Prolonged grief and insomnia symptoms in cancer-bereaved parents: a latent class analysis

Parents who experience the death of a child may develop a range of mental health problems including insomnia and prolonged grief disorder (PGD). Insomnia symptoms predict worsening of prolonged grief symptoms and persons with more chronic insomnia trajectories may be at risk of developing PGD. However, it remains to be established when prolonged grief and insomnia symptomatology co-occur and which potential risk factors heighten the risk of comorbid insomnia and prolonged grief. To address these questions, we conducted a cross-sectional, registry-based survey study involving 225 Swedish parents who lost a child to cancer 1–5 years ago. We assessed sociodemographic and loss-related characteristics, self-rated health, grief rumination, and depressive, posttraumatic stress, prolonged grief, and insomnia symptoms. A latent class analysis yielded a three-class solution, including a resilient class (n = 58, 25.9%), characterized by predominantly low to moderate odds of insomnia and prolonged grief symptoms, a prolonged grief class (n = 75, 33.1%), characterized by moderate to high probability of prolonged grief symptoms and low to moderate probability of insomnia symptoms, and a comorbid prolonged grief/insomnia class (n = 92, 41.0%), characterized by predominantly high odds of prolonged grief and insomnia symptoms. Univariate analyses of covariates demonstrated that self-rated health, grief rumination, depressive, posttraumatic stress, prolonged grief, and insomnia symptoms differed across classes. The resilient class demonstrated the lowest levels of these covariates, the prolonged grief class higher levels, and the prolonged grief/insomnia class the highest levels. Results for sociodemographic and loss-related variables were less consistent. Multivariate analyses including all covariates simultaneously identified older age and grief rumination variables uniquely distinguishing two or more latent classes. Results confirm that bereaved parents are at risk of experiencing comorbid insomnia and prolonged grief. However, substantive subgroups of this population report prolonged grief symptoms without severe insomnia symptoms or demonstrate resilience. Older age of the parent and rumination emerged as potential risk factors for co-occurring severe insomnia and prolonged grief symptoms. Rumination may be a key target for interventions for bereaved parents experiencing these mental health problems. Not applicable.