The longitudinal mediation pathways between positive mental health and prolonged grief disorder among refugees

The grief experience includes positive and negative factors that collectively contribute to its persistence, protective factors can buffer against the development of prolonged grief disorder (PGD). To investigate the longitudinal associations between positive mental health (PMH), anxiety, depression, and PGD among refugees who have experienced a loss related to a death event. In the present study, longitudinal data were assessed through an online self-report survey at the baseline (T1), at the 3-month follow-up (T2), and at the 6-month follow-up (T3). The total sample at baseline included 196 adult Arabic-speaking refugees who reported prolonged grief symptoms at least six months after a death event of a close person, (78.6% women, Mage 36.1, SD = 11.03, Myears of refugee status 8.25 years, SD = 3.8). Serial-parallel mediation models were used to investigate the longitudinal associations among PMHT1, depressionT1,T2, anxietyT1,T2, and PGDT1,T2,T3. The results showed that PMHT1 is associated with PGDT3 through the mediation of PGD, depression, and anxiety at T1 and T2, with total indirect effects b = − 0.139, SE = 0.069. Furthermore, the serial mediation model indicated that PMHT1 was negatively associated with PGDT3 through the sequential mediation of depressionT2 and anxietyT2, with total indirect effects b = − 0.097, SE = 0.050. The present findings corroborate the interactive association between PMH as a positive factor and grief-related disorders as a negative factor in maintaining PGD symptoms over time. PMH can indirectly foster integrated grief through its negative association with anxiety and depression.