The Longitudinal Association Between Death Attitudes and Grief Symptoms: A Three-Wave Cross-Lagged Study

Prolonged grief disorder (PGD) is characterized by persistent and impairing grief symptoms following bereavement. Although certain death attitudes have been associated with grief symptoms, their bidirectional relationships over time remain unclear. This three-wave (6-month intervals) study examined reciprocal associations between five dimensions of death attitudes (fear of death, death avoidance, neutral acceptance, approach acceptance, escape acceptance) and grief symptoms in 159 bereaved Chinese college students using cross-lagged panel models. Results showed that fear of death at Time 1 predicted higher grief symptoms at Time 2. Conversely, higher grief symptoms at Time 1 predicted lower neutral acceptance at Time 2, while higher grief symptoms at Time 2 predicted greater escape acceptance at Time 3. No other significant cross-lagged effects emerged. These findings reveal a dimension-specific, bidirectional pattern of longitudinal associations between death attitudes and grief symptoms, and highlight the potential relevance of death-related cognition in grief interventions.