The Aarhus Bereavement Study (TABS)

The Aarhus Bereavement Study - a Prospective Study on Natural and Prolonged Grief Reactions in the Adult Population

Psychological distress is a natural reaction following the death of a loved one. Nevertheless, research has shown that for a significant minority of bereaved individuals the grieving process is disturbed. These individuals experience an intense grief reaction that persists across time characterized by longing for the deceased or persistent preoccupation with the deceased. It has been suggested that this intense, persistent grief reaction meets criteria to be considered a distinct mental disorder. Prolonged grief disorder (PGD) has been proposed to capture this condition and will be included in the forthcoming ICD-11. The proposed project aims to prepare healthcare services to use the diagnosis of prolonged grief disorder (PGD) by determining the frequency of PDG in a population sample of bereaved spouses and their adult children. It will also identify early predictors of PGD and trajectories of natural and prolonged grief as well as investigate the specificity of PGD in relation to other common loss-related reactions. Thus, the project will provide a prognostic tool to identify individuals with high versus low risk of developing PGD.

Study Overview

• Status: Active, not recruiting
• Conditions: Grief
• Intervention / Treatment: Diagnostic test: Survey

Detailed Description

BACKGROUND:

Prolonged grief disorder (PGD) is a new diagnosis that may occur after the death of a partner, parent, child, or other person close to the bereaved. PGD is characterized by a persistent and pervasive grief response including longing for the deceased or persistent preoccupation with the deceased accompanied by intense emotional pain (e.g. sadness, guilt, anger, denial, blame, difficulty accepting the death). The disorder has been admitted as an official diagnosis in the World Heath Organization's newest diagnostic manual (International Classification of Diseases, 11th revision; ICD-11). When introducing the diagnosis in ICD-11, health care services are obliged to identify and treat PGD.

PURPOSE AND AIMS:

The primary purpose of the study is to prepare healthcare services to use the diagnosis of PGD. More specifically, the project aims to determine the frequency and structure of PDG in a population sample of bereaved spouses and their adult children. It will also identify early predictors of PGD and common trajectories of natural and prolonged grief as well as investigate the specificity of PGD in relation to other common loss-related reactions. Finally, the project will also assess the socioeconomic costs of PGD by analyzing health data registries.

HYPOTHESES:

Based on existing bereavement literature and empirical research, the project explores the following hypotheses:

1. High rumination, low levels of mental and physical health, loss of spouse versus loss of parent, and presence of psychopathology at time of loss (T1) will predict degree of PGD symptoms among the bereaved at 6 (T2) and 11 (T3) months post-loss.
2. The majority of bereaved individuals will exhibit a grief trajectory with a gradual decline in PGD symptoms over time, while a significant minority of bereaved individuals will show a trajectory with high levels of PGD symptoms across all measured time-points.
3. PGD, PTSD, depression, and anxiety will be distinct constructs.

On a more genereal level. trajectories of grief and in line with the aim of this study, structure and frequency of prolonged grief disorder, and the relationship with PGD and other forms of complicated grief reactions will be analyzed across the timepoints and factors related to grief will be investigated.

PARTICIPANTS AND PROCEDURES:

Individuals (age 25-85) will be consecutively recruited through the Danish Civil Personal Registry (CPR) from the Central Region of Denmark. After the loss, participants are contacted with a letter of condolence and a brief introduction to the study. Two months post-loss, potential participants are telephoned and invited to participate in the study. Participants are asked to complete self-report questionnaires, respectively at 2 (T1), 6 (T2), 11 (T3), 18 (T4), 26 (T5), months and continue with data collections at 3 (T6), 4 (T7), 5 (T8) and 6 (T9) years post-loss. To meet different needs, participants can choose to fill in the questionnaire online or by postal service.

Bereaved individuals constitute a highly vulnerable group with a heightened risk of suicide, social isolation, depression, etc. In the event, participants appear suicidal or particularly distressed (e.g. high score on suicidal ideation) they will be contacted by the researchers and a suicide risk screening is performed.

• Study Type: Observational
• Enrollment (Actual): 1243

Contacts and Locations

Study Locations

• Denmark
  • Aarhus, Denmark, DK-8000
    • Aarhus University, Department of Psychology and Behavioural Sciences, Unit for Bereavement Research

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 81 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Spousal bereaved individuals (age 25-85) living in the Central Denmark Region plus their adult children (age 18 or above). Eligible participants will be identified through a data extraction of the Danish Civil Registration System (CPR) every sixth week over a period of one year.

