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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Thompson, C., Williams, K., Masso, M. R., Morris, D., Kobel, C., Duncan, C., & Samsa, P. (2017) · Research Online (University of Wollongong) · Cited by 6
Reciprocal regulation in social support interactions between bereaved parents and their potential supporters: a qualitative study
Tognela, J. A., Breen, L. J., & Rudaizky, D. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1659628 · Cited by 6
Experiencing Missing Contact With Professionals and Long Term Bereavement Outcome
Ramstad, E. S., Thegen, L. S., Guldin, M., Neergaard, M. A., & Nielsen, M. K. (2022) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2022.09.006 · Cited by 5
Support in bereavement processes in cases of suicide or substance-related death in childhood: a systematic review
Reime, M. A., Grimholt, T. K., Kjoelaas, S., Bringedal, N., & Hogstad, I. J. (2024) · Mortality · doi:10.1080/13576275.2023.2298814 · Cited by 7
“…of the adult population is documented that social support can be important for counteracting negative effects of the loss (Hibberd et al., 2010; Lobb et al., 2010), thus there are also some inconclusive findings regarding the effect on social support on for example complicated grief (Stroebe…”
How Does Bereavement Affect the Health-Related Quality of Life of Household Members Who Do and Do Not Provide Unpaid Care? Difference-in-Differences Analyses Using the UK Household Longitudinal Survey
Pennington, B., Alava, M. H., & Strong, M. (2024) · PharmacoEconomics · doi:10.1007/s40273-024-01452-1 · Cited by 5
“…carers may be more prepared for the death of the patient, and low preparedness is associated with more complicated grief and worse symptoms [35], or caregivers may feel that the death of the patient was a relief to themselves due to protracted and stressful caregiving [31], or carers may…”
Child mortality and parental grief: An evolutionary analysis
Reynolds, T. A., Boutwell, B. B., Shackelford, T. K., Weekes‐Shackelford, V. A., Nedelec, J. L., Beaver, K. M., & Abed, M. G. (2020) · New Ideas in Psychology · doi:10.1016/j.newideapsych.2020.100798 · Cited by 5
“Indeed, one symptom associated with complicated grief is searching for the deceased (Lobb et al., 2010).”
Background
Self-identity processing and grief: The role of avoidance and flexibility
Maccallum, F. (2022) · Personality and Individual Differences · doi:10.1016/j.paid.2021.111478 · Cited by 5
No time to grieve: Inuit loss experiences and grief practices in Nunavik, Quebec
Hordyk, S. R., Macdonald, M. E., Brassard, P., Okalik, L., & Papigatuk, L. (2022) · Transcultural Psychiatry · doi:10.1177/13634615221135423 · Cited by 6
“Families providing care are often simultaneously confronted by the reduced physical and relational capacities of patients nearing the end of life and increased economic stress related to loss of income or costs related to care (Lobb et al., 2010; Payne et al., 1999).”
Background
Relatives’ grief at three moments after death of a loved one during COVID-19 pandemic (the CO-LIVE study)
Baalen, C. N., Witkamp, F. E., Korfage, I. J., Pasman, H. R. W., Becqué, Y. N., Zee, M. S., van der Heide, A., Onwuteaka-hilipsen, B. D., & Goossensen, A. (2023) · Death Studies · doi:10.1080/07481187.2023.2297055 · Cited by 5
“Higher unfin-ished business scores were previously associated with more negative grief symptoms (Klingspon et al., 2015; Lobb et al., 2010).”
Background
Stellenschlüssel für therapeutische Gesundheitsfachberufe auf Intensivstationen
Klarmann, S., Hierundar, A., Deffner, T., Markewitz, A., Waydhas, C., & Sektionen Therapeutische Gesundheitsfachberufe, P. V. S. D. S. Q. U. Ö. I. D. I. D. D. I. V. F. I. U. N. (. (2024) · Medizinische Klinik - Intensivmedizin und Notfallmedizin · doi:10.1007/s00063-024-01125-z · Cited by 5
The stigmatization of prolonged grief disorder and disenfranchised grief: A vignette-based experimental study
Sarper, E., & Rodrigues, D. L. (2024) · Death Studies · doi:10.1080/07481187.2024.2340726 · Cited by 5
“…certain contextual determinants can also increase the risk of more severe grief experiences, including losing some-one after a violent death (e.g., homicide, suicide, fatal accident; Nakajima et al., 2012) and having a more emotionally intimate relationship with the deceased (Lobb et al., 2010).”
