The neglected role of post-loss anxiety in bereavement outcomes : a SEM longitudinal study on Hong Kong bereaved Chinese

Abstract

Anxiety often appears as one of the natural grief reactions. However, post-loss anxiety is strikingly lack of research evidence as compared to other psychological symptoms such as depression and complicated grief. The current study aims to fill in the gap by examining anxiety at the onset of bereavement in relation to complicated grief and depression up to seven months after the death. Furthermore, it investigates the grief coping behind anxiety within the Dual-Process Model (DPM) including Loss-Oriented (LO) coping and Restoration-Oriented (RO) coping.

The present thesis consists of two parts of result and discussion to achieve these two research objectives: (1) testing the relationship among bereavement-related symptoms; (2) modeling anxiety with grief coping. Importantly, the nature of the study is exploratory, so it gathers new research evidence towards a theory of post-loss anxiety. The study used secondary data analysis of a longitudinal dataset of bereaved family members of Hong Kong hospice service users from February to December 2011. All available bereaved families were invited to join the study. 101 participated, of which the majority were middle aged female with parental loss. The collection was primarily through one-on-one structured interviews in filling the questionnaires.

The first part of the finding consists a series of analysis using Bayesian Structural Equation Modelling (BSEM) that confirm the distinctiveness of development paths for three observed symptom variables: complicated grief, depressive symptoms, and anxiety based on the three-wave panel data (T1 at the first month post loss, T2 at the fourth month, and T3 at the seventh month). In particular, three simplex models show that post-loss anxiety maintained a high degree of consistency throughout the seven months of bereavement, so did depressive symptoms and complicated grief. In cross-lagged models, post-loss anxiety at T1 appeared as a strong predictor for both depressive symptoms (standardized estimate 0.386*) and complicated grief symptoms (standardized estimate 0.300*) at T2. The causal directions suggest the important-but-neglected role of post-loss anxiety at early bereavement. The second part of findings indicate the consistency of grief coping process LO and RO in the seven months. Anxiety at T1 and T2 are best modelled as direct outcomes of Loss-Oriented coping at T1 and T2, where only the link at T1 is significant. LO and RO at T1 reciprocally negatively contributed to each other at T2.

So far as is known, this is the first longitudinal study in Hong Kong bereaved population with the groundbreaking finding in its modeling post-loss anxiety as the outcome of grief coping by the first month of bereavement and as a predictor for the depressive symptoms and complicated grief. Some practical considerations for early interventions to facilitate grief coping may help to reduce anxiety and to make adaptive adjustment to losses. Future directions on post-loss anxiety studies are proposed, encouraged, and organized in a conceptual frame. (464 words)