Psychological Risk Factors Associated With Mental Health Outcomes Among Bereaved Care Partners: A Meta-Regression Analysis of Prospective Studies.

OBJECTIVE

Bereaved informal care partners are at a risk of developing symptoms of prolonged grief, depression, anxiety, and posttraumatic stress disorder. This meta-analytic review investigated whether certain predeath psychological factors heighten these risks.

DESIGN

Systematic review of longitudinal studies and meta-analysis.

SETTINGS AND

PARTICIPANTS

Care partners aged ≥18 years, providing informal care, across any care setting.

METHODS

We systematically searched 4 databases for prospective studies assessing predeath psychological risk factors of postdeath mental health outcomes at >6 months postdeath. Correlation coefficients (r) were used as effect sizes in a multilevel meta-analysis, with random-effects meta-regressions identifying sources of heterogeneity.

RESULTS

We included 49 studies (published between 1990 and 2024) assessing 14,274 informal care partners. Strongest risk factors for prolonged grief symptoms (PGS) were predeath grief (r, 0.46; 95% CI, 0.31-0.60), depressive (r, 0.22; 95% CI, 0.09-0.34), and anxiety (r, 0.15; 95% CI, 0.09-0.21) symptoms. Predeath depressive (r, 0.33; 95% CI, 0.23-0.42) and anxiety (r, 0.23; 95% CI, 0.12-0.35) symptoms predicted postdeath depressive and anxiety symptoms, respectively. Studies with a higher proportion of spousal care partners showed a weaker association between predeath grief symptoms and PGS. Pooled prevalence estimates were 15% (8%-22%) for prolonged grief disorder (PGD) and 11% (4%-17%) using only PG-13 instrument; 27% (20%-33%) for depression and 22% (18%-26%) for anxiety. PGD prevalence was similar at 6 to 12 months [17% (12%-22%)] and 1-year postdeath [18% (12%-24%)].

CONCLUSIONS AND IMPLICATIONS: Predeath psychological factors influence care partners' postdeath mental health outcomes. Predeath grief offers some protection for spousal care partners against PGS highlighting its dual nature-both as a risk and protective factor. Assessment tools should be standardized for accuracy of prevalence assessment.