Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis

Abstract

Background: ‘Complicated grief reactions’ is an umbrella term covering symptoms of prolonged grief disorder (PGS) and other post-loss complications, including symptoms of depression, anxiety, and posttraumatic stress (PTS). While PGS often co-occurs with symptoms of depression, anxiety, and PTS, no pooled prevalence estimates of their co-occurrence have yet been established. Methods: The present systematic review and meta-analysis provided pooled prevalence estimates of co-occurrence of PGS and symptoms of depression, anxiety, and PTS based on the available literature, and examined possible moderators and risk of bias. Results: Based on the 23 included studies, the pooled prevalence estimates indicated that 70% of adults with PGS experienced one or more other type of complicated grief reaction, and 46% experienced two or more other types of complicated grief reactions. Estimates of PGS with co-occurring depression, anxiety, and PTS were 63%, 54%, and 49%, respectively. Heterogeneity was considerable (I2=92.5–95.6), and subsequent moderator-analyses showed that higher estimates of co-occurrence were found in studies with longer mean time since loss, and when co-occurrence was assessed with interviews compared with questionnaires. Limitations: The results should be considered preliminary due to high risk of bias of the included studies. Conclusions: Co-occurring cases of PGS and other types of complicated grief reactions were more prevalent than ‘pure’ cases of PGS with no co-occurrence. More population-based studies of symptom co-occurrence in non-traumatic bereavement are needed.

Keywords

• Meta-analysis
• Co-occurrence
• Prolonged grief
• Depression
• Anxiety
• Posttraumatic stress