Support needs of Australians bereaved during the COVID-19 pandemic: A cross-sectional survey study
Ivynian, S. E., Maccallum, F., Chang, S., Breen, L. J., Phillips, J. L., Agar, M. R., Hosie, A., Tieman, J., DiGiacomo, M. L., Luckett, T., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0304025 · Cited by 5
“Social support is modifiable and can helpfully influence the grieving process, making it an effective way to reduce the risk of deleterious grief outcomes [20,21].”
BackgroundSelf-citation
Perceived social support and symptoms of prolonged grief after a drug-related death
Reime, M. A., O’Connor, M., Hystad, S. W., & Dyregrov, K. (2024) · Death Studies · doi:10.1080/07481187.2024.2376037 · Cited by 5
“Research has shown that social support can be a buffer against the development of complicated grief reactions (Hibberd et al., 2010; Lobb et al., 2010) and is one of the most significant predictors of a healthy bereavement process (Burke & Neimeyer, 2013).”
Estudio del perfil de una población de personas en duelo complicado que acuden a un centro de escucha de duelo
Durbán, M. V., Loarte, M. M., Higuera, J. C. B., Maza, R. C., & Fernández, I. S. (2012) · Medicina Paliativa · doi:10.1016/j.medipa.2012.05.007 · Cited by 5
Bereavement among Israeli parents who lost children in military service: Protective factors for coping with loss
Schiff, M., Elkins, Y., Aharoni, E., Weisler-Mamou, I., Goldberger, S. P., & Simhon, Y. (2020) · Death Studies · doi:10.1080/07481187.2020.1815102 · Cited by 5
“Parents’ psychological distress following children’s sudden death was found to be greater than that after children’s expected death, as after a long illness (Lobb et al., 2010).”
Background
A cross-sectional examination of sudden-death bereavement in university students
Bhaskaran, J., Afifi, T. O., Sareen, J., Vincent, N., & Bolton, J. M. (2021) · Journal of American College Health · doi:10.1080/07448481.2021.1947298 · Cited by 5
Arrhythmia care co-ordinators: Their impact on anxiety and depression, readmissions and health service costs
Ismail, H., & Coulton, S. (2015) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515115584234 · Cited by 5
A Longitudinal Perspective on Bereaved Parent's Changes in Life Experience after the 2014 Sewol Ferry Sinking
Kim, Y., Lee, D. H., & Jeon, H. J. (2020) · OMEGA - Journal of Death and Dying · doi:10.1177/0030222820947238 · Cited by 5
“…to suicide, accidents, and homicide—has been found to elicit more intense and complicated grief in parents than nonviolent bereavement (Dickens, 2014; Lobb et al., 2010), and they are also more likely to experience traumatic distress compared to those bereaved by natural causes (Holland &…”
Background
Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care
Díez‐Manglano, J., Muñoz, L. Á. S., Fenoll, R. G., Freire, E., Pérez, S. I. D. I., Carneiro, A. H., & Torres, O. H. (2020) · Revista Clínica Española (English Edition) · doi:10.1016/j.rceng.2020.04.009 · Cited by 5
Treating Prolonged Grief
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“anxiety disorders, such as major depression and generalized anxiety disorder (Lobb et al., 2010).”
BackgroundInfluential
The APSY-SED study: protocol of an observational, longitudinal, mixed methods and multicenter study exploring the psychological adjustment of relatives and healthcare providers of patients with cancer with continuous deep sedation until death
Fasse, L., Roche, N., Flahault, C., Garrouste-Orgeas, M., Ximenes, M. L., Pagès, A., Evin, A., Dauchy, S., Scotté, F., Provost, J. L., et al. (2022) · BMC Palliative Care · doi:10.1186/s12904-022-01106-z · Cited by 4
The Grief of Peer Loss Among Adolescents: A Narrative Review
Chen, X.-X., Chen, J., & Zhong, B. (2025) · Psychology Research and Behavior Management · doi:10.2147/prbm.s504117 · Cited by 4
An experience sampling study exploring associations between contextual factors and prolonged grief reactions in daily life
Pociūnaitė-Ott, J., Kraiss, J. T., van Eersel, J. H. W., Franzen, M., & Lenferink, L. I. M. (2025) · Scientific Reports · doi:10.1038/s41598-025-23122-8 · Cited by 4
Development and initial test of the self-report grief and bereavement assessment
Sealey, M., Breen, L. J., Aoun, S. M., & O’Connor, M. (2022) · Death Studies · doi:10.1080/07481187.2022.2081998 · Cited by 4
“We developed a list of risk and protective factors associated with prolonged grief based on a systematic review of empirical studies (Lobb et al., 2010).”
