Department of Experimental Psychology, University of Oxford, Oxford, UK.
Oxford Health NHS Foundation Trust, Oxford, UK.
Psychol Med. 2023 Mar;53(4):1542-1551. doi: 10.1017/S0033291721003123. Epub 2021 Aug 27.
Psychological models of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) make predictions about the role of unhelpful coping strategies in maintaining difficulties by blocking self-correction of negative appraisals and memory integration following stressful life events like bereavement. However, few studies have tested these predictions directly.
We used counterfactually based causal mediation to assess whether unhelpful coping strategies mediated the relationship between (1) loss-related memory characteristics and/or (2) negative grief-related appraisals and symptoms of PGD, PTSD and depression using a three-wave longitudinal sample ( = 275). Appraisals and memory characteristics were measured at time point 1, unhelpful coping strategies at T2, and symptom variables at T3. Additionally, multiple mediation analyses within a structural equation modelling (SEM) framework assessed which types of coping strategies differentially mediated symptoms of PGD, PTSD and depression.
Coping strategies mediated the relationship between negative appraisals and memory characteristics and symptoms of PGD, PTSD and depression after adjusting for demographics and loss characteristics. Sensitivity analyses suggested that these results were most robust for PGD, followed by PTSD and then depression. Multiple mediation analyses suggested that all four subscales (avoidance, proximity seeking, loss rumination and injustice rumination) individually mediated the effect of memory characteristics and appraisals on PGD.
These results suggest that core predictions of the cognitive model for PTSD and the cognitive behavioural model of PGD are useful in predicting symptoms of post-loss mental health problems in the first 12-18 months after loss. Targeting unhelpful coping strategies is likely to reduce symptoms of PGD, PTSD and depression.
创伤后应激障碍（PTSD）和长期悲伤障碍（PGD）的心理模型对无助应对策略在维持困难方面的作用做出了预测，这些应对策略通过阻止负面评估和记忆整合，从而阻碍了应激性生活事件（如丧亲）后的自我修正。然而，很少有研究直接检验这些预测。
我们使用基于反事实的因果中介分析来评估无助应对策略是否在以下方面中介了（1）与丧失相关的记忆特征和/或（2）负面悲伤相关的评估与 PGD、PTSD 和抑郁症状之间的关系，使用了一个三波纵向样本（n=275）。评估在第 1 时间点进行，无助应对策略在 T2 进行测量，症状变量在 T3 进行测量。此外，在结构方程模型（SEM）框架内进行的多项中介分析评估了哪种类型的应对策略可以不同地中介 PGD、PTSD 和抑郁症状。
在调整了人口统计学和丧失特征后，应对策略中介了负面评估和记忆特征与 PGD、PTSD 和抑郁症状之间的关系。敏感性分析表明，这些结果在 PGD 中最为稳健，其次是 PTSD，然后是抑郁。多项中介分析表明，所有四个分量表（回避、接近寻求、丧失沉思和不公正沉思）单独中介了记忆特征和评估对 PGD 的影响。
这些结果表明，PTSD 的认知模型和 PGD 的认知行为模型的核心预测在预测丧失后 12-18 个月内的丧失后心理健康问题的症状方面是有用的。针对无助的应对策略可能会减轻 PGD、PTSD 和抑郁症状。
