title: Anxious and depressive avoidance behavior in post-loss psychopathology: a longitudinal study.
abstract: BACKGROUND
  Avoidance behavior is a central component of cognitive behavioral theories of bereavement-related psychopathology. Yet, its role is still not well understood. This study examined associations of anxious and depressive avoidance behaviors with concurrently and prospectively assessed symptom-levels of prolonged grief disorder (PGD), depression, and posttraumatic stress disorder (PTSD).
  
  
  METHODS
  Two hundred and ninety-one individuals, confronted with loss maximally three years earlier, completed self-report measures of anxious and depressive avoidance and emotional distress and again completed distress measures one year later.
  
  
  RESULTS
  Anxious and depressive avoidance were concurrently associated with symptom-levels of PGD, depression, and PTSD, even when controlling for the shared variance between both forms of avoidance and relevant socio-demographic and loss-related variables. Prospective analyses showed that baseline anxious avoidance predicted increased symptom-levels of PGD, depression, and PTSD one year later, among participants who were in their first year of bereavement but not among those who were beyond this first year. Baseline depressive avoidance was significantly associated with elevated PTSD one year later, irrespective of time since loss.
  
  
  CONCLUSIONS
  Both anxious and depressive avoidance are associated with different indices of poor long-term adjustment following loss. However, anxious avoidance seems primarily detrimental in the first year of bereavement.
authors.affiliation: a Department of Clinical and Health Psychology , Utrecht University , Post Box 80140, 3508 TC Utrecht , the Netherlands.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Boelen
authors.forename: Maarten C
authors.initials: MC
authors.lastname: Eisma
mesh_terms: D001008:Anxiety Disorders / Q000523:psychology*; D001293:Attitude to Death; D001362:Avoidance Learning; D001601:Bereavement; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology
keywords: avoidance-behavior; bereavement; depression; grief; posttraumatic stress disorder