International comparison of postloss prolonged grief, posttraumatic stress, and depressive symptoms

Symptoms of prolonged grief (PG), posttraumatic stress (PTS), and depression often co-occur. Patterns of co-occurrence change over time and across cultures but are predominantly identified cross-sectionally in Western countries. We longitudinally compare Dutch and Taiwanese samples for patterns and prevalence of PG-PTS-depressive-symptom states. This study is a secondary analysis of two observational studies from the Netherlands and Taiwan on emotional grief reactions for 501 Dutch and 303 Taiwanese bereaved. PG-PTS-depression-symptom states and their evolution were identified by latent transition analysis at 6, 13, and 18 months post loss. Four PG-PTS-depressive-symptom states were identified for each sample. Dutch participants exhibited resilient, PG-dominant, PG-PTS-dominant, and high co-occurring PG-PTS-depressive-symptom states, while Taiwanese participants showed resilient, PG-dominant, high co-occurring, and subthreshold depression-dominant states. For the Dutch sample, prevalence of resilient (16.0 to 28.4%) and high co-occurring PG-PTS-depressive-symptom (31.7 to 18.2%) states increased and decreased, respectively, whereas prevalence of PG-dominant (23.0 to 25.6%) and PG-PTS dominant (29.4 to 27.9%) slightly changed over time. The proportion of resilient Taiwanese participants increased substantially (62.7 to 80.3%), whereas prevalence of PG-dominant (12.9 to 4.7%) and subthreshold depression-dominant (19.5 to 11.9%) states decreased with slight change for the high co-occurring PG-PTS-depressive-symptom state (4.9 to 3.1%). In conclusion, resilient, PG-dominant, and high co-occurring PG-PTS-depressive-symptom states were consistently identified for both samples. A unique state was identified for each sample, with differing prevalence evolution likely reflecting motivations for participation, causes of death, and cultural grief reactions. Culturally sensitive treatments/care should be provided to bereaved with high co-occurring PG-PTS-depressive-symptom or PG-dominant states.