Prolonged Grief, Loneliness and Depression
Submitted by Heather Rhodes, APRN-BC
Tags: behavioral interventions counseling Empathy grief mental health psychology wellbeing
The article, “Prolonged Grief Symptoms Predict Social and Emotional Loneliness and Depression Symptoms,” by M.C. Eisma and A Buyukcan-Tetik seeks to address the dichotomy between how loneliness, which can be changed therapeutically, may perpetuate grief and how grief may worsen loneliness resulting in an increase in the occurrence of prolonged grief disorder (PGD) and depression. The research problem being addressed is the gap in knowledge between these two constructs and if they impact PGD and depression.
The article abstract lays out the complex problem succinctly and identifies that loneliness can have severe prolonged health consequences creating a moral obligation to study the issue. The aim of the study was to identify the bidirectional temporal relationship between loneliness and grief. The hypotheses are threefold: 1) that loneliness will predict higher prolonged grief symptoms, 2) that higher prolonged grief symptoms will predict loneliness and 3) that people who experience within-person change in prolonged grief symptoms also experience a change in their loneliness. The symptom of depression is targeted as a predictor and outcome variable for the study. Although there is no formally identifiable conceptual or theoretical framework utilized within the research study, a robust literature review was completed containing 64 references, most of which are primary sources that support the basis for this research study.
Strengths and Limitations
The article was published by the international journal Behavior Therapy, a subsidiary of Elsevier which publishes original empirical research. The study was approved by the Ethical Committee Psychology of the University of Groningen. Two questionnaires were used, administered six months apart to adult clients. A cross-legged panel model analysis design, which is a structural equation model that measures two different variables at two points in time, was used. Note that this type of evaluative design model is only valid to identify causal relationships if two assumptions are present: 1) Synchronicity and 2) Stationarity. Synchronicity assumes the measurements on the two variables at each point in time were made at the exact same time and Stationarity assumes that the variable and the relationships between the variable remain constant over time. The limitation for reliability of cross-legged panel model analysis design was identified in the study and a latent change score model applied to unravel longitudinal associations at between-person and within-person levels. To better understand the concept of loneliness, this emotion was delineated into three categories: emotional loneliness, social loneliness and general loneliness and measured with the De Jong Gierveld Loneliness Scale. This scale has shown high levels of internal consistency and reliability and is suitable for use in various age groups and populations (Giraldo-Rodrigues, Alvarez-Cisneros & Agudelo-Botero, 2023). Depression was measured using the 16-item Quick Inventory of Depressive Symptomatology (QIDS) which proves to be both a reliable and valid tool in depressed older adults only (Liu, et al., 2021).
There were 354 participants in the study (311 were women, 91 were men with a mean age of 54) which is a relatively small cohort given that the authors recruited participants using online ads linked to a website containing information about the study. It’s unclear how long the ads were run and which countries, if any, outside of the United States were targeted. Participants must have experienced the death of a friend, partner or family member within the last five years to qualify for the study, but the authors admit that some participants who had experienced a death outside of this time frame were included to increase the cohort size. It appears that most participants were higher educated females and there is no delineation of race or culture within the study.
Discussion
The authors sum the research well by identifying that “temporal associations between prolonged grief symptoms and loneliness were consistent for emotional and social loneliness.” They also found that depressive symptoms do not predict prolonged grief symptoms. However, prolonged grief symptoms do in fact predict depressive symptoms.
Albeit a small study with some limitations within the cohort selected, this remains an important foundational study showing that the more severe prolonged grief symptoms a client experiences, the more likely the client is to experience higher loneliness over time. This research article has broad applications across many disciplines and can greatly impact how providers intervene with clients who are experiencing grief by identifying clients who are experiencing prolonged grief symptoms and monitoring for increasing depressive symptoms which have been shown to negatively impact overall health as well as suicide rates.