Boelen, P. A., & Bout, J. van den (2010). Anxious and depressive avoidance and symptoms of prolonged grief, depression, and posttraumatic stress-disorder . Psychologica Belgica, 50, 49-67.
Following loss, people can develop symptoms of depression, post-traumatic stress disorder (PTSD), or complicated grief (CG)—also termed Prolonged Grief Disorder (PGD). A recent cognitive-behavioural model has proposed that avoiding confrontation with the reality of the loss (called “anxious avoidance” [AA]) and refraining from activities that could foster adjustment (called “depressive avoidance” [DA]) both play a critical role in CG/PGD. The present study examined this assumption, using self-reported data from 161 mourners. Findings showed that items constituting AA and DA represented two distinct factors. Both factors were strongly correlated with other measures of bereavement-related avoidance and both accounted for a unique part of the explained variance in CG/PGD severity, beyond relevant background variables, negative cognitions, and concomitant symptom-levels of depression and PTSD. DA also explained unique variance in depression beyond these variables. Moreover, AA and DA mediated the linkages of neuroticism, attachment anxiety, and attachment avoidance with symptom-levels of CG/PGD.