title: The temporal relationship between change in symptoms of prolonged grief and posttraumatic stress following old age spousal bereavement.
abstract: BACKGROUND
  High levels of prolonged grief symptoms (PGS) and posttraumatic stress symptoms (PTS) are relatively common following bereavement. The two types of bereavement complications share some but not all of the same features. Little research has studied which of the two precedes the other following the death of a loved one. The purpose of this study was to examine the temporal relationship between change in PGS and PTS during the first 4 years following old age spousal loss.
  
  
  METHODS
  Participants were 237 Danes (40% male; mean age = 73 years, SD = 4.4; range 65-81) who during the year of 2006 lost their spouse. Participants completed self-report questionnaires at 6 months (n = 237), 13 months (n = 198), 18 months (n = 192), and 48 months (n = 213) post loss. Main outcome measures were Inventory of Complicated Grief-Revised and the Harvard Trauma Questionnaire.
  
  
  RESULTS
  Lower level mediation analyses were performed. Results indicated that PGS mediated 83% of the relationship between time and PTS, whereas PTS only mediated 17% of the relationship between time and PGS. These results suggest that changes in PGS mediated changes in PTS following spousal bereavement to a greater extent than vice versa.
  
  
  CONCLUSIONS
  The findings in the present study indicate that changes in PGS may precede and potentially directly impact changes in PTS following bereavement. This tentative conclusion points to the potential value of targeting PGS in psychological interventions at an early point in the long-term perspective following old age spousal bereavement.
authors.affiliation: Unit for Psychooncology and Health Psychology, Department of Psychology, Aarhus University, Aarhus C, Denmark.
authors.forename: Maja
authors.initials: M
authors.lastname: O'Connor
authors.forename: Angela
authors.initials: A
authors.lastname: Nickerson
authors.forename: Idan M
authors.initials: IM
authors.lastname: Aderka
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bryant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003718:Denmark; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006117:Grief; D006801:Humans; D008297:Male; D012307:Risk Factors; D057566:Self Report; D018454:Spouses / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D011795:Surveys and Questionnaires; D013995:Time
keywords: PTSD/posttraumatic stress disorder; geriatric/aging/elderly; grief/bereavement/complicated grief; life events/stress; treatment