Abstract：
Bereaved ICU family surrogates are at risk of comorbid prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. Knowledge about temporal relationships between PGD, PTSD, and depression is limited by a lack of relevant studies and diverse or inappropriate assessment time frames given the duration criterion for PGD. We aimed to determine the temporal reciprocal relationships between PGD, PTSD, and depressive symptoms among ICU decedents\' family surrogates during their first 2 bereavement years with an assessment time frame reflecting the PGD duration criterion.
This prospective, longitudinal, observational study examined PGD, PTSD, and depressive symptoms among 303 family surrogates of ICU decedents from two academic hospitals using 11 items of the Prolonged Grief Disorder-13, the Impact of Event Scale-Revised, and the depression subscale of the Hospital Anxiety and Depression Scale, respectively, at 6, 13, 18, and 24 months post-loss. Cross-lagged panel modeling was conducted: autoregressive coefficients indicate variable stability, and cross-lagged coefficients indicate the strength of reciprocal relationships among variables between time points.
Symptoms (autoregressive coefficients) of PGD (0.570-0.673), PTSD (0.375-0.687), and depression (0.591-0.655) were stable over time. Cross-lagged standardized coefficients showed that depressive symptoms measured at 6 months post-loss predicted subsequent symptoms of PGD (0.146) and PTSD (0.208) at 13 months post-loss. PGD symptoms did not predict depressive symptoms. PTSD symptoms predicted subsequent depressive symptoms in the second bereavement year (0.175-0.278). PGD symptoms consistently predicted subsequent PTSD symptoms in the first 2 bereavement years (0.180-0.263), whereas PTSD symptoms predicted subsequent PGD symptoms in the second bereavement year only (0.190-0.214). PGD and PTSD symptoms are bidirectionally related in the second bereavement year.
PGD, PTSD, and depressive symptoms can persist for 2 bereavement years. Higher PGD symptoms at 6 months post-loss contributed to the exacerbation of PTSD symptoms over time, whereas long-lasting PTSD symptoms were associated with prolonged depression and PGD symptoms beyond the first bereavement year. Identification and alleviation of depression and PGD symptoms as early as 6 months post-loss enables bereaved surrogates to grieve effectively and avoid the evolution of those symptoms into long-lasting PGD, PTSD, and depression.
This prospective, longitudinal, observational study examined PGD, PTSD, and depressive symptoms among 303 family surrogates of ICU decedents from two academic hospitals using 11 items of the Prolonged Grief Disorder-13, the Impact of Event Scale-Revised, and the depression subscale of the Hospital Anxiety and Depression Scale, respectively, at 6, 13, 18, and 24 months post-loss. Cross-lagged panel modeling was conducted: autoregressive coefficients indicate variable stability, and cross-lagged coefficients indicate the strength of reciprocal relationships among variables between time points.
Symptoms (autoregressive coefficients) of PGD (0.570-0.673), PTSD (0.375-0.687), and depression (0.591-0.655) were stable over time. Cross-lagged standardized coefficients showed that depressive symptoms measured at 6 months post-loss predicted subsequent symptoms of PGD (0.146) and PTSD (0.208) at 13 months post-loss. PGD symptoms did not predict depressive symptoms. PTSD symptoms predicted subsequent depressive symptoms in the second bereavement year (0.175-0.278). PGD symptoms consistently predicted subsequent PTSD symptoms in the first 2 bereavement years (0.180-0.263), whereas PTSD symptoms predicted subsequent PGD symptoms in the second bereavement year only (0.190-0.214). PGD and PTSD symptoms are bidirectionally related in the second bereavement year.
PGD, PTSD, and depressive symptoms can persist for 2 bereavement years. Higher PGD symptoms at 6 months post-loss contributed to the exacerbation of PTSD symptoms over time, whereas long-lasting PTSD symptoms were associated with prolonged depression and PGD symptoms beyond the first bereavement year. Identification and alleviation of depression and PGD symptoms as early as 6 months post-loss enables bereaved surrogates to grieve effectively and avoid the evolution of those symptoms into long-lasting PGD, PTSD, and depression.
