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Grief is a natural response to loss and grief responses differ in severity and duration between individuals. For some individuals, grief can lead to psychological distress, including prolonged grief disorder (PGD), bereavement-related depression and, in cases of violent loss, posttraumatic stress disorder (PTSD). Comorbidity between PGD, depression and PTSD is frequent and there is some overlap of symptoms among the three. While there are commonalities, research has shown that PGD is distinguishable from bereavement-related PTSD and depression.
Understanding the differences in responses to loss is important to develop tailored care plans for the bereaved individual. To advance this understanding of difference, Heeke (2023) and colleagues conducted a systematic review to provide a comprehensive overview of the state of research using latent class analysis – a person-centered statistical approach – on PGD, PTSD and depression in bereaved adults.
The systematic review included 21 published research studies that used latent class analysis to study PGD, PTSD and depression in bereaved adults. Latent class analysis is a person-centered statistical approach that identifies groups or “classes” of individuals based on their response patterns to a set of observed variables. In grief research, this approach has been used to classify subgroups of individuals according to symptoms of PGD, depression or PTSD. Latent class analysis can help to can reveal classes of individuals with similar characteristics that may not be apparent through other research approaches.
The 21 studies included in this review were published between 2014 and 2022. These studies included a total of 10,338 participants across 11 countries. Nine studies included participants who lost their significant other to violence, 8 studies included participants who lost their significant other to non-violent loss and 4 studies either did not report the cause of loss or included both individuals that experienced a violent and non-violent loss.
All 21 reviewed studies used symptoms of PGD and at least one further mental health outcome as indicators, including symptoms of PTSD, depression, anxiety symptoms, functional impairment items, anger and posttraumatic growth.
PGD, PTSD, and depression symptoms were the most commonly studied outcomes. Of the ten studies that investigated PGD, PTSD and depression, nine found a three-class solution and one study a four-class solution that had distinct symptom-profiles.
Almost all studies found a resilient class, characterised by low symptomatology across various syndromes, and a combined symptom class, characterised by medium to high symptomatology across various syndromes. This indicates that symptom profiles differed in terms of the severity of symptoms.
Two thirds of the included studies identified a PGD only class. This finding supports the idea that for some bereaved individuals, PGD symptoms are the primary and only symptomatic response to loss. Further, it suggests that PGD is distinguishable from PTSD and depression.
Some studies identified a PTSD or depression only class, suggesting that after a loss, it might be an exception that people develop depression or PTSD symptoms without also developing PGD symptoms.
To date, latent class analysis has been used as an exploratory approach in grief research but has shown promise in clarifying the unique responses of individuals to loss and how individuals experience symptoms. This is important to help develop tailored care plans for individuals.
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Source: Heeke, C., Franzen, M., Knaevelsrud, C., & Lenferink, L. I. (2023). Latent classes of prolonged grief and other indicators of mental health in bereaved adults: A systematic review. Journal of Affective Disorders Reports, 100654.
