Factors Associated with Mental Health Outcomes Following Drug Overdose Loss

The ongoing overdose crisis has created a widespread but understudied population of bereaved individuals at elevated risk for adverse mental health outcomes. This study examines cognitive, emotional, and interpersonal factors associated with symptom severity of prolonged grief disorder (PGD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) among 115 adults who lost a loved one to drug overdose. Participants completed an online survey assessing continuing bonds, centrality of the death event, integration of the loss, unfinished business, resilience, and social support. Multivariable linear regression was used to estimate associations between these factors and severity of mental health outcomes, adjusting for relevant covariates. Results indicated that greater centrality of the death event was consistently associated with higher PGD, MDD, and GAD symptoms, while unfinished business, particularly surrounding unfulfilled wishes, was associated with higher MDD and PTSD symptoms. Continuing bonds were also linked to higher PGD and GAD symptoms. In contrast, greater integration of the loss and higher resilience were associated with lower symptom severity across multiple outcomes, and greater social support was associated with lower depressive symptoms. Findings highlight the multidimensional nature of overdose bereavement and identify potentially modifiable factors that warrant further investigation in longitudinal and intervention research.