Symptoms of persistent complex bereavement disorder, depression, and PTSD in a conjugally bereaved sample: a network analysis
Abstract
Background: Complicated and persistent grief reactions afflict approximately 10% of bereaved individuals and are associated with severe disruptions of functioning. These maladaptive patterns were defined in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as persistent complex bereavement disorder (PCBD), but its criteria remain debated. The condition has been studied using network analysis, showing potential for an improved understanding of PCBD. However, previous studies were limited to self-report and primarily originated from a single archival dataset. To overcome these limitations, we collected structured clinical interview data from a community sample of newly conjugally bereaved individuals (N= 305). Methods: Gaussian graphical models (GGM) were estimated from PCBD symptoms diagnosed at 3, 14, and 25 months after the loss. A directed acyclic graph (DAG) was generated from initial PCBD symptoms, and comorbidity networks with DSM-5 symptoms of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) were analyzed 1 year post-loss. Results: In the GGM, symptoms from the social/identity PCBD symptoms cluster (i.e. role confusion, meaninglessness, and loneliness) tended to be central in the network at all assessments. In the DAG, yearning activated a cascade of PCBD symptoms, suggesting how symptoms lead into psychopathological configurations. In the comorbidity networks, PCBD and depressive symptoms formed separate communities, while PTSD symptoms divided in heterogeneous clusters. Conclusions: The network approach offered insights regarding the core symptoms of PCBD and the role of persistent yearnings. Findings are discussed regarding both clinical and theoretical implications that will serve as a step toward a more integrated understanding of PCBD.
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Network-analytic studies have converged on the conclusion that yearning for the deceased and associated emotional pain have a cascading effect on other symptoms.
“studies using network-analytic approaches to model the centrality of prolonged grief disorder symptoms have converged on the conclusion that yearning for the deceased and associated emotional pain have a cascading effect on other symptoms 53,54 .”
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- Authors
- Malgaroli, M., Maccallum, F., & Bonanno, G. A.
- Affiliations
- Columbia University (US)
- UNSW Sydney (AU)
- Corresponding author
- Malgaroli, Matteo
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2018-07-18
- Volume
- 48
- Issue
- 14
- Pages
- 2439-2448
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2884786602
- Cited by
- 116
- References
- 75
- Citations by year
- 2026: 15 · 2025: 21 · 2024: 18 · 2023: 7 · 2022: 15 · 2021: 20 · 2020: 13 · 2019: 6 · 2018: 1
- FWCI
- 11.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH091034)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Keywords
- prolonged grief disorder, complicated grief, major depressive disorder, post-traumatic stress disorder, longing, identity diffusion, meaninglessness, loneliness, symptom comorbidity, symptom networks
- MeSH terms
- Bereavement, Major Depressive Disorder, Female, Follow-Up Studies, Humans, Interpersonal Relations, Male, Middle Aged, Stress Disorders, Post-Traumatic, Models, Statistical, Comorbidity, Spouses
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