Prolonged Grief Disorder, Posttraumatic Stress Disorder, Depression, and Anxiety Symptom States Over ICU Family Members' First Two Bereavement Years.

Abstract

Co-occurrence of prolonged grief disorder (PGD) with psychologic distress like posttraumatic stress disorder (PTSD) and depression is widely studied. However, only two non-ICU studies from Western countries have cross-sectionally examined co-occurring PGD, PTSD, depression, and anxiety symptoms among individuals who experienced traumatic bereavement, yielding inconsistent findings. Despite this, PGD symptoms frequently co-occur with anxiety symptoms, which strongly predicts PTSD-depression trajectories and PGD-PTSD-depression symptom states. To identify and examine transitions through distinct states of co-occurring PGD, PTSD, depression, and anxiety symptoms over the first two bereavement years among Taiwanese ICU bereaved who lost a family member to diseases. Prospective cohort study. MICUs of two Taiwanese medical centers. Three hundred three family members. None. Participants were surveyed at 6, 13, 18, and 24 months of post-bereavement with 11 items from the PG-13, the Impact of Event Scale-Revised, and depression and anxiety subscales of the Hospital Anxiety and Depression Scale. Latent transition analysis was used to examine the PGD-PTSD-depression-anxiety symptom states and their prevalence over time. At 6 months of post-bereavement, we identified four distinct PGD-PTSD-depression-anxiety symptom states (prevalence): resilient (62.7%), subthreshold PGD-depression (21.2%), PGD-dominant (11.2%), and co-occurring PGD-PTSD-depression-anxiety (4.9%). Symptom states were mostly stable over time; however, when participants transitioned between states, they typically moved toward lower distress states. At 24 months of post-bereavement, the prevalence rankings remained unchanged: resilient (81.1%), subthreshold PGD-depression (10.9%), PGD-dominant (5.5%), and co-occurring PGD-PTSD-depression-anxiety (2.5%). We consistently observed four distinct PGD-PTSD-depression-anxiety-symptom states during the first two bereavement years of ICU family members. Persistently elevated PGD symptoms, alone or with PTSD, depression, and anxiety, can already be detected within 6 months of bereavement, underscoring the need for early screening to provide timely psychologic support or treatments for those at risk of chronic PGD or co-occurring symptom states.