Risk factors for maladaptive grief and posttraumatic stress in children and adolescents following loss: a systematic review

Abstract Background Traumatic losses in childhood and adolescence can evoke both maladaptive grief symptoms (MGS) and posttraumatic stress symptoms (PTSS). The aim of this study was to systematically review the existing literature to identify which risk factors are shared by both phenomenologies or differentiate between them. Methods The systematic review was pre-registered in PROSPERO and conducted in accordance with PRISMA guidelines. A systematic literature search was performed in PubMed, Medline, PsycInfo, and Web of Science, identifying 18 studies based on 14 samples that met the inclusion criteria. A quality assessment was performed using the JBI critical appraisal checklist. Results Encompassing a total of 5,034 individuals, the samples were generally gender-balanced ( M = 52% female, SD = 14%) with a mean age of 12.88 years ( SD = 2.19). The risk factors were summarised in six superordinate clusters. Intrapersonal reactions were very often significantly associated with both MGS and PTSS. In addition, other mental health problems were examined in most studies and were significantly associated with PTSS and MGS in all of these studies, indicating a very high relevance. We could draw no conclusion regarding demographic factors and the relevance of loss characteristics and circumstances. The quality of the included studies was good, but only three studies were longitudinal. Conclusions The study emphasizes the relevance of intrapersonal factors and other comorbidity, with detailed discussion of their implications. Improving the specific identification of children and adolescents with high-risk profiles would particularly benefit areas with few resources for care. Due to the relevance of the topic, there is an urgent need for more studies investigating MGS and PTSS following loss in childhood and adolescence in the same sample.