An experience sampling study exploring associations between contextual factors and prolonged grief reactions in daily life

Theoretical and anecdotal work suggests that Prolonged Grief Disorder (PGD) reactions go up and down during the day. However, empirical evidence supporting this claim is lacking. It is also unknown in which context PGD reactions go up and down. Using Experience Sampling Methodology (ESM), we examined whether PGD reactions (ESM-PGD) relate to contextual factors in daily life. For 14 days, five times per day, bereaved adults (N = 53; 74% women) rated the intensity of 11 ESM-PGD reactions representing DSM-5-TR PGD symptoms. Using mixed-effect regression analyses, we examined whether contextual factors (i.e., physical and social environments, and time of day) were associated with each ESM-PGD reaction separately. Being away from home compared to being at home was associated with more avoidance. Being alone compared to being in a pleasant social contact was associated with more preoccupation with the loss, intensified feelings that part of oneself died, and increased perception of the loss as unreal. Lastly, a later time of day was related to stronger feelings of loneliness and difficulties moving on. Our findings suggest that ESM-PGD reactions may be context-dependent. This calls for a context-sensitive treatment approach, such as ecological momentary interventions.