The loss of a family member can trigger diverse emotional responses shaped by the type of death and cultural context. Grief may follow a gradual terminal decline or a sudden death, influencing how it is experienced. This qualitative study examines the lived experiences of Iranian families facing both loss types. Using a phenomenological approach guided by Colaizzi's method, 22 bereaved participants were interviewed. Analysis identified 49 meaning units and 13 themes, organized into four overarching clusters representing a temporal grief trajectory: (1) Acute grief (emotional rupture, embodied distress), (2) Mid-term turmoil (self-blame, existential despair), (3) Cultural and relational mediation (attachment, social support), and (4) Continuing bonds and meaning reconstruction (enduring connection, adaptive/spiritual acceptance). Findings suggest sudden losses produce intense acute and mid-term distress, while gradual losses allow preparation and movement toward acceptance and meaning making. These insights emphasize the value of culturally sensitive, individualized grief interventions in Iranian contexts.

Social disconnection is characterized by a tendency among bereaved individuals to assign negative meaning to others' behaviors, perceive themselves as changed in social interactions, and find comfort in withdrawal. It constitutes an important psychosocial pathway in bereavement adaptation. This study validated the Chinese version of Oxford Grief-Social Disconnection Scale (C-OG-SD) and examined its longitudinal predictive validity. A total of 428 bereaved adults (56.54% women) completed measures of grief, depression, and post-traumatic stress symptoms at baseline and three months later. Analyses included item analysis, confirmatory factor analysis, measurement invariance, reliability, criterion validity, and regression models. C-OG-SD showed a stable three-factor structure, good invariance, and high reliability and validity. Higher social disconnection correlated with more severe grief, depression, and post-traumatic stress. Younger individuals reported more disconnection. Baseline social disconnection predicted follow-up grief, with Altered Social Self as the strongest predictor. C-OG-SD is a reliable tool, and targeting alterations in social self may enhance intervention outcomes.

Background: Prolonged grief disorder (PGD) is characterized by fluctuating, wave-like reactions that unfold over hours, yet little is known about the short-term temporal dynamics among daily grief symptoms. Objective: This study examined within-person temporal and contemporaneous symptom networks using intensive longitudinal data. Method: Thirty bereaved adults who lost a loved one on average 19.5 months ago completed a daily sampling protocol for 2 weeks (5 prompts/day; 3-hour intervals). The assessment adapted 14 items from the International Prolonged Grief Disorder Scale (IPGDS) (e.g., “In the past three hours, I have felt a longing or yearning for the deceased”). Multilevel vector autoregressive models estimated a lagged temporal network and a contemporaneous network (within-time partial correlations). Results: In the temporal network, difficulties accepting the loss showed the highest out-strength and predicted subsequent avoidance, difficulties engaging in social activities, and guilt. Preoccupation predicted later yearning. Emotional numbness and difficulties feeling joy predicted each other at subsequent time points, suggesting a short-term feedback process. Highest in-strength was observed for difficulties engaging in social activities, avoidance, and yearning. In the contemporaneous network, symptoms were densely interconnected; identity disruption, yearning, and sadness were most central. The strongest within-time association linked emotional numbness with difficulties feeling joy, and social-activity difficulties co-occurred strongly with guilt and blame. Acceptance-related unrealness emerged as a key short-term predictor of downstream avoidance and withdrawal, while a numbing–anhedonia loop may sustain affective constriction throughout the day. Conclusion: This study contributes to the understanding of the daily lives of bereaved individuals, highlighting grief as an interactive, mutually reinforcing dynamic system over time. Findings then suggest candidate mechanisms for exposure and behavioral activation interventions but should be considered hypothesis-generating for larger replications.

