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Psychol Med. 2018 Nov 9:1-9. doi: 10.1017/S0033291718003264. [Epub ahead of print]

Pre-loss personal factors and prolonged grief disorder in bereaved mothers.

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Division of General Pediatrics,Department of Medicine,Boston Children's Hospital, and Harvard Medical School,Boston, MA,USA.
Institutional Centers for Clinical and Translational Research,Boston Children's Hospital,Boston, MA,USA.
Department of Psychosocial Oncology and Palliative Care,Dana-Farber Cancer Institute,Boston, MA,USA.
Faculty of Medicine and Health Science,Department of Obstetrics and Gynaecology,Stellenbosch University,Tygerberg,Cape Town,South Africa.
Center for Pediatric and Community Research,Avera McKennan Hospital & University Health Center Sioux Falls,Sioux Falls, SD,USA.
Department of Pathology,Boston Children's Hospital and Harvard Medical School,Boston, MA,USA.
Center for Research on End-of-Life Care, Weill Cornell Medicine,New York, NY,USA.



Identifying characteristics of individuals at greatest risk for prolonged grief disorder (PGD) can improve its detection and elucidate the etiology of the disorder. The Safe Passage Study, a study of women at high risk for sudden infant death syndrome (SIDS), prospectively examined the psychosocial functioning of women while monitoring their healthy pregnancies. Mothers whose infants died of SIDS were followed in bereavement.


Pre-loss data were collected from 12 000 pregnant mothers and analyzed for their associations with grief symptoms and PGD in 50 mothers whose infants died from SIDS, from 2 to 48 months after their infant's death, focusing on pre-loss risk factors of anxiety, depression, alcohol use, maternal age, the presence of other living children in the home, and previous child loss.


The presence of any four risk factors significantly predicted PGD for 24 months post-loss (p < 0.003); 2-3 risk factors predicted PGD for 12 months (p = 0.02). PGD rates increased in the second post-loss year, converging in all groups to approximately 40% by 3 years. Pre-loss depressive symptoms were significantly associated with PGD. Higher alcohol intake and older maternal age were consistently positively associated with PGD. Predicted risk scores showed good discrimination between PGD and no PGD 6-24 months after loss (C-statistic = 0.83).


A combination of personal risk factors predicted PGD in 2 years of bereavement. There is a convergence of risk groups to high rates at 2-3 years, marked by increased PGD rates in mothers at low risk. The risk factors showed different effects on PGD.


Bereavement; maternal; prolonged grief disorder; prospective; risk factors; sudden infant death syndrome


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