The role of post-loss anxiety in the development of depressive symptoms and complicated grief symptoms: a longitudinal SEM study

Abstract

Background: Though grief, anxiety, and depression often co-occur, existing evidence mostly focus on any two of them at a time. Our study examined the relationships among the three clusters of symptoms.

Methods: A Chinese community sample of 101 bereaved individuals participated at T1. We utilized Bayesian Structural Equation Modelling (BSEM) to conduct cross-lagged analyses on three-wave panel data (T1 at one-month post-loss, T2 at four-months, and T3 at seven-months).

Results: BSEM findings confirmed the presence of distinctive developmental paths for complicated grief (CG), anxiety, and depressive symptoms. Three simplex models showed that anxiety, CG symptoms, and depressive symptoms maintained high consistency. In cross-lagged models, anxiety at T1 was a significant predictor of depressive symptoms (standardized estimate B=0.386*) and CG symptoms (standardized estimate B=0.300*) at T2. The remaining positive directions (0.338*, 0.256*) in the final model suggest the important role of anxiety at early bereavement, while at a later stage, T2 CG contributed to depressive symptoms at T3 (0.356*).

Limitations: In addition to attrition, the overall sample size was limited. Data were based on self-report. Future research with repeated measures and Bayesian informative priors would be more useful to establish relational patterns of symptoms.

Conclusions: In our models, the reduction in anxiety symptoms contributed to the development of depressive and CG symptoms, and these results should be replicated. Theories of mechanisms underlying post-loss anxiety can be explored as a potential means of reducing later symptoms.