Cited by 611Grief, Bereavement, and Mental HealthDeath, Funerary Practices, and MourningDeath Anxiety and Social Exclusion

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Predictors of Complicated Grief: A Systematic Review of Empirical Studies

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Lobb, Elizabeth A., Kristjanson, Linda J., Aoun, Samar M., Monterosso, Leanne, Halkett, Georgia K. B., Davies, Anna·2010·Death Studies

DOI 10.1080/07481187.2010.496686

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Abstract

A systematic review of the literature on predictors of complicated grief (CG) was undertaken with the aim of clarifying the current knowledge and to inform future planning and work in CG following bereavement. Predictors of CG prior to the death include previous loss, exposure to trauma, a previous psychiatric history, attachment style, and the relationship to the deceased. Factors associated with the death include violent death, the quality of the caregiving or dying experience, close kinship relationship to the deceased, marital closeness and dependency, and lack of preparation for the death. Perceived social support played a key role after death, along with cognitive appraisals and high distress at the time of the death. Inconsistent definitions of CG and measurement tools were noted in the earlier studies reviewed. Limitations identified in the studies included use of cross-sectional designs, heterogeneous samples, high attrition, demographic differences between cases and controls, differences in length of time since death, and differences in types of death experienced. Notwithstanding these limitations, some consistent findings have emerged. Further research into conceptualizations of CG in terms of attachment theory and constructivist and cognitive-behavioral concepts of finding purpose and meaning after bereavement is warranted.

