Predictors and Diagnostic Markers of Prolonged Grief

描述(申请人提供)：这个项目是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，着眼于在评估和临床干预方面提供新的方向。通常，近50%的失去亲人的人在失去亲人后的头几个月会出现严重的悲痛症状。许多人最终康复了，但有相当一部分人(占所有失去亲人的人的10%-15%)继续遭受PG反应的影响，这些反应损害了他们几年甚至更长时间的功能。这项研究的前一阶段仅限于横断面设计，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、潜伏性生长混合模型)、PG病理发展的早期预测指标的测量以及PG相关缺陷的生物标记物(EMG、ERP)。该项目将使用结构化的临床访谈和一系列实验和访谈任务，在丢失后4、14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图，(2)评估早期情绪缺陷和情绪相关脑活动作为预测晚期PG发展的指标，以及(3)评估情绪调节和丧亲后情绪相关脑活动作为PG相关缺陷的标志。一组假设预测，4个月大时患有急性悲痛的丧亲者如果(A)未能证明上下文敏感的情绪反应(例如，负面话题中的负面情绪)；(B)产生总体较少的积极情绪；以及(C)在调节情感体验和情绪表达方面表现出较低的灵活性，那么他们将在以后的评估中发展为PG。第二组假设预测，18个月大的PG患者将(A)从死者的描述中感受到更少的舒适感(通过自我报告和面部肌电来衡量)，以及(B)当被启动与配偶相关的词语时，对张开嘴巴的悲伤表情表现出更多的关注；以及(C)在描述与死者的亲密关系时，表现出更多的非语言悲伤，而不是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.