Prolonged grief disorder and depression are distinguishable syndromes: A latent transition analysis for bereaved family caregivers of cancer patients

Fur Hsing Wen, Holly G. Prigerson, Wen Chi Chou, Jen Shi Chen, Wen Cheng Chang, Mei Huang Hsu, Siew Tzuh Tang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

3 Scopus citations


Objective: To determine whether distinctive prolonged-grief-disorder- (PGD) and depressive-symptom states emerge among family caregivers of cancer patients over their first 2 years of bereavement. This may extend cross-sectional evidence that PGD and major depressive disorder (MDD) symptoms can co-occur/occur independently and validate their construct distinctiveness. Methods: In this secondary-analysis study, PGD symptoms and depressive symptoms were measured over 666 caregivers using 11 grief symptom items of the Prolonged Grief-13 scale and 16 items of the Center for Epidemiologic Studies-Depression scale, respectively. Distinct PGD/depressive-symptom states were identified by latent transition analysis with dichotomous indicators (presence/absence) of PGD or depressive symptoms. Results: Four distinct PGD/depressive-symptom states emerged. The resilient and subthreshold depression-dominant states showed low and moderate probabilities of the presence of majority of depressive symptoms, respectively, with no PGD symptoms having a greater than moderate probability of presence. The depression-dominant state was marked by a high probability of the presence for 9 of 16 depressive symptoms, with moderate probabilities for almost all PGD symptoms. The PGD-depression comorbid state was characterized by a high probability of presence of all PGD symptoms and depressive symptoms, except for moderate probabilities of presence of two depressive symptoms. Conclusion: Our longitudinal identification of a predominantly depressive state but absence of a PGD-dominant state provides further evidence that PGD and MDD are related but distinct constructs that can occur independently or concurrently as the PGD-depression comorbid state. When PGD is suspected, bereaved individuals should be assessed for the potential comorbidity of MDD.

Original languageEnglish
Pages (from-to)1144-1151
Number of pages8
Issue number7
StatePublished - 07 2022

Bibliographical note

Publisher Copyright:
© 2022 John Wiley & Sons Ltd.


  • cancer
  • construct distinctiveness
  • depressive symptoms
  • end-of-life care
  • latent transition analysis
  • oncology
  • prolonged grief disorder
  • symptom trajectories


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