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Symptoms of persistent complex bereavement disorder, depression, and PTSD in a conjugally bereaved sample: a network analysis

Published online by Cambridge University Press:  18 July 2018

Matteo Malgaroli Open the ORCID record for Matteo Malgaroli [Opens in a new window] ,
Fiona Maccallum  and
George A. Bonanno
Matteo Malgaroli*
Affiliation:
Teachers College, Columbia University, New York, NY 10027, USA
Fiona Maccallum
Affiliation:
University of New South Wales, Sidney, Australia
George A. Bonanno
Affiliation:
Teachers College, Columbia University, New York, NY 10027, USA
*
Author for correspondence: Matteo Malgaroli, PhD E-mail: mm4408@columbia.edu
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Abstract

Background

Complicated and persistent grief reactions afflict approximately 10% of bereaved individuals and are associated with severe disruptions of functioning. These maladaptive patterns were defined in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as persistent complex bereavement disorder (PCBD), but its criteria remain debated. The condition has been studied using network analysis, showing potential for an improved understanding of PCBD. However, previous studies were limited to self-report and primarily originated from a single archival dataset. To overcome these limitations, we collected structured clinical interview data from a community sample of newly conjugally bereaved individuals (N = 305).

Methods

Gaussian graphical models (GGM) were estimated from PCBD symptoms diagnosed at 3, 14, and 25 months after the loss. A directed acyclic graph (DAG) was generated from initial PCBD symptoms, and comorbidity networks with DSM-5 symptoms of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) were analyzed 1 year post-loss.

Results

In the GGM, symptoms from the social/identity PCBD symptoms cluster (i.e. role confusion, meaninglessness, and loneliness) tended to be central in the network at all assessments. In the DAG, yearning activated a cascade of PCBD symptoms, suggesting how symptoms lead into psychopathological configurations. In the comorbidity networks, PCBD and depressive symptoms formed separate communities, while PTSD symptoms divided in heterogeneous clusters.

Conclusions

The network approach offered insights regarding the core symptoms of PCBD and the role of persistent yearnings. Findings are discussed regarding both clinical and theoretical implications that will serve as a step toward a more integrated understanding of PCBD.

Keywords

Bereavementdepressiongriefnetwork analysisPTSD
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 14 , October 2018 , pp. 2439 - 2448
Copyright
Copyright © Cambridge University Press 2018 

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