Exploring Functional Impairment in Light of Prolonged Grief Disorder: A Prospective, Population-Based Cohort Study
Open accessAbstract
Background: Functional impairment is essential in the diagnostic criteria for prolonged grief disorder (PGD) in the ICD-11. It refers to the negative impact on everyday life, including inability to maintain the usual level of functioning. We aimed to assess the extent of functional impairment, emotion-related role limitation, and impaired social functioning before and after bereavement, and to explore associations with PGD, as measured by the 13-item Prolonged Grief Scale (PGD PG13). Method: Relatives of terminally ill patients (n = 1,622) completed a questionnaire before and after bereavement. The questionnaire assessed “overall functional impairment” (PG-13 item) and “aspects of functional impairment” measured by mean scores of the 36-item Short Form Survey (SF-36) subscales emotional role and social functioning (0: worst; 100: best). We analyzed associations between PGD PG13 and functional impairment prior to bereavement using logistic regression models adjusted for age, gender, personal relation, education, time interval to patient's death, and pre-loss grief. Results: In total, 51% reported overall functional impairment before bereavement, 27% reported functional impairment at 6 months after bereavement, and 19% reported functional impairment at 3 years after bereavement. The mean emotional role score was 47.5 (95%CI: 45.4–49.7) before bereavement, increasing to 77.4 (95%CI: 75.7–79.0) at 3 years after bereavement, compared to 85.1 (95%CI: 77.6–92.6) in a reference sample. Mean social functioning score increased gradually reaching the mean of the reference sample at 3 years after bereavement. PGD PG13 was present in 26% of those with overall functional impairment at 6 months after bereavement, decreasing to 11% at 3 years after bereavement. Pre-bereavement measures of emotional role and social functioning were associated with PGD PG13 at 6 months and 3 years after bereavement. Discussion: Overall functional impairment was prevalent as reflected in low scores on daily activities and social functioning compared to a reference sample. Functioning may be an important factor during caregiving and bereavement and pre-bereavement functional impairment was associated with PGD PG13. Future studies should investigate if maintaining daily activities and social functioning before bereavement could be key in early supportive care. Moreover, the role of functional impairment in bereavement interventions should be explored.
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Longitudinal studies using latent growth mixture modelling have noted a group with high grief symptoms that do not improve over time.
“Longitudinal studies assessing bereaved people at multiple time points, and using latent growth mixture modelling to map the different trajectories of grief symptoms over time, have noted the presence of a group with high grief symptoms that do not improve over time 88-90 .”
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 [90]
The Discussion (Clinical Implications; page unavailable) reports that prior studies found persistently high grief symptom levels, and the Methods (Setting and Design; page unavailable) identifies an earlier analysis of grief-symptom trajectories in this cohort. Our copy does not say that those trajectories were mapped using latent growth mixture modelling, so it supports the persistent-symptoms finding but not the specified method. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPeople with prolonged grief disorder experience deterioration in functioning that can persist for at least 3 years post-bereavement.
“Longitudinal studies also indicate that people with prolonged grief disorder experience deterioration in functioning, and this can persist for at least 3 years post-bereavement 90 .”
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 [90]
The Results report functional impairment at three years after bereavement, including some people who met the study’s PGD criteria. But the Discussion (Comparison With Previous Finding; page unavailable) describes functioning as improving from before to after bereavement, not deteriorating, and says only a small proportion of those impaired at three years had PGD. The paper therefore supports possible long-lasting impairment, not the claimed deterioration in people with PGD. (LLM, conf=0.84)
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- Authors
- Nielsen, M. K., Christensen, K. S., Neergaard, M. A., Bidstrup, P. E., & Guldin, M.-B.
- Affiliations
- Aarhus University (DK)
- Aarhus University Hospital (DK)
- University of Copenhagen (DK)
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2020-12-09
- Volume
- 11
- Pages
- 537674-537674
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC7755858
- OpenAlex
- W3111397618
- Cited by
- 30
- References
- 38
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 3 · 2023: 5 · 2022: 5 · 2021: 3
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Scopus (Elsevier) (submittedVersion, other-oa)
- Funders
- Novo Nordisk Fonden
- Kræftens Bekæmpelse
- 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, functional disability, bereavement, relatives of terminally ill patients, caregivers, emotional role limitation, social functioning, ICD-11 diagnostic criteria, SF-36, caregiver burden
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