The DOI matches its Crossref record; 22 of the 24 references it cites were found in a registry or an index.
Prevalence of complicated grief in a representative population-based sample.
Abstract
Background Complicated grief (CG) has been proposed as a distinct diagnostic category in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). However, few epidemiological studies to date have measured CG in the general population.Methods Prevalence of CG, sociodemographic characteristics, and grief-related factors were examined in a representative population-based survey (N = 2520) through face-to-face contact. The sample included all bereaved subpopulations and all age groups from 14 to 95 years.Results The conditional prevalence of developing CG after major bereavement was 6.7%; the prevalence of CG in the general sample was 3.7%. Predictors of higher risk for developing CG were female gender, lower income (< €1250/month), older age (> 61 years), having lost a child or a spouse, or cancer as the cause of death.Limitations The sample of bereaved people was small, and some categories contained very few cases. Psychiatric comorbidities were not assessed in this study.Conclusions The results indicate that CG is prevalent in the population, and risk factors were identified.
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“Studies estimate that only 7-10% of bereaved people may suffer from this condition 77,78 .”
In the citing paper
“At the level of the general population, estimates indicate that only 2-3% of people may experience prolonged grief disorder, in contrast with the nearly universal experience of bereavement 62,77 .”
In the citing paper
“In a representative population-based German sample, those bereaved by a violent death had a disordered grief rate of 20% (Kersting et al., 2011).”
From The assessment of grief in refugees and post-conflict survivors: a narrative review of etic and emic research (2018) · cites this paper as Kersting et al., 2011
In the citing paper
“For example, recent studies of the rates of disordered grief in the Global North find prevalence rates ranging from 3.7% (Kersting et al., 2011) to 9.8% (Lundorff et al., 2017).”
From The assessment of grief in refugees and post-conflict survivors: a narrative review of etic and emic research (2018) · cites this paper as Kersting et al., 2011
In the citing paper
“This is much higher than prevalence studies of general population samples.”
From The assessment of grief in refugees and post-conflict survivors: a narrative review of etic and emic research (2018) · cites this paper as Kersting et al., 2011
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“For the same reasons, they could feel guilty about not being present at the time of death, although witnessing the death has been shown to raise the risk of CG in one previous study on bereavement after ICU stay (27).”
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European Journal of Psychotraumatology
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“, 2010; Kersting et al., 2011; Newson et al., 2011). In this study, using the diagnostic criteria proposed by Prigerson et al. (2009), the point prevalence of PGD was 1.”
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“…has reported that approximately 10% of the bereaved show symptoms that cause impairment in everyday life (Bonanno, et al., 2008; Ott, 2003), European studies have reported prevalence values of 4.2% in a sample of older Swiss (Maercker et al., 2008) and 4% in a German sample (Kersting et al., 2011).”
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Pohlkamp, L., Kreicbergs, U., Prigerson, H. G., & Sveen, J. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.06.004 · Cited by 120
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“Risk factors for developing complicated grief include female gender, older age, lower income, lower education levels, having lost a child or a spouse, or cancer as the cause of death (Kersting et al., 2011; Newson, Boelen, Hek, Hofman, & Tiemeier, 2011).”
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“Factors such as violent death, loss of child, and preexisting psychopathology have also been associated with rates as high as 78% (e.g., Dyregrov, Nordanger, & Dyregrov, 2003; Kersting et al., 2011; Simon et al., 2005).”
BackgroundPohlkamp, L., Kreicbergs, U., & Sveen, J. (2019) · Psycho-Oncology · doi:10.1002/pon.5112 · Cited by 110
“A recent meta‐analysis reported a pooled PGD prevalence rate of 10% in nonviolent adult bereavement,(4) but PGD prevalence rates tend to be higher in samples of bereaved parents.(5,6) Common psychological symptoms associated with bereavement are depression, posttraumatic stress, and insomnia.”
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The impact of losing a child on the clinical presentation of complicated grief
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“Bereaved parents may suffer more than those who have lost another relation (Zisook and Lyons, 1988, Cleiren, 1991, Gamino et al., 1998, Middleton et al., 1998), and bereaved parents may be among the most vulnerable group to develop CG (Kersting et al., 2011).”
