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

OBJECTIVE: 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. DESIGN: Prospective cohort study. SETTING: MICUs of two Taiwanese medical centers. SUBJECTS: Three hundred three family members. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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%). CONCLUSIONS: 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.