Reciprocal Relations of Worry, Rumination, and Psychopathology Symptoms After Loss: A Prospective Cohort Study

Examining the moderating role of depressive symptoms on the dynamic interplay between cognitive reappraisal and rumination: Evidence from experience sampling

The dynamic view of emotion regulation (ER) posits that ER is a temporally dynamic process unfolding over time. Cognitive reappraisal and rumination, two extensively investigated ER strategies, are implicated in depression. However, it remains unclear whether these two strategies exhibit reciprocal relations in real-world contexts, and whether such relations vary across baseline depressive symptoms. To address this, we conducted two experience sampling studies and applied residual dynamic structural equation modeling (RDSEM). Results of the RDSEM revealed significant bidirectional associations between cognitive reappraisal and rumination in the Chinese sample, whereas in the Belgian sample, only a unidirectional relationship was found where rumination predicts subsequent cognitive reappraisal. Additionally, both strategies demonstrated stable autoregressive effects. Interestingly, higher depressive symptoms predicted a lower autoregressive effect of cognitive reappraisal within the Chinese sample, while this was not the case in the Belgian sample. These findings highlight the importance of targeting factors such as dynamics in ER and its relationship with depression symptoms.

Psychometric Properties of the Persian Version of Utrecht Grief Rumination Scale

This study evaluates the Persian version of the Utrecht Grief Rumination Scale (UGRS), developed to assess grief-related rumination. The UGRS, originally validated in Western and Eastern cultures, had not been examined in a Iranian context. The research involved translating the UGRS into Persian, followed by a thorough psychometric evaluation involving 325 bereaved Persian-speaking adults. The Persian UGRS demonstrated strong internal consistency (Cronbach's alpha and McDonald's ω = 0.92) and test-retest reliability (ICC = 0.85). Confirmatory factor analyses supported a second-order hierarchical model of grief rumination. Concurrent validity was affirmed through significant correlations with depression, anxiety, prolonged grief, and PTSD. Known-groups validity highlighted higher rumination levels among individuals with lower education, those who lost close family members, and women. These findings underscore the Persian UGRS's reliability and validity, offering a robust tool for assessing grief-related rumination in the Iranian population.

From loss to disorder: The influence of maladaptive coping on prolonged grief

Research indicates that post-bereavement coping strategies can be adaptive or maladaptive. Understanding which strategies lead to poorer outcomes is an important clinical and theoretical question with the potential to guide intervention. The Oxford Grief - Coping Strategies scale was developed from interviews with bereaved people with and without prolonged grief disorder (PGD) to assess the frequency of maladaptive cognitive and behavioural strategies after bereavement. Factorial and psychometric validity were assessed using exploratory and confirmatory factor analysis (N = 676). A three-wave cross-lagged panel model (N = 275) was used to assess the predictive validity of the tool in explaining symptoms of PGD. Results supported a four-factor solution (Avoidance, Proximity Seeking, Loss Rumination, Injustice Rumination) with good psychometric properties. The OG-CS predicted prospective symptoms of PGD in the short-term (6-12 months) and long term (12-18 months), controlling for baseline symptoms and autocorrelations. Subscale analyses demonstrated that the use of coping strategies predicted ICD-11 PGD in both the short-term and the long-term. However, avoidance was not predictive of outcomes early in the grieving process. At 6-12 months, avoidance predicted PGD at 12-18 months.

Examining worry and secondary stressors on grief severity using machine learning

BACKGROUND & OBJECTIVES

Worry and loss-related secondary stressors appear to be important correlates of problematic grief responses. However, the relative importance of these variables in the context of established correlates of grief responding, ranging from indicators of identity disruption and demographic characteristics of the bereaved to characteristics of the loss of quality of the relationship with the deceased, is unknown. Modeling the relative associations of these factors can be problematic, given the high degree of collinearity between these variables. This study used a machine learning approach to provide accurate estimations of the relative importance of these correlates for post-loss symptom severity.

METHODS AND RESULTS

A convenience sample of 428 bereaved people who had lost a parent, spouse, or child in the last 30 to 365 days completed an online survey. Random forest regression modeling examined the effects of worry and secondary stressors on symptom severity in the context of established correlates. Results indicated worry and the number of secondary stressors experienced were among the factors most strongly associated with severity of grief, depression, posttraumatic stress and problems functioning.

CONCLUSIONS

These results also provide insight into the relative importance of worry and secondary stressors affecting grief severity to guide future research.

