Disturbed grief, posttraumatic stress, and depression symptoms in disaster-bereaved people: Symptom-profiles, temporal associations, and treatment

Lonneke Lenferink, Angela Nickerson, Geert Smid, Jos de Keijser, Paul Boelen



The risk of persistent complex bereavement disorder (PCBD, and comorbid posttraumatic stress disorder (PTSD) and depression, is greater following a sudden/violent loss (e.g., disaster-related loss). This has also been referred to as “traumatic grief”. Knowledge on the course of traumatic grief among disaster-bereaved people could enhance our understanding of aetiology and treatment of traumatic grief. In a Dutch four-wave longitudinal study, we conducted two studies, examining the course of traumatic grief symptoms among people (N = 172) whose significant other died due to a plane disaster with flight MH17 that took place in 2014. People completed PCBD, PTSD, and depression questionnaires 11, 22, 31, and 42 months after the disaster.
To identify (predictors of) trajectories of PCBD, PTSD, and depression in disaster-bereaved people (study 1) and to examine temporal associations between these symptoms (study 2) latent class growth modelling and cross-lagged analyses were used, respectively. In study 3, people (N = 39) with elevated traumatic grief levels were included in a randomized controlled trial (RCT) examining the effects of cognitive plus EMDR therapy (vs. waitlist controls) on PCBD, PTSD, and depression symptoms. Participants completed questionnaires before and after treatment or waiting period. Multi-level modelling was used for data-analysis.
In study 1, a Mild (81.8%) and Chronic (18.2%) PCBD class emerged. For PTSD and depression we found a Mild (85.2% and 85.6%), Recovered (4.4% and 8.2%), and Chronic trajectory (10.3% and 6.2%). A lower educational level predicted chronic trajectories. In study 2, changes in PCBD symptoms had a greater impact on changes in PTSD and depression symptoms than vice versa. In study 3, preliminary RCT findings showed that PCBD, PTSD, and depression symptom-levels significantly declined for both groups with a significantly stronger decline in depression for the treatment condition.
To conclude, in study 1 we found support for differential trajectories across the outcomes, suggesting that different symptom-profiles post-loss may need different treatment approaches. Study 2’s findings run counter to the notion that PTSD and depression symptoms should be addressed before grief in treatment. Based on study 3, we suggest that cognitive therapy plus EMDR might be useful for treating people with traumatic grief, but there is room for improvement.
Originele taal-2English
StatusPublished - 20-jul.-2019
Evenement9th World Congress of Behavioural and Cognitive Therapies - Berlin, Germany
Duur: 17-jul.-201920-jul.-2019


Conference9th World Congress of Behavioural and Cognitive Therapies
Verkorte titelWBCT
Internet adres

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