The Prevalence,Comorbidity And Risks Of Prolonged Grief Disorder Among Chinese Shidu Parents

Objective: China’s family planning policy has been accompanied by the emergence of a special group of "shidu parents ".In Chinese culture,the death of an only child is often more devastating to parents who have lost their only child.Parents who have lost their only child may experience a variety of emotional reactions in their lives,such as prolonged grief disorder,post-traumatic stress disorder,depression,and anxiety.Prolonged grief disorder is one of the most common psychological disorders among shidu parents.It refers to the fact that after the death of a close person for 6 months,the individual’s longing for the deceased continues to permeate all aspects of life and everything about the deceased is always haunting,and these reactions seriously impair the social function of the individual.The purpose of this study was to study the prevalence and influencing factors of prolonged grief disorder among shidu parents and their relationship with other psychological disorders.Methods: Two-stage sampling method was used in this study.In the first stage,15 communities were randomly selected from each of the five districts in Shenyang.In the second phase,a cluster sample of 75 randomly selected communities was selected and a parent meeting the inclusion criteria was randomly selected from each of the exclusive sites to participate in the study.A total of 595 questionnaires were distributed and 516 were returned.The responding rate was 86.72%,483 valid questionnaires were collected,and the effective response rate was 81.18%.The questionnaire included general demographic characteristics and information related to loss,Duke University Functional Social Support Scale,Center for Epidemiological Survey,Depression Scale(CES-D),Self-rating Anxiety Scale(SAS),post-traumatic stress disorder scale(pcl-5),and Prolonged Grief Disorder Scale(PG-13).SPSS Windows22.0 was used for statistical analysis,and correlation regression analysis,chi-square analysis and multiple Logistic regression analysis were used.Results: All the scales used in the questionnaire had good reliability and validity,with 483 samples,including 201(41.6%)males and 282(58.4%)females.The mean score of PG-13 scale was 26.12±9.88,and the prevalence of prolonged grief disorder was 9.5%.The chi-square test results showed that the parents’ educational background,debt,religious belief,social discrimination,contact avoidance,the age of the deceased child and the time of the child’s death were significantly correlated with prolonged grief disorder.The results of multiple logistic regression analysis showed that education background,debt,social discrimination and avoidance of association were influential factors of the prevalence of prolonged grief disorder among parents who lost their only child(p<0.05).Parents with debts had 11.89 times of risk of developing prolonged grief disorder than parents without debts,parents who avoided social contact had 9.46 times of risk of developing prolonged grief disorder than parents who did not avoid contact with others,parents who felt social discrimination had 2.38 times of risk of developing prolonged grief disorder than parents who did not felt discrimination.The higher the education level,the higher the risk of PGD.Post-traumatic stress disorder(PTSD),depressive symptoms,and anxiety were more prevalent and more severe among parents with prolonged grief disorder.Among the437 parents without prolonged grief disorder,69(15.8%)of the parents met the diagnostic criteria for PTSD with a score of 40.21,351(80.3%)met the diagnostic criteria for depression with a mean score of 22.89,and 198(45.3%)met the diagnostic criteria for anxiety with a mean score of 48.59.Of the 46 parents with prolonged grief disorder,33(71.7%)met the criteria for post-traumatic stress disorder with a mean score of 69.26,45(97.8%)met the criteria for depressive symptoms with a mean score of 34.59,and 39(84.5%)met the criteria for anxiety with a mean score of 61.85.Conclusion: The prevalence of prolonged grief disorder among parents who have lost their only child is 9.5%,which is much higher than that of the general population.Factors affecting the prolonged grief disorder in parents who have lost their only child included education,debt,perceived social discrimination and avoidance of social contact.Those with higher education,debt,social stigma and avoidance of social interaction were more likely to develop prolonged grief disorder.Post-traumatic stress disorder(PTSD),depressive symptoms,and anxiety were more prevalent and moresevere among parents with prolonged grief disorder.