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“Some studies reported that the severity of CG and PTSD was significantly positively correlated.(12,14,19,25,29) It has been suggested that these conditions affected one other.”
BackgroundKang, J., Shin, D. W., Choi, J. E., Sanjo, M., Yoon, S. J., Kim, H. K., Oh, M. S., Kwen, H.-S., Choi, H. Y., & Yoon, W. H. (2012) · Psycho-Oncology · doi:10.1002/pon.3033 · Cited by 91
“Previous research suggested that lower income was a predictor of negative consequences of family caregiving and that complicated grief was greater in family caregivers with low income [32,35,45,46].”
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Rozalski, V., Holland, J. M., & Neimeyer, R. A. (2016) · Journal of Loss and Trauma · doi:10.1080/15325024.2016.1161426 · Cited by 89
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“…socioeconomic status, being female, and being older (Gilbar and Ben-Zur, 2002; Ferrario et al., 2004; Simon et al., 2005; Vanderwerker et al., 2006; Kersting et al., 2011; Newson et al., 2011; Sung et al., 2011; Hu et al., 2015; Fernández-Alcántara and Zech, 2017; Heeke et al., 2017; Lundorff et…”
InfluentialShear, M. K. (2012) · Depression and Anxiety · doi:10.1002/da.21963 · Cited by 86
“An important minority, estimated at about 7%,[5] of bereaved people fail to mourn effectively because of grief complications.”
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“However, rather than integrating grief and re-engaging in ongoing life, about 7% of bereaved individuals will experience prolonged acute grief with marked distress and functional impairment for years after the death.[2] Complicated grief (CG) or prolonged grief disorder (PGD) is a severe, impairing, syndrome that was…”
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“7% (Kersting et al., 2011) up to 25.”
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“These three labels refer to the same syndrome of clinically impairing grief, which affects approximately 7%215% of bereaved individuals (9, 10).”
BackgroundLosing a child: finding meaning in bereavement
Bogensperger, J., & Lueger‐Schuster, B. (2014) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v5.22910 · Cited by 84
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Stammel, N., Heeke, C., Bockers, E., Chhim, S., Taing, S., Wagner, B., & Knaevelsrud, C. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.05.063 · Cited by 73
“Research on the factors influencing prolonged grief in civilian settings has identified female gender, a close relation with the deceased, traumatic or violent loss, and lack of social support as risk factors for the development of PGD (Kersting et al., 2011; Vanderwerker and Prigerson, 2004; Neria and Litz, 2004).”
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“In a representative population-based German sample, those bereaved by a violent death had a disordered grief rate of 20% (Kersting et al., 2011).”
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A population study of prolonged grief in refugees
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“PGD is estimated to occur in approximately 7% of those who are bereaved,[12] but the prevalence is considerably higher after the loss of a child and/or loss after sudden and violent deaths.”
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“Cancer as a cause of death has been shown to be a risk factor for complicated grief.(6) Bereaved individuals also showed an increased prevalence of depression (54.”
BackgroundSelf-citationSocial support following bereavement: The role of beliefs, expectations, and support intentions
Logan, E. L., Thornton, J. A., Kane, R. T., & Breen, L. J. (2017) · Death Studies · doi:10.1080/07481187.2017.1382610 · Cited by 73
“For the small proportion of bereaved individuals who are at high risk for developing complications of bereavement (Aoun et al., 2015; Kersting et al., 2011), a slight majority of participants in this study would not support a diagnostic classification.”
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Self-citationAssessment and associated features of prolonged grief disorder among Chinese bereaved individuals
Li, J., & Prigerson, H. G. (2016) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.12.001 · Cited by 65
“4% [13,30–32].”