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Dantas, C. D. R., de Azevedo, R. C. S., Vieira, L. C., Côrtes, M. T. F., Federmann, A. L. P., Cucco, L. D. M., Rodrigues, L. R., Domingues, J. F. R., Dantas, J. E., Portella, I. P., et al. (2020) · Revista Latinoamericana de Psicopatologia Fundamental · doi:10.1590/1415-4714.2020v23n3p509.5 · Cited by 65
What determines supportive behaviors following bereavement? A systematic review and call to action
Logan, E. L., Thornton, J. A., & Breen, L. J. (2017) · Death Studies · doi:10.1080/07481187.2017.1329760 · Cited by 72
“Although a multitude of factors (e.g., attachment to the deceased or cause of death) may complicate the grieving process (Lobb et al., 2010), very few of these can be modified after the fact to the extent that social support can (Bath, 2009).”
Background
Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial
Reitsma, L., Boelen, P. A., de Keijser, J., & Lenferink, L. I. M. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104286 · Cited by 64
Restricted Mourning: Impact of the COVID-19 Pandemic on Funeral Services, Grief Rituals, and Prolonged Grief Symptoms
Mitima-Verloop, H. B., Mooren, T. T. M., Kritikou, M. E., & Boelen, P. A. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.878818 · Cited by 63
Parental bereavement during mid-to-later life: Pre- to postbereavement functioning and intrapersonal resources for coping.
Floyd, F. J., Seltzer, M. M., Greenberg, J. S., & Song, J. (2012) · Psychology and Aging · doi:10.1037/a0029986 · Cited by 63
“In a sense, the failure to obtain a main effect on depression symptoms for the accident subgroup would seem to contrast with a large body of research showing robust predictions of complicated grief by sudden and violent deaths as opposed to other causes (see Lobb et al., 2010).”
Result
Adolescent Resilience during the COVID-19 Pandemic: A Review of the Impact of the Pandemic on Developmental Milestones
Garagiola, E. R., Lam, Q., Wachsmuth, L. S., Tan, T. Y., Ghali, S., Asafo, S. M., & Swarna, M. (2022) · Behavioral Sciences · doi:10.3390/bs12070220 · Cited by 78
A Network Approach to Understanding Quality of Life Impairments in Prolonged Grief Disorder
Maccallum, F., & Bryant, R. A. (2019) · Journal of Traumatic Stress · doi:10.1002/jts.22383 · Cited by 68
Prolonged grief disorder among asylum seekers in Germany: the influence of losses and residence status
Comteße, H., & Rosner, R. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1591330 · Cited by 60
“The differentiation of losses within family and friends might be a more suitable approach to examine the impact of multiple losses (Hengst et al., 2018; Stammel et al., 2013); particularly as the familial relationship to the deceased has been shown to affect PGD severity (Lobb et al., 2010).”
Background
Parental bereavement – impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review
Vig, P. S., Lim, J. Y., Lee, R. W. L., Huang, H., Tan, X. H., Lim, W. Q., Lim, M. B. X. Y., Lee, A. S. I., Chiam, M., Lim, C., et al. (2021) · BMC Palliative Care · doi:10.1186/s12904-021-00831-1 · Cited by 59
Predictors of Prolonged Grief Disorder in a German Representative Population Sample: Unexpectedness of Bereavement Contributes to Grief Severity and Prolonged Grief Disorder
Doering, B. K., Barke, A., Vogel, A., Comteße, H., & Rosner, R. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.853698 · Cited by 58
Bereaved College Students: Social Support, Coping Style, Continuing Bonds, and Social Media Use as Predictors of Complicated Grief and Posttraumatic Growth
Lipp, N. S., & O’Brien, K. M. (2020) · OMEGA - Journal of Death and Dying · doi:10.1177/0030222820941952 · Cited by 67
“In addition, a systematic review of the literature found that perceived social support was critical after experiencing a death (Lobb et al., 2010).”
Background
Prolonged grief symptomatology following violent loss: The mediating role of meaning
Milman, E., Neimeyer, R. A., Fitzpatrick, M., MacKinnon, C. J., Muis, K. R., & Cohen, S. R. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1503522 · Cited by 56
“Contrary to previous research findings and theory (e.g. Burke & Neimeyer, 2013; Lobb et al., 2010), violent loss was not significantly correlated with”
BackgroundResultInfluential
Risk and Resilience Factors Related to Parental Bereavement Following the Death of a Child with a Life-Limiting Condition
Jaaniste, T., Coombs, S., Donnelly, T. J., Kelk, N., & Beston, D. (2017) · Children · doi:10.3390/children4110096 · Cited by 59
“There are numerous pre-existing intrapersonal factors, such as substance abuse, mental health problems, and poor physical health, which are widely recognized to compromise an individual’s coping resources and place them at greater risk of poor bereavement outcomes [43,111].”
Background
Meaning-Centered Psychotherapy for Cancer Caregivers: A pilot trial among caregivers of patients with glioblastoma multiforme
Applebaum, A. J., Baser, R. E., Roberts, K. E., Lynch, K. A., Gebert, R. R., BREITBART, W. S., & Diamond, E. L. (2022) · Translational Behavioral Medicine · doi:10.1093/tbm/ibac043 · Cited by 55
Factors that influence the health of older widows and widowers—A systematic review of quantitative research
Holm, A. L., Berland, A. K., & Severinsson, E. (2019) · Nursing Open · doi:10.1002/nop2.243 · Cited by 55
“Lobb et al. (2010) aimed to clarify current knowledge to inform future planning and work in the area of complicated grief following bereavement.”
Background
Grief After Euthanasia and Physician-Assisted Suicide: A Systematic Review
Andriessen, K., Krysinska, K., Castelli Dransart, D. A., Dargis, L., & Mishara, B. L. (2020) · Crisis · doi:10.1027/0227-5910/a000630 · Cited by 54
“Unresolved grief questions, lack of social support, and perceived stigma may increase their risk of disordered grief and negative mental health (Lobb et al., 2010; Oexle, Feigelman, & Sheehan, 2018; Pitman et al., 2017; Wagner, Keller, et al., 2012).”
Background
The Association Between Bereavement and Biomarkers of Inflammation
Cohen, M. W., Granger, S., & Fuller‐Thomson, E. (2013) · Behavioral Medicine · doi:10.1080/08964289.2013.866539 · Cited by 58
“There are a number of factors that affect the nature and intensity of the grieving process, including relationship (eg parent, spouse), nature of the death,(2) and previous psychiatric history of the bereaved.(3) In bereavement, individuals often experience a range of distressing emotions (anguish, loss, sadness, sorr…”
Background
Care at End of Life Influences Grief: A Nationwide Long-Term Follow-Up among Young Adults Who Lost a Brother or Sister to Childhood Cancer
Lövgren, M., Sveen, J., Nyberg, T., Eilegård, A., Prigerson, H. G., Steineck, G., & Kreicbergs, U. C. (2017) · Journal of Palliative Medicine · doi:10.1089/jpm.2017.0029 · Cited by 60
Grief 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
General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study
O’Connor, M., & Breen, L. J. (2014) · BMC Medical Education · doi:10.1186/1472-6920-14-59 · Cited by 52
Psychosocial factors affecting the bereavement experience of relatives of palliative-stage cancer patients: a systematic review
Hasdenteufel, M., & Quintard, B. (2022) · BMC Palliative Care · doi:10.1186/s12904-022-01096-y · Cited by 52
Prolonged grief and attachment security: A latent class analysis
Maccallum, F., & Bryant, R. A. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.07.038 · Cited by 55
Is complicated grief a risk factor for substance use? A comparison of substance-users and normative grievers
Masferrer, L., Garre‐Olmo, J., & Caparrós, B. (2017) · Addiction Research & Theory · doi:10.1080/16066359.2017.1285912 · Cited by 53