The Paradox of Aging-Related Fears: Fear of Loneliness in Old Age as a Motivator for Loneliness Preventive Activities

INTRODUCTION

Aging is often seen as a challenging process, prompting individuals to form emotional reactions in response to the perceived challenges associated with growing older, manifested as aging-related fears. The present study focuses on the fear of loneliness in old age, a significant concern considering the socioemotional importance of close relationships in later life. Drawing from proactive coping theory, the study explores the association between fear of loneliness and aging preparation. This research aimed to investigate whether the fear of loneliness motivates individuals to engage in activities aimed at preventing loneliness in old age. For exploratory purposes, we consider both linear and nonlinear effects at the interindividual level, as well as the intraindividual-level differences between fear levels and behavioral outcomes. In addition, we also investigate the moderating role of trait neuroticism in these associations.

METHODS

Data from the "Ageing as Future (AAF)" project in Germany (N = 1,183) spanning from 2012 to 2023 were utilized. A multilevel model considered both intra- and interindividual variations, incorporating time-varying variables and covariates.

RESULTS

Linear mixed model analysis revealed that increased fear of loneliness corresponded to heightened engagement in preventive activities linearly, while a quadratic term indicated an inverted U-shaped relationship. The inclusion of occasion-specific deviation scores showed that individuals were more inclined to engage in preventive activities when experiencing heightened fear of loneliness than usual. This impact of deviation in fear perception was particularly evident among those with high levels of trait neuroticism.

CONCLUSION

The study reveals that fear of loneliness in old age is associated with proactive engagement in preventive activities, with those prone to higher levels of fear or worry being particularly affected. These results emphasize the importance of a moderate level of fear in driving action without succumbing to excessive pessimism or unrealistic optimism. The findings contribute to understanding the motivational role of aging-related fears and hold implications for gerontological practices, emphasizing the need for a balanced fear perception in addressing potential negative impacts of aging. Future research could explore moderators and long-term consequences of motivational aging-related fears.

Health literacy, worry about unmet needs for medical care, and psychological well-being among older Chinese adults

AIM

This study aims to examine the relationship between older adults' health literacy and their psychological well-being and the role of worry about future unmet needs for medical care in mediating this relationship.

METHODS

We adopted a sample of 965 older Chinese people aged 60+ (49.74% female) from the 2021 Chinese General Social Survey. A series of structural equation models (SEMs) were performed. Health literacy was measured by three items regarding older people's ability to understand medical professionals, ask them questions, and read medical instructions. A single-item question was adopted to measure participants' worry about unmet needs for future medical care. Psychological well-being was measured by three items regarding emotional problems and depressed or anxious mood in the past 4 weeks.

RESULTS

Worry about future unmet needs for medical care mediates the relationship between lack of health literacy and Chinese older people's psychological well-being. The indirect effect accounts for 22.3% of the total effect. The SEM model has a satisfactory model fit (goodness of fit index = 1.000, comparative fit index = 0.999, Tucker-Lewis index = 0.997, root mean square error of approximation = 0.009, standardized root mean square residual = 0.023, chi-square test = 50.96,  P = 0.321).

CONCLUSIONS

The findings of this study underscore the importance of improving communication quality between healthcare providers and older adults. Clinical interventions that promote health literacy and address worries about unmet needs for medical services may benefit older adults. Geriatr Gerontol Int 2024; 24: 202-207.

Cross-Lagged Analyses of Prolonged Grief and Depression Symptoms with Insomnia Symptoms

Prolonged grief disorder, characterized by severe, persistent and disabling grief, has recently been added to the DSM-5-TR and ICD-11. Treatment for prolonged grief symptoms shows limited effectiveness. It has been suggested that prolonged grief symptoms exacerbate insomnia symptoms, whereas insomnia symptoms, in turn, may fuel prolonged grief symptoms. To help clarify if treating sleep disturbances may be a viable treatment option for prolonged grief disorder, we examined the proposed reciprocal relationship between symptoms of prolonged grief and insomnia. On three time points across 6-month intervals, 343 bereaved adults (88% female) completed questionnaires to assess prolonged grief, depression, and insomnia symptoms. We applied random intercept cross-lagged panel models (RICLPMs) to assess reciprocal within-person effects between prolonged grief and insomnia symptoms and, as a secondary aim, between depression and insomnia symptoms. Changes in insomnia symptoms predicted changes in prolonged grief symptoms but not vice versa. Additionally, changes in depression and insomnia symptoms showed a reciprocal relationship. Our results suggest that targeting insomnia symptoms after bereavement is a viable option for improving current treatments for prolonged grief disorder.