Description

Inclusion Criteria, partner:

• Resident in the following municipalities: Aarhus, Favrskov, Horsens, Norddjurs, Odder, Randers, Silkeborg, Skanderborg, Syddjurs
• Age 25-85
• Has lost a partner or spouse within the last 5 weeks from inclusion

Inclusion Criteria, child:

• Resident in the following municipalities: Aarhus, Favrskov, Horsens, Norddjurs, Odder, Randers, Silkeborg, Skanderborg, Syddjurs
• Age 18-85
• Has lost a parent or step-parent within the last 5 weeks from inclusion

Exclusion Criteria, all:

- Psychiatric inpatients

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Partner; Spousal bereaved individuals (age 25-85) in the Central Denmark Region identified through a data extraction of the Danish Civil Registration System (CPR) every sixth week over a period of one year. The group will complete a survey at respectively 2 (T1), 6 (T2), 11 (T3), 18 (T4), and 26 (T5) months post-loss as well as 3, 4, 5 and 6 years post loss.	Diagnostic test: Survey; Completion of surveys with diagnostic measurements (e.g., PGD, depression, anxiety, PTSD).
Child; Parental bereaved individuals (age 18 or above) that are children of the partner group. The group will complete a survey at respectively 2 (T1), 6 (T2), 11 (T3), 18 (T4), and 26 (T5) as well as 3, 4, 5 and 6 years post loss.	Diagnostic test: Survey; Completion of surveys with diagnostic measurements (e.g., PGD, depression, anxiety, PTSD).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prolonged grief	Changes in prolonged grief symptoms measured using the Prolonged Grief Disorder-13 (PG-13; Prigerson et al., 2009)	2, 6, 11, 18, and 26 months post-loss
Complicated grief	Changes in complicated grief symptoms measured using the Inventory of Complicated Grief Revised (ICG-R; Prigerson & Jacobs, 2001)	2, 6, 11, 18, and 26 months post-loss

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Depression	Symptoms of depression are measured using the Center for Epidemiologic Studies Short Depression Scale (CES-D 10; Radloff, 1977)	2, 6, 11, 18, and 26 months post-loss
Generalized anxiety	Symptoms of generalized anxiety are measured using the Generalized Anxiety Disorder-7 (GAD-7; Spitzer et al., 2006)	2, 6, 11, 18, and 26 months post-loss
Post-traumatic stress	Symptoms of post-traumatic stress are measured using the PTSD checklist - Civilian Version (PCL-C; Ruggiero et al., 1999)	2, 6, 11, 18, and 26 months post-loss
Well-being	Levels of well-being are measured using the World Health Organization-5 (WHO-5; Heun et al., 2001)	2, 6, 11, 18, and 26 months post-loss
Mental and physical health	Levels of mental and physical health are measured using the 12-Item Short Form Health Survey (SF-12; Ware et al., 1996)	2, 18, and 26 months post-loss

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Loneliness	Levels of loneliness are measured using the Three-Item Loneliness Scale (T-ILS; Hughes, Waite, Hawkley, & Cacioppo, 2004)	2, 6, 11, 18, and 26 months post-loss
Rumination	Levels of rumination are measured using the Rumination-Reflection Questionnaire (RRQ; Trapnell & Campbell, 1999)	2, 6, and 11 months post-loss
Social support	Levels of social support are measured using the Crisis Social Support scale (CSS; Joseph, Andrews, Williams, & Yule, 1992)	2, 6, and 11 months post-loss
Attachment	Attachment orientations are measured using the Experiences in Close Relationship Scale - short (ECR; Wei et al., 2007)	2 months post-loss
Optimism	Levels of optimism are measured using the Life Orientation Test - Revised (LOT-R; Scheier, Carver, & Bridges, 1994)	2 months post-loss
Neuroticism	Levels of neuroticism are measured using the NEO Personality Inventory-Revised - neuroticism only (NEO-PI-R; Costa & McRae, 2004)	2 months post-loss
Centrality of event	Levels of centrality of event are measured using the Centrality of Event Scale (CES; Berntsen & Rubin, 2006)	2, 6, and 11 months post-loss
Emotional expression	Ability of emotional expression are measured using the Flexible Regulation of Emotional Expression (FREE; Burton & Bonanno, 2015)	2 months post-loss
Emotion regulation	Levels of emotion regulation are measured using the Emotion Regulation Questionnaire (ERQ; Gross & John, 2003)	2 months post-loss

Collaborators and Investigators

• Sponsor: University of Aarhus
• Investigators: Principal Investigator: Maja O'Connor, MSc PhD, University of Aarhus

Publications and helpful links

General Publications

• Komischke-Konnerup KB, Vang ML, Lundorff M, Elklit A, O'Connor M. Do early symptoms of prolonged grief disorder lead to symptoms of posttraumatic stress disorder and depression? A longitudinal register-based study of the two first years of bereavement. J Psychopathol Clin Sci. 2023 Nov;132(8):996-1006. doi: 10.1037/abn0000859. Epub 2023 Aug 3.

Helpful Links

• Webpage with information on the research unit conduction the study

Study record dates

Study Major Dates

• Study Start (Actual): February 7, 2017
• Primary Completion (Actual): April 1, 2024
• Study Completion (Estimated): April 1, 2030

Study Registration Dates

• First Submitted: February 7, 2017
• First Submitted That Met QC Criteria: February 7, 2017
• First Posted (Estimated): February 9, 2017

Study Record Updates

• Last Update Posted (Estimated): August 28, 2025
• Last Update Submitted That Met QC Criteria: August 21, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: bereavement; natural grief; prolonged grief; complicated grief
• Additional Relevant MeSH Terms: Reproductive Physiological Phenomena; Reproductive and Urinary Physiological Phenomena; Fertility
• Other Study ID Numbers: AU2017

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No