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Cited by 138Grief, Bereavement, and Mental HealthDeath, Funerary Practices, and MourningPalliative Care and End-of-Life Issues

Looking beyond the mean in grief trajectories: A prospective, population-based cohort study

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Nielsen, Mette Kjærgaard, Carlsen, Anders Helles, Neergaard, Mette Asbjoern, Bidstrup, Pernille Envold, Guldin, Mai-Britt·2019·Social Science & Medicine
DOI 10.1016/j.socscimed.2018.10.007
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Abstract

BACKGROUND: Most individuals adjust to the loss of a close person, but some experience adverse grief that challenges everyday life. No previous study has examined the development of grief symptoms in trajectories over time. We aimed to investigate trajectories of grief symptoms in bereaved partners and non-partners of severely ill patients starting before death until three years after death of the patient. METHOD: We conducted a prospective population-based cohort study including 1138 partners and 597 non-partners of terminally ill patients. Participants completed the Prolonged Grief-13 scale pre-loss, six months post-loss, and three years post-loss. On this basis, we developed semi-parametric group-based trajectory models. Multinomial logistic regression models estimated, odds ratios (ORs) with 95% confidence intervals (CIs) between selected characteristics: age, gender, educational level, the patient's survival time, and types of grief trajectories. RESULTS: We identified five specific grief trajectories for partners and four for non-partners. Low grief was identified in 34% of partners and 45% of non-partners, moderate/decreasing grief in 30% of partners and 31% of non-partners, high/decreasing grief in 20% of partners and 16% of non-partners, and high grief in 7% of partners and 8% of non-partners. In addition, a late grief trajectory was identified in 10% of partners. Low education compared to high education was associated with adverse grief trajectories (OR = 0.19 (95% CI = 0.80, 0.43) for partners following a high grief trajectory). CONCLUSIONS: This study is the first to systematically describe specific trajectories of grief based on grief symptoms. The majority had a low or decreasing grief trajectory, whereas minor groups of partners and non-partners had a high grief trajectory, and a group of partners had a late grief trajectory. A consistent vulnerability factor was low education. Bereaved individuals may benefit from information on possible patterns of grief development, including adverse grief trajectories.

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  • Further studies with larger sample sizes or longer-term time frames have observed distinct trajectories: most people are resilient, a smaller but significant proportion have grief symptoms improving over time, others have moderate and persistent symptoms, and a smaller group exhibits high levels of grief symptoms that do not improve over time.

    “Further studies, particularly those with larger sample sizes or longer-term time frames, have observed distinct trajectories in which most people are resilient to the effects of bereavement, a smaller but significant proportion have grief symptoms improving over time, others have moderate and persistent symptoms, and a smaller group exhibits high levels of grief symptoms that do not improve over”

    From Emerging experience with selected new categories in the <scp>ICD</scp>‐11: complex <scp>PTSD</scp>, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [92]

    The Results (§3.2; page unavailable) identify groups with decreasing grief symptoms and a small high-grief group; the Conclusions (§5) describe the latter as persistent. But the low-grief group comprises 34% of partners and 45% of non-partners, not most participants, and the reported trajectories do not include a moderate, persistent-symptom group. (LLM, conf=0.88)

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  1. Guldin, M.B., Nielsen, M.K., Carlsen, A.H., Jensen, A.B., Prigerson, H.G., Vedsted, P., (n.d. ).Translation, adaptation and validation of a Danish version of the Prolonged Grief Disorder Scale (PG-13). Manuscript under review.

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Authors
Nielsen, M. K., Carlsen, A. H., Neergaard, M. A., Bidstrup, P. E., & Guldin, M.-B.
Affiliations
  • Aarhus University (DK)
  • Aarhus University Hospital (DK)
  • Danish Cancer Society (DK)
Corresponding author
Nielsen, Mette Kjærgaard
ORCID
Venue
Social Science & Medicine
Publisher
Elsevier BV
Published
2019-07
Volume
232
Pages
460-469
ISSN
0277-9536 (ISSN-L)
DOI
10.1016/j.socscimed.2018.10.007
OpenAlex
W2896464374
Cited by
138
References
36
Citations by year
2026: 18 · 2025: 23 · 2024: 23 · 2023: 19 · 2022: 17 · 2021: 17 · 2020: 16 · 2019: 4
FWCI
10.85
Type
journal article
Language
en
Open access
Licence
Locations
  • Social Science & Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
  • Kræftens Bekæmpelse (R160-A10389-16-S3)
  • Novo Nordisk Fonden (NNF17OC0024410)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords
prolonged grief disorder, bereavement, grief trajectories, terminal illness, educational attainment, bereavement support
MeSH terms
Aged, Bereavement, Educational Status, Family, Female, Grief, Humans, Male, Middle Aged, Neoplasms, Prospective Studies, Spouses

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