“We assumed a prevalence of 15% in the general population (Lobb et al. 2010; Wittouck et al. 2011) and an a level of 0.05 for a precision of ±5% units in a bilateral contrast.”
BackgroundInfluential
The impact of bereavement support on wellbeing: a comparative study between Australia and Ireland
Aoun, S. M., Keegan, O., Roberts, A., & Breen, L. J. (2020) · Palliative Care and Social Practice · doi:10.1177/2632352420935132 · Cited by 53
Self-citation
Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the world mental health surveys
Atwoli, L., Stein, D. J., King, A., Petukhova, M. V., Aguilar‐Gaxiola, S., Alonso, J., Bromet, E. J., de Girolamo, G., Demyttenaere, K., Florescu, S., et al. (2016) · Depression and Anxiety · doi:10.1002/da.22579 · Cited by 53
“tentwith prior studies of complicated grief, includingwork on bereavement symptoms after loss of a spouse or child (Kristensen et al., 2012; Lobb et al., 2010).”
BackgroundResult
Death and Mourning Process in Frontline Health Care Professionals and Their Families During COVID-19
Das, S., Singh, T., Varma, R., & Arya, Y. K. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.624428 · Cited by 50
‘Saying goodbye’ during the COVID-19 pandemic: A document analysis of online newspapers with implications for end of life care
Selman, L. E., Sowden, R., & Borgstrom, E. (2021) · Palliative Medicine · doi:10.1177/02692163211017023 · Cited by 49
Prolonged grief disorder: Its co-occurrence with adjustment disorder and post-traumatic stress disorder in a bereaved Israeli general-population sample
Killikelly, C., Lorenz, L., Bauer, S., Shamir, M. M., Ben‐Ezra, M., & Maercker, A. R. A. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.02.014 · Cited by 55
Randomised controlled trial of a cognitive narrative intervention for complicated grief in widowhood
Barbosa, V., Sá, M., & Carlos Rocha, J. (2014) · Aging & Mental Health · doi:10.1080/13607863.2013.833164 · Cited by 47
Investigating risk for grief severity: Attachment to the deceased and relationship quality
Smigelsky, M. A., Bottomley, J. S., Relyea, G. E., & Neimeyer, R. A. (2019) · Death Studies · doi:10.1080/07481187.2018.1548539 · Cited by 51
“Finally, it may be surprising to see an increased risk for grief severity for the Securely attached group, given that it is attachment insecurity that is commonly implicated as a risk factor (Lobb et al., 2010).”
Background
Prolonged grief during and beyond the pandemic: factors associated with levels of grief in a four time-point longitudinal survey of people bereaved in the first year of the COVID-19 pandemic
Harrop, E., Medeiros, R., Goss, S., Longo, M., Byrne, A., FARNELL, D. J. J., Seddon, K., Penny, A., Machin, L., Sivell, S., et al. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1215881 · Cited by 55
“…of the death, ability to say goodbye to the deceased, support from healthcare professionals at the end of life, perceived social support) (10, 23, 44–46) or are known to be indirectly associated with such outcomes (qualifications, health status, place of death, cause of death) (47, 48).”
BackgroundResultInfluential
Changes in Parental Self-Identity Following the Death of a Child to Cancer
O'Connor, K., & Barrera, M. (2014) · Death Studies · doi:10.1080/07481187.2013.801376 · Cited by 48
“…1991), and that difficulties with selfidentity following the death of a child are consistently associated with a range of negative outcomes (e.g., Lobb et al., 2010), a targeted examination of parental self-identity is essential for a comprehensive understanding of the multifaceted dimensions…”
Background
Toward a Better Understanding of Psychological Symptoms in People Confronted With the Disappearance of a Loved One: A Systematic Review
Lenferink, L. I. M., de Keijser, J., Wessel, I., de Vries, D., & Boelen, P. A. (2017) · Trauma Violence & Abuse · doi:10.1177/1524838017699602 · Cited by 50
“35 2 Systematic reviews have shown that the death of a significant other can lead to serious mental health issues, including depression, posttraumatic stress disorder (PTSD), and complicated grief1(Kristensen, Weisæth, & Heir, 2012; Lobb et al., 2010; van Denderen, de Keijser, Kleen, & Boelen, 2015).”
BackgroundInfluential
Communicating about death and dying with adults with intellectual disabilities who are terminally ill or bereaved: A UK‐wide survey of intellectual disability support staff
Tuffrey‐Wijne, I., Finlayson, J., Bernal, J., Taggart, L., Lam, C. K. K., & Todd, S. (2020) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.12714 · Cited by 46
“Lack of preparation for the death of a loved one is a risk factor for complicated grief processes, both within the general population (Lobb et al., 2010) and for people with ID (Blackman, 2003).”
Background
Does ‘Time Heal all Wounds?’ The Prevalence and Predictors of Prolonged Grief Among Drug-Death Bereaved Family Members: A Cross-Sectional Study
Titlestad, K. B., & Dyregrov, K. (2022) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228221098584 · Cited by 51
“Proper support from informal networks (families, friends, work-colleagues, etc.) may counteract negative consequences of loss and be of great importance for coping with grief (Lobb et al., 2010).”
BackgroundResultInfluential
Stigma, grief and depressive symptoms in help-seeking people bereaved through suicide
Scocco, P., Preti, A., Totaro, S., Corrigan, P. W., & Castriotta, C. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.10.098 · Cited by 45
Prevalence, comorbidities, and factors associated with prolonged grief disorder, posttraumatic stress disorder and complex posttraumatic stress disorder in refugees: a systematic review
Lechner‐Meichsner, F., Comteße, H., & Olk, M. (2024) · Conflict and Health · doi:10.1186/s13031-024-00586-5 · Cited by 47
Interpersonal predictors of suicide ideation and complicated-grief trajectories among suicide bereaved individuals: A four-year longitudinal study
Levi‐Belz, Y., & Aisenberg-Shafran, D. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.01.006 · Cited by 50
Public Attitudes About Normal and Pathological Grief
Penman, E. L., Breen, L. J., Hewitt, L. Y., & Prigerson, H. G. (2014) · Death Studies · doi:10.1080/07481187.2013.873839 · Cited by 43
“A number of factors shape the experience of grief (Lobb et al., 2010).”
Background
Restorative Retelling for Violent Loss: An Open Clinical Trial
Saindon, C., Rheingold, A. A., Baddeley, J. L., Wallace, M. M., Brown, C., & Rynearson, E. K. (2013) · Death Studies · doi:10.1080/07481187.2013.783654 · Cited by 45
“Survivors of violence loss are at increased risk for a variety of psychological symptoms and disorders including posttraumatic stress disorder (PTSD), depression, and substance abuse (Amick-McMullan, Kilpatrick, & Resnick, 1991; Zinzow, Rheingold, Hawkins, Saunders, & Kilpatrick, 2009) as well as prolonged grief (Lobb…”
Background
Holding Parents So They Can Hold Their Children: Grief Work with Surviving Spouses to Support Parentally Bereaved Children
Werner‐Lin, A., & Biank, N. M. (2012) · OMEGA - Journal of Death and Dying · doi:10.2190/om.66.1.a · Cited by 43
“For example, a recent systematic review found that pre-death dependence on a spouse, pre-loss burden (associated, perhaps, with increased caregiving and parenting responsibilities), and intense or severe life events are predictors of complicated grief (Lobb et al., 2010).”
Background
Is There Anybody Out There? Attachment Style and Interpersonal Facilitators as Protective Factors Against Complicated Grief Among Suicide-Loss Survivors
Levi‐Belz, Y., & Ari, L. L. (2019) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000940 · Cited by 45

