Identifying risk factors of acute and prolonged grief using large-scale survey data

Bereavement can precipitate severe acute grief. If such grief reactions persist beyond six months post-loss, they may develop into prolonged grief disorder (PGD). Charting risk factors of severe grief before and beyond six months post-loss is critical to help identify people who may benefit from preventative and curative interventions for PGD.

Bereaved adults <6 months post-loss (N = 2450) and ≥ 6 months post-loss (N = 3609) completed an online survey. We assessed demographic variables (age, gender), loss characteristics (e.g., cause of death, relationship to the deceased, death expectedness), and situational factors (e.g., pre-death ICU admission, saying goodbye appropriately, COVID-19 infection, quarantine, financial setbacks, funeral alterations, funeral and social support satisfaction, pandemic phase of loss).

Univariate and multivariate analyses showed that loss of a partner or child (vs. other relationship), unnatural deaths (vs. natural), unexpected deaths (vs. expected), and a lower social support satisfaction uniquely related to both higher acute and prolonged grief severity. In multivariate analyses, some factors (age, pre-death ICU admission, saying goodbye appropriately, COVID-19 infection, financial setbacks) related exclusively to acute grief severity, whereas COVID-19 deaths (vs natural) related exclusively to prolonged grief severity.

A self-selected sample may limit generalizability. Self-report measures precluded establishing PGD diagnoses.

Findings suggest the unique importance of kinship, cause of death, expectedness of death, and social support in identifying people who may benefit from preventative and curative interventions for PGD. Pandemic-related loss circumstances appear more relevant to understanding acute grief reactions than prolonged grief reactions.