Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis

• Main Authors: Katrine B. Komischke-Konnerup, Robert Zachariae, Maja Johannsen, Louise Dyrvig Nielsen, Maja O'Connor
• Format: Article
• Language: English
• Published: Elsevier 2021-04-01
• Series: Journal of Affective Disorders Reports
• Subjects: Meta-analysis; Co-occurrence; Prolonged grief; Depression; Anxiety; Posttraumatic stress
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666915321000676

Background: ‘Complicated grief reactions’ is an umbrella term covering symptoms of prolonged grief disorder (PGS) and other post-loss complications, including symptoms of depression, anxiety, and posttraumatic stress (PTS). While PGS often co-occurs with symptoms of depression, anxiety, and PTS, no pooled prevalence estimates of their co-occurrence have yet been established. Methods: The present systematic review and meta-analysis provided pooled prevalence estimates of co-occurrence of PGS and symptoms of depression, anxiety, and PTS based on the available literature, and examined possible moderators and risk of bias. Results: Based on the 23 included studies, the pooled prevalence estimates indicated that 70% of adults with PGS experienced one or more other type of complicated grief reaction, and 46% experienced two or more other types of complicated grief reactions. Estimates of PGS with co-occurring depression, anxiety, and PTS were 63%, 54%, and 49%, respectively. Heterogeneity was considerable (I2=92.5–95.6), and subsequent moderator-analyses showed that higher estimates of co-occurrence were found in studies with longer mean time since loss, and when co-occurrence was assessed with interviews compared with questionnaires. Limitations: The results should be considered preliminary due to high risk of bias of the included studies. Conclusions: Co-occurring cases of PGS and other types of complicated grief reactions were more prevalent than ‘pure’ cases of PGS with no co-occurrence. More population-based studies of symptom co-occurrence in non-traumatic bereavement are needed.