Identifying risk factors of acute and prolonged grief using large-scale survey data.

BACKGROUND: Bereavement can precipitate severe acute grief. If such grief reactions persist beyond six months post-loss, they may develop into prolonged grief disorder (PGD). Charting risk factors of severe grief before and beyond six months post-loss is critical to help identify people who may benefit from preventative and curative interventions for PGD. METHODS: Bereaved adults <6 months post-loss (N = 2450) and ≥ 6 months post-loss (N = 3609) completed an online survey. We assessed demographic variables (age, gender), loss characteristics (e.g., cause of death, relationship to the deceased, death expectedness), and situational factors (e.g., pre-death ICU admission, saying goodbye appropriately, COVID-19 infection, quarantine, financial setbacks, funeral alterations, funeral and social support satisfaction, pandemic phase of loss). RESULTS: Univariate and multivariate analyses showed that loss of a partner or child (vs. other relationship), unnatural deaths (vs. natural), unexpected deaths (vs. expected), and a lower social support satisfaction uniquely related to both higher acute and prolonged grief severity. In multivariate analyses, some factors (age, pre-death ICU admission, saying goodbye appropriately, COVID-19 infection, financial setbacks) related exclusively to acute grief severity, whereas COVID-19 deaths (vs natural) related exclusively to prolonged grief severity. LIMITATIONS: A self-selected sample may limit generalizability. Self-report measures precluded establishing PGD diagnoses. CONCLUSIONS: Findings suggest the unique importance of kinship, cause of death, expectedness of death, and social support in identifying people who may benefit from preventative and curative interventions for PGD. Pandemic-related loss circumstances appear more relevant to understanding acute grief reactions than prolonged grief reactions.