Predictors of Complicated Grief and Depression in Bereaved Caregivers: A Nationwide Prospective Cohort Study

Complicated grief and depressive symptoms in bereaved caregivers have been associated with female gender, spousal relation, and preloss psychological distress, but population-based, prospective studies are scarce.

We aimed to investigate whether severe preloss grief and depressive symptoms, caregiver burden, preparedness for death, communication about dying, and socioeconomic factors predicted complicated grief and postloss depressive symptoms.

We conducted a population-based, prospective Danish survey of caregivers. Questionnaires for their closest caregiver were mailed to patients registered with drug reimbursement for terminal illness. Of the 3635 (38%) responding caregivers, 2420 were bereaved within six months. Of these, 2215 (88%) completed a postloss follow-up questionnaire. Associations between complicated grief (Prolonged Grief-13), postloss depressive symptoms (Beck Depression Inventory-II), and predictive factors were analyzed with mutually adjusted multivariable logistic regression models.

At six-month follow-up, 7.6% reported complicated grief and 12.1% reported postloss depressive symptoms, whereas the levels of grief and depressive symptoms were higher preloss. Complicated grief and postloss depressive symptoms were predicted by severe preloss grief symptoms (adjusted odds ratio [OR] = 3.8, 95% CI: 2.4-6.1), preloss depressive symptoms (adjusted OR = 5.6, 95% CI: 3.5-9.0), being a partner (adjusted OR = 2.2, 95% CI: 1.2-3.7), and low educational level (adjusted OR = 2.0, 95% CI: 1.2-3.7). Complicated grief was not predicted by age and gender, whereas postloss depressive symptoms were predicted by young age, female gender, and low preparedness for death.

Severe preloss grief and depressive symptoms were key predictors of postloss complicated grief and depressive symptoms. Systematic assessment may identify caregivers with a high risk profile who need targeted support.