Longitudinal Trajectories of Grief Before and After Bereavement and Their Association With Mental Health Outcomes: A Pilot Prospective Cohort Study From the China Grief Cohort 2025

Abstract

Background Prolonged grief disorder (PGD) impairs psychophysiological well‐being and social functioning. Although post‐death grief trajectories have been well‐documented, pre‐death grief trajectories remain understudied, particularly within the same cohort. Objective This exploratory pilot study aimed to identify candidate longitudinal trajectories of grief before and after bereavement and to examine their associations with subsequent mental health outcomes, with the goal of generating hypotheses to inform a larger confirmatory cohort. Methods This prospective cohort study was conducted at Peking Union Medical College Hospital. Participants were adult immediate family members of terminally ill patients with a life expectancy of 6 months or less enrolled between October and December 2023. Grief, depression, anxiety and stress were measured using the Anticipatory Grief Scale (AGS) and the PGD‐13 Revised (PG‐13‐R), the 17‐item Hamilton Rating Scale for Depression (HAMD‐17), the Hamilton Anxiety Scale (HAMA) and the Impact of Event Scale‐Revised (IES‐R), at baseline, monthly before bereavement and quarterly for 6 months after bereavement, respectively. Results A total of 60 participants (mean [SD] age, 52.82 [10.18%] years; 32 [53.3%] women) were enrolled, most were offspring of terminally ill patients (44 [73.3%]). Two pre‐death grief trajectories (Low, n = 51 [85%]; and increasing, n = 9 [15%]) and four post‐death grief trajectories (high/decreasing, n = 9 [15%]; moderate/decreasing, n = 26 [43.33%]; low/decreasing, n = 15 [25%]; and high/prolonged, n = 10 [16.67%]) were identified. At the final visit, the incidences of PGD, depressive disorders, anxiety disorders and stress‐related disorders were 16.7%, 16.7%, 30.0% and 0%, respectively. Participants in the Increasing pre‐death grief trajectory and the persistently high/prolonged post‐death grief trajectory had higher incidences of PGD, depressive disorders, and anxiety disorders compared to other groups. Conclusions Individuals experiencing increasing pre‐death grief or persistently high‐level post‐death grief are more likely to develop PGD and other mental disorders. Findings are exploratory and require replication in a larger, theoretically informed cohort. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2300071236