Gender differences in prolonged grief: a network perspective on symptom interconnections and functional impairment

Background: While prior studies have reported gender differences in prolonged grief symptom severity, less is known about symptom interconnections and their associations with functional impairment. Clarifying these may inform more targeted bereavement care.Methods: A total of 1,093 bereaved adults (274 males; mean age = 37.03) in Hong Kong completed Prolonged Grief Disorder-13-Revised. Network analysis was used to examine gender differences in edge strength, centrality (expected influence; EI), global strength, and network structure. Functional impairment was included to explore its associations with grief symptoms.Results: Females reported higher overall symptom severity than males. Meaninglessness and Disengagement showed the strongest EI in both networks. Network structure differed significantly by gender (M = 0.35, p = .018), whereas global strength did not (S = 0.75, p = .114). Identity Disruption showed higher EI in males. In exploratory analyses including functional impairment, symptom-function associations also differed by gender.Conclusions: Findings indicate gender-related differences in the structure and functional correlates of prolonged grief symptoms. Meaninglessness and Disengagement were central symptoms across genders, suggesting that meaning-making and re-engagement may be important intervention targets. Identity Disruption appeared more central in males, and differences in symptom-function associations may help inform gender-sensitive assessment and clinical support for bereaved individuals.