title: Trajectories of depressive symptoms for bereaved family members of chronically ill patients: a systematic review.
abstract: OBJECTIVE
  To synthesise concepts of distinct depressive-symptom trajectories in published studies by establishing a measurable standard and estimate the prevalence of recategorised trajectories for bereaved families of chronically ill patients.
  
  
  BACKGROUND
  Grieving is a dynamic/individualised process. In studies treating depressive-symptom trajectories as heterogeneous, different criteria were used to identify distinct trajectories, resulting in inconsistent findings.
  
  
  METHODS
  A systematic review of research guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.
  
  
  METHODS
  Five databases were systematically searched since each one's launch through June 2015. Two reviewers independently extracted data and assessed study quality using the qualsyst evaluation tool. Distinct depressive-symptom trajectories were narratively synthesised based on depressive-symptom level, duration and improvement over time. The prevalence of recategorised depressive-symptom trajectories was recalculated from published data.
  
  
  RESULTS
  We identified six studies, published in 1994-2012, that followed 56-301 bereaved families from eight months to five years. We synthesised five new distinct trajectories (prevalence in synthesised sample): 'endurance' (54·2%), 'resilience' (8·8%), 'transient reaction' (7·7%), 'chronic grief' (19·4%) and 'chronic depression' (9·9%). The 'endurance' group experienced low depressive symptoms throughout the bereavement process. The 'resilience' group had severe depressive symptoms when they first transitioned into bereavement, but quickly recovered. The 'transient reaction' group's distress lasted 7-12 months postbereavement, gradually returning to prebereavement levels. After bereavement, the chronic grief and depression groups experienced prolonged periods of depressive symptoms, which improved gradually only in the 'chronic grief' group.
  
  
  CONCLUSIONS
  Most bereaved families endured their grief and adjusted, returning to prebereavement depressive-symptom levels within one year postloss (represented by our synthesised 'endurance', 'resilience' and 'transient reaction' groups), with only 9·9% suffering 'chronic depression'.
  
  
  CONCLUSIONS
  Guided by the synthesised distinct trajectories of depressive symptoms, clinicians should identify bereaved families' depressive-symptom trajectories and provide suitable interventions to facilitate adjustment of those with chronic depressive symptoms.
authors.affiliation: Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.|Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
authors.forename: Su Ching
authors.identifier: http://orcid.org/0000-0002-9941-8604
authors.initials: SC
authors.lastname: Kuo
authors.affiliation: Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan.
authors.forename: Jia Ling
authors.identifier: http://orcid.org/0000-0002-0227-6364
authors.initials: JL
authors.lastname: Sun
authors.affiliation: School of Nursing, Chang Gung University, Taoyuan, Taiwan.|Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan.|Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
authors.forename: Siew Tzuh
authors.initials: ST
authors.lastname: Tang
mesh_terms: D002908:Chronic Disease; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D018450:Disease Progression; D005190:Family / Q000523:psychology*; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D015995:Prevalence; D036301:Qualitative Research; D055500:Resilience, Psychological; D013997:Time Factors
keywords: bereaved family members; bereavement; depressive-symptom trajectories; systematic review