persons. A potential protective factor is self-compassion, referring to openness toward and acceptance of one’s own pain, failures, and inadequacies. One could reason that self-compassion is associated with lower levels of emotional distress following ambiguous loss, because it might serve as a buffer for getting entangled in ruminative thinking about the causes and consequences of the disappearance (‘grief rumination’).Objective: In a sample of relatives of missing persons we aimed to examine (1) the prediction that greater self-compassion is related to lower symptom-levels of PG, depression, and PTS and (2) to what extent these associations are mediated by grief rumination.Method: Dutch and Belgian relatives of long-term missing persons (N = 137) completed self-report measures tapping self-compassion, grief rumination, PG, depression, and PTS. Mediation analyses were conducted.Results: Self-compassion was significantly, negatively, and moderately associated with PG, depression, and PTS levels. Grief rumination significantly mediated the associations of higher levels of self-compassion with lower levels of PG (a*b = −0.11), depression (a*b = −0.07), and PTS (a*b = −0.11). Specifically, 50%, 32%, and 32% of the effect of self-compassion on PG, depression, and PTS levels, respectively, was accounted for by grief rumination.Conclusions: Findings suggest that people with more self-compassion experience less severe psychopathology, in part because these people are less strongly inclined to engage in ruminative thinking related to the disappearance. Strengthening a self-compassionate attitude using, for instance, mindfulness-based interventions may therefore be a useful intervention to reduce emotional distress associated with the disappearance of a loved one.

ABSTRACTBackground: Hundreds of individuals lost one or more significant others in the MH17 plane crash in 2014 in Ukraine. The current study is the first to explore subgroups of disaster-bereaved individuals based on presence of psychopathology clusters. This may inform the development of diagnostic instruments and tailored interventions.Objective: Aims of the current study were to examine (1) subgroups based on presence of prolonged grief disorder (PGD), major depressive disorder (MDD), and posttraumatic stress disorder (PTSD) symptom clusters and (2) associations between class membership, disaster-related variables (i.e. experiencing multiple losses, conducting multiple burials for the same deceased, and time to confirmation of death), and a sense of unrealness.Method: Self-rated PGD (10 items of the Traumatic Grief Inventory represented in two symptom clusters), MDD (16-item Quick Inventory Of Depressive Symptomatology represented in one symptom cluster), and PTSD (20-item PTSD Checklist for DSM-5 represented in four symptom clusters) from 167 participants were subjected to latent class analysis to identify subgroups (i.e. classes). Correlates of class membership were assessed using the three-step approach.Results: A three-class solution yielded the best model fit. Class 1 (Resilient class; 20.0%) was predominantly characterized by low probability of PGD, MDD, and PTSD symptom clusters, class 2 (PGD class; 41.8%) by moderate to high probability of presence of PGD, and class 3 (Combined class; 38.2%) by moderate to high probability of presence of PGD, MDD, and PTSD symptom clusters. Compared with the Resilient class, a sense of unrealness was more likely to be experienced by individuals in the PGD class and the Combined class.Conclusions: Our results indicate that subgroups of disaster-bereaved individuals can be distinguished based on the presence of PGD, MDD, and PTSD symptom clusters. A sense of unrealness was the strongest distinguishing feature of the subgroups.

ABSTRACTBackground: Confrontation with a traumatic (e.g. disaster-related) loss is a risk factor for the development of psychopathology, including symptoms of prolonged grief (PG), posttraumatic stress (PTS), and depression. Although interventions have been developed for reducing post-loss psychopathology, more research into the effectiveness of treatment is needed to improve care for bereaved persons. Cognitive therapy (CT) and eye movement desensitization and reprocessing (EMDR) have been shown to be effective in trauma-exposed populations. We hypothesize that CT and EMDR are also effective in reducing symptoms among people exposed to traumatic loss.Objective: In this article we describe the rationale of a randomized controlled trial (RCT) to examine (1) treatment effects of CT and EMDR for reducing PG, PTS, and depression among traumatically bereaved people, and (2) the associations between improvements in PG, PTS, and depression symptoms on the one hand and tentative mechanisms of change, including a sense of unrealness, negative cognitions, avoidance behaviour, and intrusive memories, on the other hand.Method: A two-armed (intervention versus waiting list controls) RCT will be conducted. Participants will be asked to fill in questionnaires prior to treatment, during treatment, and one, 12, and 24 weeks post-treatment. Potential participants are people who have lost one or multiple significant other(s) in the Ukrainian plane disaster in 2014 with clinically significant levels of self-rated PG, PTS, and/or depression. Multiple regression, including analysis of covariance, and multilevel regression analyses will be used.Discussion: There is a need for treatment for psychopathology following traumatic loss. Strengths of this study are the development of a treatment that targets grief and trauma-related complaints and the examination of potential mechanisms of change in CT and EMDR. Bereaved people, clinicians, and researchers could benefit from the results of this study.