Anxious and depressive avoidance behavior in post-loss psychopathology: a longitudinal study

Abstract

Background: Avoidance behavior is a central component of cognitive behavioral theories of bereavement-related psychopathology. Yet, its role is still not well understood. This study examined associations of anxious and depressive avoidance behaviors with concurrently and prospectively assessed symptom-levels of prolonged grief disorder (PGD), depression, and posttraumatic stress disorder (PTSD). Design and Methods: Two hundred and ninety-one individuals, confronted with loss maximally three years earlier, completed self-report measures of anxious and depressive avoidance and emotional distress and again completed distress measures one year later. Results: Anxious and depressive avoidance were concurrently associated with symptom-levels of PGD, depression, and PTSD, even when controlling for the shared variance between both forms of avoidance and relevant socio-demographic and loss-related variables. Prospective analyses showed that baseline anxious avoidance predicted increased symptom-levels of PGD, depression, and PTSD one year later, among participants who were in their first year of bereavement but not among those who were beyond this first year. Baseline depressive avoidance was significantly associated with elevated PTSD one year later, irrespective of time since loss. Conclusions: Both anxious and depressive avoidance are associated with different indices of poor long-term adjustment following loss. However, anxious avoidance seems primarily detrimental in the first year of bereavement.

Keywords:

• grief
• avoidance-behavior
• bereavement
• depression
• posttraumatic stress disorder

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. The measure of PGD includes one item (“Avoiding places, objects, people reminding of the loss”) and the measure of PTSD includes two items (“Try not to think of loss”, “Avoiding activities, places, people reminding of the loss”) that have some overlap with items of the DAAPGQ tapping anxious avoidance. However, outcomes of the analyses with PGD and PTSD severity as dependent variables were similar when these items were removed from the PGD scale and PSS-SR.

2. Detailed outcomes are available on request.