Complicated grief and post-traumatic stress symptom profiles in bereaved earthquake survivors: a latent class analysis

Figures & data

Table 1. Sample characteristics.

Gender, valid N (%)
Male	273 (63.1)
Female	466 (36.9)
Age (years), M (SD), range	46.72 (15.51), 16–98
Educational level, valid N (%)
Primary school	335 (42.2)
Junior high school	285 (35.9)
High school	96 (12.1)
Technical secondary school	59 (7.4)
College/university	19 (2.4)
Ethnic minority group, valid N (%)
Qiang	421 (52.8)
Han	340 (42.6)
Other	42 (4.6)
Religious beliefs, valid N (%)
No religion	570 (74.3)
Buddhism	159 (20.7)
Other	38 (5.0)
Deceased person(s) is/are, valid N (%)^a
Partner	170 (21.3)
Child(ren)	268 (33.4)
Other family members	636 (79.7)
Friends or colleagues	789 (98.4)
Family members missing, valid N (%)	373 (46.6)
Physical injury, valid N (%)	379 (47.4)

^a Categories are not mutually exclusive.

Table 2. Goodness-of-fit statistics for one- to six-class models (N = 803).

Model	LL	SA-BIC	BIC	AIC	BLRt p	Entropy R^2	Smallest class size
One-class	−18,244.05	36,614.55	36,728.87	36,560.09
Two-class	−15,161.71	30,579.85	30,811.67	30,469.42	<.001	.95	306
Three-class	−13,881.28	28,148.96	28,498.27	27,982.55	<.001	.94	229
Four-class	−13,374.07	27,264.53	27,731.33	27,042.15	.002	.94	114
Five-class	−13,013.21	26,672.78	27,257.08	26,394.42	.036	.93	108
Six-class	−12,689.33	26,154.99	26,856.79	25,820.66	.068	.94	79

LL, log-likelihood; SA-BIC, sample-size adjusted Bayesian information criterion; BIC, Bayesian information criterion; AIC, Akaike information criterion; BLRt, bootstrap likelihood ratio test.

Table 3. Probability estimates of symptom endorsement for all participants and per class (N = 803).

		Overall symptom frequency (N = 803)		CG class (n = 209; 26.0%)		PTSD/CG class (n = 205; 25.5%)		No PTSD/Partial CG class (n = 145; 18.1%)		Partial PTSD/CG class (n = 136; 16.9%)		Resilient class (n = 108; 13.4%)
	Symptom	n	%	Prob.	SE	Prob.	SE	Prob.	SE	Prob.	SE	Prob.	SE
PTSD Re-experiencing cluster	Intrusions	335	44.3	.28	.03	.85	.03	.17	.03	.56	.04	.18	.04
	Nightmares	227	28.5	.11	.03	.70	.04	.06	.02	.35	.04	.04	.02
	Flashbacks	242	30.6	.15	.03	.72	.03	.06	.02	.38	.05	.05	.02
	Emotionally distressed	361	45.4	.29	.04	.87	.03	.09	.03	.73	.04	.12	.03
	Physically distressed	283	35.3	.16	.03	.79	.03	.06	.02	.54	.05	.06	.03
PTSD Avoidance cluster	Avoid thoughts	273	34.1	.19	.03	.70	.03	.07	.02	.55	.05	.06	.02
	Avoid activities	261	32.7	.16	.03	.72	.03	.04	.02	.51	.05	.06	.02
	Amnesia	233	29.3	.14	.03	.68	.03	.01	.01	.42	.05	.07	.02
	Loss of interest	246	30.9	.15	.03	.72	.03	.02	.02	.48	.05	.03	.02
	Feeling detached	167	20.8	.05	.02	.57	.04	.00	.00	.27	.04	.02	.02
	Restricted affect	147	18.3	.03	.02	.52	.04	.00	.00	.23	.04	.01	.01
	Foreshortened future	183	22.9	.06	.02	.62	.04	.00	.00	.32	.04	.01	.01
PTSD Hyperarousal cluster	Insomnia	324	40.4	.20	.04	.83	.03	.16	.03	.58	.05	.11	.03
	Irritability	317	39.5	.20	.03	.82	.03	.07	.02	.66	.04	.08	.03
	Difficulty concentrating	304	37.9	.14	.03	.83	.03	.07	.03	.64	.04	.05	.02
	Hypervigilance	284	35.6	.11	.03	.81	.03	.07	.02	.60	.05	.05	.02
	Startle response	296	37.1	.11	.03	.85	.03	.05	.02	.64	.05	.05	.02
CG	Preoccupation with the person who died	581	72.8	.90	.02	.97	.01	.64	.04	.71	.04	.08	.03
	Memories of the person who died are upsetting	598	74.9	.94	.02	.99	.01	.74	.04	.63	.05	.09	.03
	The death is unacceptable	568	71.0	.94	.02	.95	.02	.61	.04	.62	.05	.05	.02
	Longing for the person who died	579	73.6	.97	.01	.98	.01	.73	.04	.60	.05	.02	.01
	Drawn to places and things associated with the person who died	575	71.9	.97	.01	.97	.01	.64	.04	.58	.05	.03	.02
	Anger about the death	492	61.6	.85	.03	.92	.02	.49	.04	.43	.05	.00	.00
	Disbelief	473	59.1	.83	.03	.86	.03	.40	.04	.46	.05	.05	.02
	Feeling stunned or dazed	527	66.0	.90	.02	.93	.02	.39	.04	.63	.05	.09	.03
	Difficulty trusting others	414	52.1	.79	.03	.86	.03	.28	.04	.25	.04	.04	.02
	Difficulty caring about others	396	49.4	.76	.04	.84	.03	.23	.04	.23	.04	.03	.02
	Lonely	336	42.0	.64	.04	.69	.03	.15	.03	.27	.04	.03	.02
	Pain in the same area of the body	473	59.2	.84	.03	.89	.02	.35	.04	.46	.05	.04	.02
	Avoidance of reminders of the person who died	492	61.7	.93	.02	.93	.02	.41	.04	.38	.05	.01	.01
	Feeling that life is empty	451	56.5	.88	.03	.87	.02	.33	.04	.30	.05	.04	.02
	Hearing the voice of the person who died	439	54.7	.82	.03	.85	.03	.34	.04	.30	.05	.04	.02
	Seeing the person who died	449	56.1	.89	.03	.89	.02	.35	.04	.23	.04	.00	.00
	Feeling it is unfair to live when the other person has died	452	56.6	.84	.03	.89	.02	.35	.04	.33	.05	.00	.01
	Bitter about the death	590	74.0	.98	.01	.95	.02	.69	.04	.65	.05	.07	.02
	Envious of others	540	67.2	.96	.02	.96	.01	.54	.04	.47	.05	.00	.00