BackgroundSelf-citation
Bereavement in the Time of COVID-19: Learning from Experiences of those Bereaved as a Result of Deaths in an Acute Hospital Setting in 2020
Lightbody, S., Catt, L., Ahmad, A. A., Glover, D., Whitney, J. C., & Hasan, S. (2022) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228221113214 · Cited by 4
“Complicated grief is more likely after a traumatic death (Lobb et al., 2010) and is associated with increased morbidity (Prigerson et al., 1997).”
Factors Associated With Treatment Response in an Internet-Based Intervention for Prolonged Grief Disorder After Cancer Bereavement
Kaiser, J., Treml, J., Hoffmann, R., Linde, K., Nagl, M., & Kersting, A. (2022) · Behavior Therapy · doi:10.1016/j.beth.2022.07.008 · Cited by 9
Feeling Connected to Nature Attenuates the Association between Complicated Grief and Mental Health
Schony, M., & Mischkowski, D. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21091138 · Cited by 4
“Namely, numerous psychological and interpersonal risk factors for CG have been identified (e.g., unpreparedness for loss, family conflict at end of life) [20,21,72].”
Background
Maladaptive Personality Characteristics, Coping and Situational Factors Predict Symptoms of Complicated Grief and Health Difficulties
Peak, A. M., Martin, L. A., Post, K. M., & Hua, W. (2024) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228241275195 · Cited by 4
“For example, individuals who experience the traumatic death of a loved one (e.g., suicide) have an increased risk of complicated grief compared to those who do not experience a traumatic loss (Jordan & Litz, 2014; Lobb et al., 2010).”
Influential
IMPLICATIONS OF CHILD ABDUCTION FOR HUMAN RIGHTS AND CHILD WELFARE SYSTEMS: A CONSTRUCTIVIST INQUIRY OF THE LIVED EXPERIENCE OF GUATEMALAN MOTHERS PUBLICALLY REPORTING CHILD ABDUCTION FOR INTERCOUNTRY ADOPTION
Mónico, C. (2013) · VCU Scholars Compass (Virginia Commonwealth University) · doi:10.25772/ks3h-za81 · Cited by 4
An Exploration of Resilience and Post-traumatic Growth Following Traumatic Death
Henry, S. L. (2017) · UST Research Online (University of St. Thomas - Minnesota) · Cited by 4
The Implications of Complicated Grief for the Sleep
de Almeida, T. (2018) · OALib · doi:10.4236/oalib.1104572 · Cited by 4
The Development of a Bereavement Support Group Curriculum for Young Adults Dealing with the Death of a Partner: A Quality Improvement Project
Morris, S. E., Souza, P. M., & Fasciano, K. M. (2020) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2020.0131 · Cited by 4
Psychological Effects of Natural Disaster: Traumatic Events and Losses at Different Disaster Stages
Kozu, S., & Gibson, A. (2020) · Springer eBooks · doi:10.1007/978-3-030-51525-6_6 · Cited by 3
Serious Mental Illness Exacerbation Post-Bereavement: A Population-Based Study of Partners and Adult Children
Tay, D. L., Thygesen, L. C., Kozlov, E., & Ornstein, K. A. (2022) · Clinical Epidemiology · doi:10.2147/clep.s372936 · Cited by 4
“Thus, we are unable to assess the quality of relationships between partners and adult children with the deceased, which is a key predictor of complicated grief.(18) While the analyses were adjusted for pre-existing chronic disease conditions, the data do not allow for the assessment of other confounders such as social…”
Background
To lose a friend: the relationship between professional help and grief among close bereaved friends after the terror attack, 22 July 2011
Johnsen, I., Mikkelsen, J. S., Opheim, A. A., & Gjestad, R. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2264118 · Cited by 4
“…(Djelantik et al., 2020) found that approximately 50% of bereaved individuals who experienced an unnatural loss may develop complicated grief symptoms, and that such symptoms are more often present after unnatural loss compared to non-violent loss (see also Lobb et al., 2010; Revet et al., 2021).”
