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Pre-loss personal factors and prolonged grief disorder in bereaved mothers

Published online by Cambridge University Press:  09 November 2018

Richard D. Goldstein Open the ORCID record for Richard D. Goldstein [Opens in a new window] ,
Carter R. Petty ,
Sue E. Morris ,
Melanie Human ,
Hein Odendaal ,
Amy Elliott ,
Deb Tobacco ,
Jyoti Angal ,
Lucy Brink  and
Hannah C. Kinney
...Show all authors
Richard D. Goldstein*
Affiliation:
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, and Harvard Medical School, Boston, MA, USA
Carter R. Petty
Affiliation:
Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
Sue E. Morris
Affiliation:
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
Melanie Human
Affiliation:
Faculty of Medicine and Health Science, Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, Cape Town, South Africa
Hein Odendaal
Affiliation:
Faculty of Medicine and Health Science, Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, Cape Town, South Africa
Amy Elliott
Affiliation:
Center for Pediatric and Community Research, Avera McKennan Hospital & University Health Center Sioux Falls, Sioux Falls, SD, USA
Deb Tobacco
Affiliation:
Center for Pediatric and Community Research, Avera McKennan Hospital & University Health Center Sioux Falls, Sioux Falls, SD, USA
Jyoti Angal
Affiliation:
Center for Pediatric and Community Research, Avera McKennan Hospital & University Health Center Sioux Falls, Sioux Falls, SD, USA
Lucy Brink
Affiliation:
Faculty of Medicine and Health Science, Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, Cape Town, South Africa
Hannah C. Kinney
Affiliation:
Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
Holly G. Prigerson
Affiliation:
Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
for the PASS Network
Affiliation:
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, and Harvard Medical School, Boston, MA, USA Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA Faculty of Medicine and Health Science, Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, Cape Town, South Africa Center for Pediatric and Community Research, Avera McKennan Hospital & University Health Center Sioux Falls, Sioux Falls, SD, USA Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
*
Author for correspondence: Richard D. Goldstein, E-mail: [email protected]
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Abstract

Background

Identifying characteristics of individuals at greatest risk for prolonged grief disorder (PGD) can improve its detection and elucidate the etiology of the disorder. The Safe Passage Study, a study of women at high risk for sudden infant death syndrome (SIDS), prospectively examined the psychosocial functioning of women while monitoring their healthy pregnancies. Mothers whose infants died of SIDS were followed in bereavement.

Methods

Pre-loss data were collected from 12 000 pregnant mothers and analyzed for their associations with grief symptoms and PGD in 50 mothers whose infants died from SIDS, from 2 to 48 months after their infant's death, focusing on pre-loss risk factors of anxiety, depression, alcohol use, maternal age, the presence of other living children in the home, and previous child loss.

Results

The presence of any four risk factors significantly predicted PGD for 24 months post-loss (p < 0.003); 2–3 risk factors predicted PGD for 12 months (p = 0.02). PGD rates increased in the second post-loss year, converging in all groups to approximately 40% by 3 years. Pre-loss depressive symptoms were significantly associated with PGD. Higher alcohol intake and older maternal age were consistently positively associated with PGD. Predicted risk scores showed good discrimination between PGD and no PGD 6–24 months after loss (C-statistic = 0.83).

Conclusions

A combination of personal risk factors predicted PGD in 2 years of bereavement. There is a convergence of risk groups to high rates at 2–3 years, marked by increased PGD rates in mothers at low risk. The risk factors showed different effects on PGD.

Keywords

Bereavementmaternalprolonged grief disorderprospectiverisk factorssudden infant death syndrome
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 14 , October 2019 , pp. 2370 - 2378
Copyright
Copyright © Cambridge University Press 2018 

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