Arizmendi, B. J., & O'Connor, M. (2015) · Australian Critical Care · doi:10.1016/j.aucc.2015.01.005 · Cited by 80
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Brodbeck, J., Berger, T., Biesold, N., Rockstroh, F., & Znoj, H. J. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.04.008 · Cited by 64
“However, some individuals experience prolonged grief symptoms or develop even a Persistent Complex Bereavement Disorder (Aoun et al., 2015; Kersting et al., 2011; Shear et al. 2013), which is characterised by persistent separation distress, frequent or disabling cognitive, emotional and behavioural symptoms such as av…”
BackgroundInfluentialGang, J., Falzarano, F. B., She, W. J., Winoker, H., & Prigerson, H. G. (2022) · Death Studies · doi:10.1080/07481187.2022.2039326 · Cited by 62
“In the context of disproportionate sampling of unnaturally bereaved in our sample (Kersting et al., 2011), this is consistent with Eisma et al. (2021) finding that the COVID-19 bereaved do not experience greater grief than the unnaturally bereaved.”
ResultMiyajima, K., Fujisawa, D., Yoshimura, K., Ito, M., Nakajima, S., Shirahase, J., Mimura, M., & Miyashita, M. (2014) · Journal of Palliative Medicine · doi:10.1089/jpm.2013.0552 · Cited by 62
Dual-Process Bereavement Group Intervention (DPBGI) for Widowed Older Adults.
Chow, A., Caserta, M. S., Lund, D. A., Suen, M. H. P., Xiu, D.-M., Chan, I. K. N., & Chu, K. M. (2018) · The gerontologist · doi:10.1093/geront/gny095 · Cited by 55
Thimm, J. C., Kristoffersen, A. E., & Ringberg, U. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1844440 · Cited by 73
“…grief reactions were relatively overrepresented in individuals with low education and low income, which aligns with findings of previous studies showing associations of complicated grief with low socio-economic status (e.g., Kersting et al., 2011; Newson, Boelen, Hek, Hofman, & Tiemeier, 2011).”
ResultCOMPLICATED GRIEF SYMPTOMS IN ANXIETY DISORDERS: PREVALENCE AND ASSOCIATED IMPAIRMENT
Marques, L. M., Bui, É., LeBlanc, N. J., Porter, E., Robinaugh, D. J., Dryman, M. T., Nadal-Vicens, M. F., Worthington, J. J., & Simon, N. M. (2013) · Depression and Anxiety · doi:10.1002/da.22093 · Cited by 71
Factors associated with possible complicated grief and major depressive disorders
Aoyama, M., Sakaguchi, Y., Morita, T., Ogawa, A., Fujisawa, D., Kizawa, Y., Tsuneto, S., Shima, Y., & Miyashita, M. (2017) · Psycho-Oncology · doi:10.1002/pon.4610 · Cited by 60
Bryant, R. A. (2013) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000031 · Cited by 58
Prevalence and risk factors of complicated grief among Sichuan earthquake survivors
Li, J., Chow, A. Y. M., Shi, Z., & Chan, C. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.01.003 · Cited by 62
Heeke, C., Stammel, N., Heinrich, M., & Knaevelsrud, C. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1286-2 · Cited by 67
The Grief of Mothers After the Sudden Unexpected Death of Their Infants
Goldstein, R. D., Lederman, R. I., Lichtenthal, W. G., Morris, S. E., Human, M., Elliott, A., Tobacco, D., Angal, J., Odendaal, H. J., Kinney, H. C., et al. (2018) · PEDIATRICS · doi:10.1542/peds.2017-3651 · Cited by 60
Breen, L. J., Aoun, S. M., O’Connor, M., Johnson, A. R., & Howting, D. A. (2019) · Palliative Medicine · doi:10.1177/0269216319880766 · Cited by 60
Comteße, H., & Rosner, R. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1591330 · Cited by 60
Doering, B. K., Barke, A., Vogel, A., Comteße, H., & Rosner, R. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.853698 · Cited by 58
“, (14)] and must therefore not be overstated in its importance.”
