Well-being comparisons and mental health outcomes following loss: a two-wave longitudinal study

Abstract

ABSTRACT Background: The loss of a significant other may lead to prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), depression, anxiety, somatic symptoms, and loneliness. Comparative thinking about one’s well-being (e.g. social, temporal, counterfactual, or expectation-based comparisons) may act as a cognitive link between bereavement and psychopathology. For example, frequently comparing current well-being to pre-loss levels (i.e. past temporal comparison) and perceiving a gap (comparison discrepancy) can intensify negative emotions (comparison affective impact), which may, in turn, exacerbate psychopathology. We hypothesized that aversive well-being comparison frequency, comparison discrepancy, and negative comparison affective impact would each predict higher psychopathology over time, with comparison discrepancy and affective impact sequentially mediating the association between comparison frequency and psychopathology. Methods: Our two-wave longitudinal study of bereaved individuals (N = 315) assessed well-being comparisons, worry, rumination, avoidance, childhood adversity, and mental health outcomes over six months post-loss. Results: Preregistered hypotheses were partly confirmed. Higher frequency of aversive well-being comparison, comparison discrepancy, and negative comparison affective impact predicted elevated psychopathology (PGD, PTSD, depression, anxiety, somatic symptoms, & loneliness) symptoms six months later. Nuanced effects persisted after accounting for autoregressive pathways, worry, rumination, avoidance, and childhood adversity. In mediation pathways, frequent comparison amplified perceived discrepancies, eliciting negative affective impact, which in turn contributed to depression, anxiety, and somatic symptoms. Conclusion: Our work suggests that well-being comparison plays a significant role in mental health outcomes following loss.