Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, and Harvard Medical School, Boston, MA, USA.
Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA.
Psychol Med. 2019 Oct;49(14):2370-2378. doi: 10.1017/S0033291718003264. Epub 2018 Nov 9.
Identifying characteristics of individuals at greatest risk for prolonged grief disorder (PGD) can improve its detection and elucidate the etiology of the disorder. The Safe Passage Study, a study of women at high risk for sudden infant death syndrome (SIDS), prospectively examined the psychosocial functioning of women while monitoring their healthy pregnancies. Mothers whose infants died of SIDS were followed in bereavement.
Pre-loss data were collected from 12 000 pregnant mothers and analyzed for their associations with grief symptoms and PGD in 50 mothers whose infants died from SIDS, from 2 to 48 months after their infant's death, focusing on pre-loss risk factors of anxiety, depression, alcohol use, maternal age, the presence of other living children in the home, and previous child loss.
The presence of any four risk factors significantly predicted PGD for 24 months post-loss (p < 0.003); 2-3 risk factors predicted PGD for 12 months (p = 0.02). PGD rates increased in the second post-loss year, converging in all groups to approximately 40% by 3 years. Pre-loss depressive symptoms were significantly associated with PGD. Higher alcohol intake and older maternal age were consistently positively associated with PGD. Predicted risk scores showed good discrimination between PGD and no PGD 6-24 months after loss (C-statistic = 0.83).
A combination of personal risk factors predicted PGD in 2 years of bereavement. There is a convergence of risk groups to high rates at 2-3 years, marked by increased PGD rates in mothers at low risk. The risk factors showed different effects on PGD.
识别患有延长哀伤障碍（PGD）风险最高的个体的特征可以提高对其的检测率，并阐明该疾病的病因。Safe Passage 研究是一项针对患有婴儿猝死综合征（SIDS）高危风险的女性的研究，前瞻性地检查了女性在监测其健康妊娠期间的社会心理功能。在丧亲期间对其婴儿死于 SIDS 的母亲进行了随访。
从 12000 名孕妇中收集了发病前的数据，并对其进行了分析，以了解与 50 名因婴儿死于 SIDS 的母亲在发病后 2 至 48 个月期间的悲伤症状和 PGD 的关系，重点是发病前的焦虑、抑郁、饮酒、母亲年龄、家中是否有其他活孩子以及之前的孩子死亡等风险因素。
任何四种风险因素的存在显著预测了发病后 24 个月的 PGD（p < 0.003）；有 2-3 种风险因素预测了发病后 12 个月的 PGD（p = 0.02）。发病后第二年 PGD 发生率增加，所有组在发病后 3 年时均约为 40%。发病前的抑郁症状与 PGD 显著相关。较高的饮酒量和较年长的母亲年龄与 PGD 呈一致的正相关。发病后 6-24 个月，预测风险评分在 PGD 和非 PGD 之间具有良好的区分度（C 统计量=0.83）。
发病前的个人风险因素组合预测了发病后 2 年内的 PGD。在 2-3 年内，风险组趋于高度一致，风险较低的母亲的 PGD 发生率增加。风险因素对 PGD 的影响不同。
