The DOI matches its Crossref record; 35 of the 36 references it cites were found in a registry or an index.
Looking beyond the mean in grief trajectories: A prospective, population-based cohort study
Open accessAbstract
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, 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 ICD‐11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [92]
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Cites
Closing the gap in a generation: health equity through action on the social determinants of health
Marmot, M. G., Friel, S., Bell, R., Houweling, T. A. J., & Taylor, S. A. J. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61690-6 · Cited by 8,473
The Danish Civil Registration System
Pedersen, C. (2011) · Scandinavian Journal of Public Health · doi:10.1177/1403494810387965 · Cited by 4,713 · cited 1×
“The date of the patient's death was obtained from the Danish Civil Registration System (Pedersen, 2011), and the patient's survival time was measured as the time (days) from the registration of drug reimbursement to death.”
MethodMuthén, B., & Muthén, L. K. (2000) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2000.tb02070.x · Cited by 3,161 · cited 1×
“Grief trajectories based on PG sum scores at T0, T1, and T2 were estimated using a semi-parametric group-based trajectory model (GBTM) for repeated measurements (Muthen and Muthen, 2000; Nagin, 2014).”
MethodGroup-Based Trajectory Modeling in Clinical Research
Nagin, D. S., & Odgers, C. L. (2010) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.121208.131413 · Cited by 2,749
Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11
Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., Raphael, B., Marwit, S. J., Wortman, C., Neimeyer, R. A., et al. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000121 · Cited by 1,863
Health outcomes of bereavement.
Stroebe, M., Schut, H., & Stroebe, W. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61816-9 · Cited by 1,746 · cited 2×
“Yet, several factors may interact in a complex interplay and affect grief reactions in relatives (Stroebe et al., 2007; Stroebe et al., 2006).”
BackgroundGrunfeld, E. (2004) · Canadian Medical Association Journal · doi:10.1503/cmaj.1031205 · Cited by 963
Resilience to loss and chronic grief: A prospective study from preloss to 18-months postloss
Bonanno, G. A., Wortman, C. B., Lehman, D. R., Tweed, R. G., Haring, M., Sonnega, J., Carr, D., & Nesse, R. M. (2002) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.83.5.1150 · Cited by 836
Group-Based Trajectory Modeling: An Overview
Nagin, D. S. (2014) · Annals of Nutrition and Metabolism · doi:10.1159/000360229 · Cited by 700 · cited 3×
“PG sum scores were modelled using the censored normal distribution (Nagin, 2014, Nagin and Odgers, 2010).”
BackgroundMethodSocioeconomic position and major mental disorders
Muntaner, C. (2004) · Epidemiologic Reviews · doi:10.1093/epirev/mxh001 · Cited by 631
Research works printed but not linked: 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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Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment
Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20200052 · Cited by 203
Reed, G. M., First, M. B., Billieux, J., Cloitre, M., Briken, P., Achab, S., Brewin, C. R., King, D. L., Kraus, S. W., & Bryant, R. A. (2022) · World Psychiatry · doi:10.1002/wps.20960 · Cited by 182
Lenferink, L. I. M., Eisma, M. C., Smid, G. E., de Keijser, J., & Boelen, P. A. (2021) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2021.152281 · Cited by 172
“The majority of bereaved people is able to adjust to life without the deceased and does not need professional support during this adaptation process [1 – 3].”
Risk factors for prolonged grief symptoms: A systematic review and meta-analysis
Buur, C., Zachariae, R. H., Komischke-Konnerup, K. B., Marello, M. M., Schierff, L. H., & O’Connor, M. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2023.102375 · Cited by 176
Prevalence of prolonged grief disorder.
Rosner, R., Comtesse, H., Vogel, A., & Doering, B. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.03.058 · Cited by 149
Metadata
- 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)
- 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
- hybrid
- doi.org
- 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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