Title: The Centrality of Sadness
Description: SIGNIFICANCE: Complicated and persistent grief reactions afflict 10% of bereaved individuals, and are associated with severe disruptions of functioning. These maladaptive patterns were tentatively included in the DSM-5 as Persistent Complex Bereavement Disorder (PCBD). The condition has been studied using network analysis, showing how symptoms activate and reinforce each other into psychopathological configurations. This approach offers unique insights to inform clinical practice and define psychopathology. Despite these strengths, previous studies were based on self-report information from a single archival dataset. To overcome these limitations, we collected clinical data from a community sample of newly bereaved individuals who suffered loss of a spouse (N=305). Symptoms of PCBD from semi-structured clinical interviews were analyzed via a network approach. METHODS: Ising model Networks of PCBD were generated from symptoms diagnosed at 3 months, 14 months, and 25 months after the loss.

Comorbidities with DSM-5 symptoms of Major Depressive Disorder, and PTSD were also explored. The role of risk factors was also assessed. Lastly, longitudinal VAR networks were generated combining the three temporal observations. RESULTS: Symptoms from the Social/Identity PCBD cluster were central in the network configurations. Yearning and Emotional Pain appeared less strongly interconnected compared to previous research. Meaninglessness activated a cascade of further PCBD symptoms over time. Loneliness, difficulties trusting others and meaninglessness bridged with comorbid depressive and trauma symptoms. CONCLUSIONS: Symptoms related to loss of identity and meaninglessness were identified as salient candidates for targeted interventions. The network approach showed potential for an improved understanding of psychopathological distress reactions following potentially traumatic events.