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Palliat Support Care. 2019 Feb 15:1-8. doi: 10.1017/S1478951518001013. [Epub ahead of print]

Long-term prevalence and predictors of prolonged grief disorder amongst bereaved cancer caregivers: A cohort study.

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St Vincent's Hospital, Melbourne,Australia.
Mel and Enid Zuckerman College of Public Health, Department of Epidemiology and Biostatistics, The University of Arizona,USA.
Centre for Medical Psychology and Evidence-based Decision-making,University of Sydney, Camperdown,Australia.
Mercy Palliative Care, VIC,Australia.
Calvary Palliative and End of Life Care Research Institute, Calvary Health Care,Kogarah,Australia.
Australian Centre for Grief and Bereavement, Melbourne,Australia.
Centre for Palliative Care, St Vincent's Hospital Melbourne,Australia.


ContextThe short-term impact of prolonged grief disorder (PGD) following bereavement is well documented. The longer term sequelae of PGD however are poorly understood, possibly unrecognized, and may be incorrectly attributed to other mental health disorders and hence undertreated.


The aims of this study were to prospectively evaluate the prevalence of PGD three years post bereavement and to examine the predictors of long-term PGD in a population-based cohort of bereaved cancer caregivers.


A cohort of primary family caregivers of patients admitted to one of three palliative care services in Melbourne, Australia, participated in the study (n = 301). Sociodemographic, mental health, and bereavement-related data were collected from the caregiver upon the patient's admission to palliative care (T1). Further data addressing circumstances around the death and psychological health were collected at six (T2, n = 167), 13 (T3, n = 143), and 37 months (T4, n = 85) after bereavement.


At T4, 5% and 14% of bereaved caregivers met criteria for PGD and subthreshold PGD, respectively. Applying the total PGD score at T4, linear regression analysis found preloss anticipatory grief measured at T1 and self-reported coping measured at T2 were highly statistically significant predictors (both p < 0.0001) of PGD in the longer term.


For almost 20% of caregivers, the symptoms of PGD appear to persist at least three years post bereavement. These findings support the importance of screening caregivers upon the patient's admission to palliative care and at six months after bereavement to ascertain their current mental health. Ideally, caregivers at risk of developing PGD can be identified and treated before PGD becomes entrenched.


Bereavement; Caregiver; Complicated grief; Mental health; Palliative care; Prolonged grief disorder


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