The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults

A prospective study



Research has shown that symptoms of Prolonged Grief Disorder (PGD, formerly called Complicated Grief) are distinct from those of depression and anxiety, and have incremental validity in that they predict impairments in functioning, independent of depression and anxiety. This study sought to replicate these findings using a prospective design, a heterogeneous sample of mourners, and the most recent criteria to define PGD.


Data from 346 mourners who were bereaved between 6 months and 2 years and who were recruited from professional and lay mental health care workers and the Internet, were used in a confirmatory factor analysis to determine the distinctiveness of symptoms of PGD, depression, and anxiety. Regression analyses estimated the effects of symptoms of PGD, depression, and anxiety on quality of life and mental health 6 months (T2) and 15 months (T3) after baseline, in a subgroup of 96 mourners assessed at follow-up.


PGD, depression, and anxiety represented three distinct factors. When we controlled the influence of relevant background variables but not the shared variance between the factors, all three factors predicted quality of life and mental health outcomes at T2 and T3. When we controlled the shared variance between factors, the PGD factor at T1 predicted unique variance in four outcomes at T2 (mental health, suicidal ideation, PGD severity, and depression severity) and two outcomes at T3 (mental health and PGD severity), the depression factor in one outcome at T2 (depression severity) but none at T3, and the anxiety factor in six outcomes at T2 (mental health, energy, general health perception, sleeping problems, depression severity, and anxiety severity) and one at T3 (anxiety severity).


We found PGD (defined according to the newest criteria) to be distinct from depression and anxiety and to be predictive of reduced quality of life and mental health. The concept of PGD is needed to detect mourners at risk for health impairments, who would go undetected with an exclusive focus on depression or anxiety.

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  1. 1.

    We wished to include at least nine indicators of PGD, five of depression, and five of anxiety in the CFA. As CFA requires at least N = 5 per estimated parameters [5] we needed data from at least 315 mourners to conduct CFA. Given that the sample included in the prospective analyses (consisting of those bereaved between 6 months and 1 year at T1) included only 96 people, for the CFA we included all those bereaved between 6 months and 2 years, in order to have sufficient data for these analyses. As PGD can only be diagnosed after the first half-year of bereavement we excluded mourners bereaved less than 6 months.

  2. 2.

    Participants recruited from mental health care workers received different sorts of help of different duration. Yet, neither the sort nor the duration of help influenced symptom scores at T1 in this group. Hence, it was considered appropriate only to control for recruitment source and not sort and duration of help.

  3. 3.

    In keeping with this notion, at T3, over 80% answered that they “never” had thoughts of ending their lives, whereas only N = 2 (2.3%) noted that they “often” had these thoughts.


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This research was supported in part by Grants NWO 451-06-011 from the Dutch Organisation for Scientific Research (PAB), MH63892 from the National Institute of Mental Health (HGP), and CA106370 from the National Cancer Institute (HGP).

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Correspondence to Paul A. Boelen Ph.D..

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Boelen, P.A., Prigerson, H.G. The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults. Eur Arch Psychiatry Clin Neurosc 257, 444–452 (2007).

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Key words

  • anxiety
  • death and dying
  • depression
  • grief
  • quality-of-life