摘要：
失去亲人的ICU家庭代理人有合并长期悲伤障碍（PGD）的风险，创伤后应激障碍（PTSD），和抑郁症。了解PGD之间的时间关系，创伤后应激障碍,根据PGD的持续时间标准，抑郁症受到缺乏相关研究和多样化或不适当评估时间框架的限制。我们的目的是确定PGD之间的时间倒数关系，创伤后应激障碍,ICU死者家庭代理人在头2年丧亲期间的抑郁症状，评估时间框架反映了PGD持续时间标准。
这个前景,纵向,观察性研究检查了PGD，创伤后应激障碍,使用11项长期悲伤障碍-13，事件量表修订的影响，和医院焦虑抑郁量表的抑郁分量表，分别,在亏损后的6、13、18和24个月。进行了交叉滞后面板建模：自回归系数表示变量稳定性，交叉滞后系数表示时间点之间变量之间的相互关系的强度。
PGD的症状（自回归系数）（0.570-0.673），PTSD（0.375-0.687），抑郁（0.591-0.655）随时间稳定。交叉滞后的标准化系数显示，在损失后6个月测量的抑郁症状预测了损失后13个月的PGD（0.146）和PTSD（0.208）的后续症状。PGD症状不能预测抑郁症状。PTSD症状预测了第二个丧亲年份的抑郁症状（0.175-0.278）。PGD症状一致地预测了在前2个丧亲年份（0.180-0.263）随后的PTSD症状，而PTSD症状仅在第二个丧亲年份预测随后的PGD症状（0.190-0.214）。PGD和PTSD症状在第二个丧亲年份是双向相关的。
PGD,创伤后应激障碍,抑郁症状可以持续2年丧亲。更高的PGD症状在6个月后损失有助于PTSD症状随着时间的推移恶化，而持久的PTSD症状与第一个丧亲年后的长期抑郁和PGD症状相关。早在损失后6个月就可以识别和缓解抑郁症和PGD症状，从而使失去亲人的代理人能够有效地悲伤并避免这些症状演变为持久的PGD，创伤后应激障碍,和抑郁症。
这个前景,纵向,观察性研究检查了PGD，创伤后应激障碍,使用11项长期悲伤障碍-13，事件量表修订的影响，和医院焦虑抑郁量表的抑郁分量表，分别,在亏损后的6、13、18和24个月。进行了交叉滞后面板建模：自回归系数表示变量稳定性，交叉滞后系数表示时间点之间变量之间的相互关系的强度。
PGD的症状（自回归系数）（0.570-0.673），PTSD（0.375-0.687），抑郁（0.591-0.655）随时间稳定。交叉滞后的标准化系数显示，在损失后6个月测量的抑郁症状预测了损失后13个月的PGD（0.146）和PTSD（0.208）的后续症状。PGD症状不能预测抑郁症状。PTSD症状预测了第二个丧亲年份的抑郁症状（0.175-0.278）。PGD症状一致地预测了在前2个丧亲年份（0.180-0.263）随后的PTSD症状，而PTSD症状仅在第二个丧亲年份预测随后的PGD症状（0.190-0.214）。PGD和PTSD症状在第二个丧亲年份是双向相关的。
PGD,创伤后应激障碍,抑郁症状可以持续2年丧亲。更高的PGD症状在6个月后损失有助于PTSD症状随着时间的推移恶化，而持久的PTSD症状与第一个丧亲年后的长期抑郁和PGD症状相关。早在损失后6个月就可以识别和缓解抑郁症和PGD症状，从而使失去亲人的代理人能够有效地悲伤并避免这些症状演变为持久的PGD，创伤后应激障碍,和抑郁症。
