Psychological Risk Factors Associated With Mental Health Outcomes Among Bereaved Care Partners: A Meta-Regression Analysis of Prospective Studies

OBJECTIVE: Bereaved informal care partners are at a risk of developing symptoms of prolonged grief, depression, anxiety, and posttraumatic stress disorder. This meta-analytic review investigated whether certain predeath psychological factors heighten these risks. DESIGN: Systematic review of longitudinal studies and meta-analysis. SETTINGS AND PARTICIPANTS: Care partners aged ≥18 years, providing informal care, across any care setting. METHODS: We systematically searched 4 databases for prospective studies assessing predeath psychological risk factors of postdeath mental health outcomes at >6 months postdeath. Correlation coefficients (r) were used as effect sizes in a multilevel meta-analysis, with random-effects meta-regressions identifying sources of heterogeneity. RESULTS: We included 49 studies (published between 1990 and 2024) assessing 14,274 informal care partners. Strongest risk factors for prolonged grief symptoms (PGS) were predeath grief (r, 0.46; 95% CI, 0.31-0.60), depressive (r, 0.22; 95% CI, 0.09-0.34), and anxiety (r, 0.15; 95% CI, 0.09-0.21) symptoms. Predeath depressive (r, 0.33; 95% CI, 0.23-0.42) and anxiety (r, 0.23; 95% CI, 0.12-0.35) symptoms predicted postdeath depressive and anxiety symptoms, respectively. Studies with a higher proportion of spousal care partners showed a weaker association between predeath grief symptoms and PGS. Pooled prevalence estimates were 15% (8%-22%) for prolonged grief disorder (PGD) and 11% (4%-17%) using only PG-13 instrument; 27% (20%-33%) for depression and 22% (18%-26%) for anxiety. PGD prevalence was similar at 6 to 12 months [17% (12%-22%)] and 1-year postdeath [18% (12%-24%)]. CONCLUSIONS AND IMPLICATIONS: Predeath psychological factors influence care partners' postdeath mental health outcomes. Predeath grief offers some protection for spousal care partners against PGS highlighting its dual nature-both as a risk and protective factor. Assessment tools should be standardized for accuracy of prevalence assessment.