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，旨在调查长期悲伤（PG）病理学的发展，并着眼于为评估和临床干预提供新的方向。通常接近50%的失去亲人的人在失去亲人后的最初几个月里会经历急性悲伤症状。许多人最终康复了，但有相当一部分人（占所有丧亲者的10%-15%）继续遭受PG反应的痛苦，这种反应会损害他们的功能，持续数年甚至更长时间。在之前仅限于横断面设计的研究阶段的基础上，当前项目的主要目标包括纵向设计、识别PG的多种方法（诊断、潜在生长混合物模型）、PG病理发展的早期预测指标的测量，以及PG相关缺陷的生物标志物（肌电图、ERP）。该项目将通过结构化的临床访谈和一系列实验和访谈任务，在失去配偶后的4、14和25个月对失去配偶的个人进行评估。主要目的是(1)绘制PG与恢复的诊断和纵向模式，(2)评估情绪和情绪相关脑活动的早期缺陷作为后期PG发展的预测因素，以及(3)评估丧亲后期情绪调节和情绪相关脑活动作为PG相关缺陷的标志。一组假设预测，丧亲之人在4个月时出现急性悲伤，如果他们(a)未能证明情境敏感的情绪反应（例如，消极话题中的消极情绪），他们将在以后的评估中发展为PG；(b)产生整体较少的积极情绪；(c)在调节情感体验和情感表达方面表现出较低的灵活性。第二组假设预测，18个月时患有PG的丧亲个体会(A)从死者的形象中体验到更少的安慰（通过自我报告和面部肌电图测量），(b)当被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，表达更多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. PUBLIC HEALTH RELEVANCE: The proposed project seeks to identify potentially treatable deficits that both predict and accompany the onset of grief-related pathology. The results of this project will be useful in guiding the development of new intervention strategies for grief.