PTSD, post-traumatic stress disorder; CG, complicated grief.

Figure 1. Estimated post-traumatic stress disorder (PTSD) and complicated grief (CG) symptom probabilities for the five-class latent class analysis solution.

Table 4. Univariate differences in complicated grief (CG) and post-traumatic stress disorder (PTSD) symptom levels between the classes (N = 803).

	CG vs PTSD/CG class			CG vs No PTSD/Partial CG class			CG vs Partial PTSD/CG class			CG vs Resilient class			Main effect
	B	SE	95% CI	B	SE	95% CI	B	SE	95% CI	B	SE	95% CI	p
ICG total score	0.09	0.02	0.06, 0.13	−0.44	0.04	−0.52, −0.36	−0.43	0.04	−0.52, −0.35	−0.71	0.05	−0.81, −0.61	<.001
PCL-C total score	0.48	0.03	0.42, 0.55	−0.16	0.02	−0.20, −0.12	0.35	0.03	0.29, 0.41	−0.20	0.03	−0.26, −0.15	<.001

ICG, Inventory of Complicated Grief; PCL-C, PTSD Checklist – Civilian version; CI, confidence interval.

Table 5. Parameter estimates for the latent class model with covariates included simultaneously (N = 699^a).

	CG vs PTSD/CG class			CG vs No PTSD/Partial CG class			CG vs Partial PTSD/CG class			CG vs Resilient class			Main effect
Covariates	B	SE	95% CI	B	SE	95% CI	B	SE	95% CI	B	SE	95% CI	p
Gender (0 = male)	0.10	0.26	−0.41, 0.60	−0.48	0.27	−1.02, 0.05	−0.50	0.28	−1.05, 0.05	−0.67	0.31	−1.27, −0.07	.055
Educational level (0 = primary school or lower)	−0.18	0.28	−0.72, 0.36	0.32	0.30	−0.27, 0.90	0.83	0.34	0.16, 1.51	−0.09	0.34	−0.75, 0.57	.033
Age (years)	0.00	0.01	−0.02, 0.02	0.00	0.01	−0.02, 0.02	−0.01	0.01	−0.03, 0.02	0.01	0.01	−0.01, 0.03	.660
Religion (0 = no)	0.33	0.26	−0.18, 0.84	−0.52	0.31	−1.13, 0.10	−0.19	0.32	−0.81, 0.44	−0.73	0.36	−1.43, −0.03	.027
Relationship to the deceased (0 = other than spouse or child)	0.08	0.26	−0.43, 0.59	−1.49	0.28	−2.04, −0.94	−1.33	0.31	−1.93, −0.73	−3.04	0.42	−3.87, −2.21	<.001
Missing family member (0 = no)	0.98	0.24	0.52, 1.44	−0.10	0.26	−0.62, 0.41	−0.17	0.29	−0.73, 0.39	−0.80	0.31	−1.41, −0.19	<.001
Physically injured (0 = no)	0.27	0.23	−0.19, 0.72	−0.58	0.27	−1.10, −0.06	−0.09	0.27	−0.61, 0.44	−0.82	0.31	−1.42, −0.22	.002

^a The sample size is 699 instead of 803 because people with missing responses on the covariates were excluded from these analyses. CG, complicated grief; PTSD, post-traumatic stress disorder; CI, confidence interval.