Authors: Lobb, E. A., Kristjanson, L. J., Aoun, S. M., Monterosso, L., Halkett, G. K. B., & Davies, A.
Affiliations: Edith Cowan University (AU)
Curtin University (AU)
Australian National University (AU)
Corresponding author: Lobb, Elizabeth A.
ORCID: Lobb, Elizabeth A.
Aoun, Samar M.
Monterosso, Leanne
Halkett, Georgia K. B.
Venue: Death Studies
Publisher: Informa UK Limited
Published: 2010-08-19
Volume: 34
Issue: 8
Pages: 673-698
ISSN: 0748-1187 (ISSN-L)
1091-7683
DOI: 10.1080/07481187.2010.496686
OpenAlex: W2047256903
Cited by: 611
References: 72
Citations by year: 2026: 25 · 2025: 45 · 2024: 46 · 2023: 72 · 2022: 69 · 2021: 74 · 2020: 68 · 2019: 41 · 2018: 33 · 2017: 34 · 2016: 22 · 2015: 22 · 2014: 18 · 2013: 25 · 2012: 12
FWCI: 1.96
Type: journal article
Language: en
Open access: green
hdl.handle.net
Locations: Death Studies (publishedVersion)
PubMed (publishedVersion)
eSpace (Curtin University) (submittedVersion)
ANU Open Research (Australian National University) (submittedVersion)
Swinburne figshare (Swinburne University of Technology) (submittedVersion)
ResearchOnline@ND (The University of Notre Dame) (submittedVersion)
Funders: Australian Government
Topics: Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
Social Sciences › Psychology › Social Psychology › Death Anxiety and Social Exclusion
Keywords: complicated grief, bereavement, attachment styles, trauma exposure, psychiatric history, violent death, caregiver experiences, kinship, marital intimacy, preparation for death, social support, cognitive appraisal, meaning-making, attachment theory, constructivist learning model, cognitive-behavioral model
MeSH terms: Adaptation, Psychological, Attitude to Death, Mental Disorders, Grief, Humans, Social Support, Stress, Psychological, Violence, Caregivers

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Predictors of Complicated Grief: A Systematic Review of Empirical Studies

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