Background
A Qualitative Evaluation of the Provision of Bereavement Care Accessed by Service Users Living in a Health and Social Care Trust Area in Northern Ireland
Montgomery, L., & Campbell, A. (2012) · Journal of Social Work in End-of-Life & Palliative Care · doi:10.1080/15524256.2012.685442 · Cited by 4
“While there is not yet consensus (Hanson & Stroebe, 2007), these have been identified as indicative of factors contributing to adverse bereavement reactions in Western cultures (Lobb et al., 2010; Parkes, 1998; Stroebe & Schut, 2001).”
Background
Etterlattes opplevelser av medienes rapportering etter Utøya-terroren
Dyregrov, K., Kristensen, P., & Dyregrov, A. (2016) · Norsk medietidsskrift · doi:10.18261/issn.0805-9535-2016-03-03 · Cited by 4
“…kan likevel ikke underslås at over tid kan mengden informasjon og stadige repetisjoner utgjøre en betydelig stressbelastning for etterlatte – spesielt fordi dette kan virke som traumatiske påminnere som igangsetter minner, tanker og reaksjoner (Lobb et al., 2010; Stroebe, Schut, & Stroebe, 2007).”
Background
Genç Yetişkinlerde Baba Kaybı ve Yas: Nitel bir Çalışma
Maraş, A., & Gençöz, F. (2020) · Ayna Klinik Psikoloji Dergisi · doi:10.31682/ayna.726517 · Cited by 3
Direct Losses and Media Exposure to Death: The Long-Term Effect of Mourning during the COVID-19 Pandemic
Caci, B., & Giordano, G. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13133911 · Cited by 3
Behandlung und Begleitung von Erwachsenen am Lebensende auf der Intensivstation: Zentrale Aspekte zum Lebensende und zum Sterben
Münch, U., Duttge, G., Eggardt, T. J., Gretenkort, P., Kleinschmidt, S., Meier, S., Nauck, F., Neitzke, G., Neukirchen, M., Salomon, F., et al. (2025) · Die Anaesthesiologie · doi:10.1007/s00101-025-01569-8 · Cited by 3
Exploring prolonged grief disorder through Iranian cultural beliefs: a qualitative thematic analysis
Ensan, N., Zarani, F., Ayatollahi, H., Panaghi, L., & Killikelly, C. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2026.2636454 · Cited by 3
“…a child or partner, insecure attachment styles, prior mental health difficulties, limited social support, and ongoing post-loss stressors, whereas supportive social networks, meaning-making processes, and reinforcing mourning rituals act as protective factors (Buur et al., 2024; Lobb et al., 2010).”
Evaluation of the Caring Ahead: Preparing for End-of-Life With Dementia Questionnaire
Durepos, P., Akhtar‐Danesh, N., Sussman, T., Ploeg, J., Boerner, K., & Kaasalainen, S. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2021.06.032 · Cited by 3
A twenty-year bibliometric analysis on the relationship between complicated grief and attachment
Ribera‐Asensi, O., Valero‐Moreno, S., & Pérez‐Marín, M. (2023) · Current Psychology · doi:10.1007/s12144-023-05518-9 · Cited by 3
“The most cited article was written by Lobb et al. (2010), with 70 citations, which was published in Death Studies .”
Trajectories of grief-related psychopathology: A decade after the MH17 plane disaster
Nijborg, L. C. J., Westerhof, G. J., Pociūnaitė-Ott, J., Kunst, M. J. J., de Keijser, J., & Lenferink, L. I. M. (2025) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2025.103036 · Cited by 4
Komplike Yas: Derleme ve Vaka Çalışması
Maraş, A. (2014) · Ayna Klinik Psikoloji Dergisi · doi:10.31682/ayna.470560 · Cited by 5
Complicated Grief in Rural Appalachia: Using Feminist Theory to Reconcile Grief
Darrow, N. E. T., & Gibbons, M. M. (2019) · Journal of Mental Health Counseling · doi:10.17744/mehc.41.4.02 · Cited by 3
Tristesse, détresse et dépression : un modèle intégratif des processus émotionnels du deuil et ses implications sur le processus thérapeutique
Couët-Garand, A., & Lecours, S. (2020) · Psychothérapies · doi:10.3917/psys.194.0203 · Cited by 7

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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