Predictors and Diagnostic Markers of Prolonged Grief

描述（由申请人提供）：该项目代表了一个更大的研究议程的第二阶段，以调查长期悲伤（PG）病理学的发展，着眼于为评估和临床干预提供新的方向。通常，接近50%的丧亲者在失去亲人后的最初几个月会出现急性悲伤症状。许多人最终康复，但一个重要的子集（所有丧失亲人的人中的10%-15%）继续遭受PG反应，这损害了他们的功能，持续数年甚至更长时间。扩展前一阶段的研究，这是有限的横截面设计，目前的项目的主要目标包括纵向设计，多种方法来识别PG（诊断，潜伏生长混合建模），PG病理发展的早期预测指标的措施，和生物标志物（EMG，ERP）PG相关的赤字。该项目将使用结构化临床访谈和一组实验和访谈任务，在损失后4个月，14个月和25个月评估失去配偶的个人。主要目的是（1）绘制PG与恢复的诊断和纵向模式，（2）评估早期情感和情感相关脑活动的缺陷，作为后期PG发展的预测因子，（3）评估丧亲后期的情感调节和情感相关脑活动，作为PG相关缺陷的标志。一组假设预测，如果他们（a）未能证明上下文敏感的情绪反应（例如，消极话题中的消极情绪）;（B）产生总体上较少的积极情绪;以及（c）在调节情感体验和情绪表达两者方面表现出降低的灵活性。第二组假设预测，在18个月时，患有PG的丧亲个体将（a）从死者的代表中感受到较少的舒适感（通过自我报告和面部EMG测量）;（B）当用配偶相关词语启动时，对张开嘴的悲伤面孔表现出更大的注意力;（c）在描述与死者的亲密关系时，表达更大的非语言悲伤和更少的非语言积极情绪。

DESCRIPTION (provided by applicant): This project represents the second phase of a larger research agenda to investigate the development of Prolonged Grief (PG) pathology with an eye toward informing new directions in assessment and clinical intervention. Typically close to 50% of bereaved individuals experience acute grief symptoms in the early months after a loss. Many eventually recover, but a significant subset (10%-15% of all bereaved individuals) continued to suffer from PG reactions that compromise their ability to function for several years and often longer. Extending the previous phase of the research, which was limited to a cross-sectional design, the primary objective of the current project includes a longitudinal design, multiple methods for identifying PG (diagnoses, latent growth mixture modeling), measures of early predictors of the development of PG pathology, and biomarkers (EMG, ERP) of PG-related deficits. The project will assess conjugally bereaved individuals at 4, 14, and 25 months post-loss using structured clinical interviews and a set of experimental and interview tasks. The primary aims are (1) to map diagnoses and longitudinal patterns of PG versus recovery, (2) to assess early deficits in emotion and emotion-related brain activity as predictors of the development of later PG, and (3) to assess emotion regulation and emotion-related brain activity later in bereavement as markers of PG-related deficits. One set of hypotheses predicts that bereaved people with acute grief at 4 months will develop PG at later assessments if they (a) fail to evidence context sensitive emotional responding (e.g., negative emotion in negative topics); (b) generate overall less positive emotion; and (c) exhibit reduced flexibility in modulating both affective experience and emotional expression. A second set of hypotheses predicts that bereaved individuals with PG at 18 months will (a) experience less comfort from representation of the deceased (measured by self-report and facial EMG) and (b) show greater attention toward open-mouth sad faces when primed with spouse-associate words; and (c) express greater nonverbal sadness and less nonverbal positive emotion when describing intimacy with the deceased.