BackgroundResultInfluentialDepressive symptoms in spouses of older patients with severe sepsis*
Davydow, D. S., Hough, C. L., Langa, K. M., & Iwashyna, T. J. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e3182536a81 · Cited by 60
Disrupted prefrontal activity during emotion processing in complicated grief: An fMRI investigation
Arizmendi, B., Kaszniak, A. W., & O'Connor, M.-F. (2016) · NeuroImage · doi:10.1016/j.neuroimage.2015.09.054 · Cited by 57
“…(CG), termed Persistent Complex Bereavement Disorder bytheDSM-5 (AmericanPsychiatricAssociation,2013),affects approximately 6.7% of all individuals who have experienced bereavement, a number that increases to 20.3% and 23.6% in spousal and child bereavement respectively (Kersting et al., 2011).”
BackgroundInfluentialPost-traumatic Stress Disorder and Complicated Grief are Common in Caregivers of Neuro-ICU Patients
Trevick, S. A., & Lord, A. S. (2017) · Neurocritical Care · doi:10.1007/s12028-016-0372-5 · Cited by 57
“7% [25], but is overall much higher in the ICU at up to 46%.”
BackgroundHanschmidt, F., Treml, J., Klingner, J., Stepan, H., & Kersting, A. (2017) · Archives of Women s Mental Health · doi:10.1007/s00737-017-0807-9 · Cited by 56
“Population-based studies within the general population found corresponding prevalence rates of 3.7% for complicated grief (Kersting et al. 2011), 2.9% for posttraumatic stress disorder (Hauffa et al. 2011), and 8.1% for depressive symptoms (Busch et al. 2013).”
BackgroundInfluentialSelf-citationYuan, M.-D., Wang, Z.-Q., Fei, L., & Zhong, B. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1016160 · Cited by 59
Zhou, N., Wen, J., Stelzer, E., Killikelly, C., Yu, W., Xu, X. Y., Shi, G., Luo, H., Wang, J., & Maercker, A. R. A. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112766 · Cited by 55
Killikelly, C., Smith, K. V., Zhou, N., Prigerson, H. G., O'Connor, M., Kokou‐Kpolou, C. K., Boelen, P. A., & Maercker, A. R. A. (2025) · The Lancet · doi:10.1016/s0140-6736(25)00354-x · Cited by 62
Cognitive functioning in complicated grief
Hall, C. A., Reynolds, C. F., Butters, M. A., Zisook, S., Simon, N. M., Corey‐Bloom, J., Lebowitz, B. D., Begley, A. E., Mauro, C., & Shear, M. K. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.07.002 · Cited by 57
“Early studies have estimated the prevalence of CG to be 4e5% in the general population and 7e25% among bereaved individuals (Newson et al., 2011; Kersting et al., 2011).”
BackgroundGrief Before and After Bereavement in the Elderly: An Approach to Care
Lechner‐Meichsner, F., O'Connor, M., Skritskaya, N. A., & Shear, M. K. (2020) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2019.12.010 · Cited by 60
Wagner, B., Hofmann, L., & Grafiadeli, R. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23192 · Cited by 59
Self-citationHasdenteufel, M., & Quintard, B. (2022) · BMC Palliative Care · doi:10.1186/s12904-022-01096-y · Cited by 52
Metadata
- Authors
- Kersting, A., Brähler, E., Glaesmer, H., & Wagner, B.
- Affiliations
- Leipzig University (DE)
- Corresponding author
- Wagner, Birgit
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2011-06
- Volume
- 131
- Issue
- 1-3
- Pages
- 339-343
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2073391963
- Cited by
- 628
- References
- 24
- Citations by year
- 2026: 14 · 2025: 37 · 2024: 48 · 2023: 48 · 2022: 37 · 2021: 58 · 2020: 67 · 2019: 55 · 2018: 54 · 2017: 60 · 2016: 42 · 2015: 41 · 2014: 23 · 2013: 20 · 2012: 19
- FWCI
- 22.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- complicated grief, bereavement, prevalence, risk factors, gender differences, socioeconomic status, loss of a child, death of a spouse, cancer mortality, general population
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Bereavement, Cross-Sectional Studies, Female, Germany, Grief, Humans, Male, Middle Aged, Surveys and Questionnaires, Risk Factors, Sex Factors, Socioeconomic Factors, Prevalence, Young Adult
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