Although grief is a universal part of the human experience, for some, it may become a debilitating mental health disorder. Prolonged grief disorder (PGD) has recently been included in diagnostic guidelines worldwide, but there is little research on global applicability. To our knowledge, this is one of the preliminary studies to examine PGD rates, risk factors and psychometric validity of the International Prolonged Grief Disorder Scale (IPGDS) concurrently across multiple African countries. It is also one of the first studies to examine probable PGD in young adults anywhere, and importantly, in a context where bereavement is often experienced earlier and more often. Psychometric validity and reliability of the IPGDS were confirmed, and exploratory factor analysis supported a one-factor structure. Despite significantly higher exposure to loss and death than in the Western samples, prevalence rates for probable PGD were similar (Kenya 9.63%, South Africa 6.85% and Namibia 5.34%, vs. the global average of 9.8%). Risk factors identified in all three samples include a close relationship to the deceased and a violent death. Gender differences were seen in Kenya and Namibia, with higher rates of probable PGD for women. Financial difficulties increased disorder-level risk in Kenya and South Africa.

PurposeThis paper aims to assess daily fluctuations in grief reactions among Vietnamese bereaved. Although grief is a universal experience, current understanding of the progression and predictive factors of bereavement-related distress predominantly originates from Western settings. Research indicates cultural variations in the development of grief over time. Notably, there has not been a study investigating how bereavement-related distress manifests in Vietnam. Design/methodology/approachExperience sampling method (ESM) can provide detailed, real-time data on daily reactions. Hundred Vietnamese bereaved adults (>18 years old) who lost a loved one in the last 6 months will complete a 2-week ESM assessment app (mPath) every 3 months for 6 months. The app sends daily reminders to complete a questionnaire about grief reactions and daily life context. Participants will complete a baseline mental health assessment before each ESM period. FindingsData collection for ESM assessments began in June 2025 and will end in December 2025. As of September 2025, 91 participants have been enrolled. A mix of longitudinal and fine-grained data will reveal daily fluctuations of grief reactions, long-term trajectories and associated contextual outcomes. Originality/valueThis study represents the inaugural research endeavor to digitally monitor grief trajectories among Vietnamese bereaved individuals. This study holds substantial potential to contribute to the development of more nuanced, culturally sensitive and technologically advanced bereavement support.

Background: Most evidence on grief and bereavement interventions originates from Western, Educated, Industrialized, Rich, and Democratic (WEIRD) populations, raising concerns about the generalizability and cultural relevance of existing findings in diverse global contexts. Individuals confronted with the death of a close person, particularly in cases of sudden or potentially traumatic loss, may be at increased risk of adverse psychological and physical health outcomes, highlighting the importance of effective interventions. This study aimed to synthesize evidence on the effectiveness of grief interventions in underrepresented regions.Method: A systematic search of Web of Science, APA PsycInfo, and Scopus, supplemented by manual reference checks, identified randomized controlled trials (RCTs) targeting bereaved individuals in underrepresented regions. Meta-analyses were conducted to estimate overall and subgroup effects based on control type, loss type, and intervention characteristics.Results: Fourteen RCTs comprising 1122 participants were included. Grief interventions demonstrated a significant moderate-to-large effect compared to control conditions (SMD = -0.74, 95% CI [-1.01, -0.47]). Substantial heterogeneity was observed (I² = 77%). No significant subgroup differences were identified.Conclusion: Grief interventions show promising effectiveness across diverse cultural and geographical contexts. However, the limited and heterogeneous evidence base highlights the need for more high-quality RCTs and for the development of culturally sensitive and contextually grounded approaches to mental health care in underrepresented regions.

Background: Prolonged Grief Disorder (PGD), recently recognized in the DSM-5-TR and ICD-11, manifests differently across cultural contexts. Although grief is a universal human response to loss, its expression and interpretation are shaped by culturally specific moral and social norms. With limited research on Iranian cultural influences on prolonged grief symptoms, this study examined how culturally embedded beliefs shape the moral meanings and social expectations of grief among individuals meeting PGD screening criteria in Iran.Methods: Semi-structured interviews were conducted with seventeen bereaved adults in Tehran (aged 21-59 years) who met PGD screening criteria based on the PG-13-R and the International Prolonged Grief Disorder Scale (IPGDS). Data were analyzed inductively using reflexive thematic analysis to capture culturally grounded meanings shaping prolonged grief experiences.Results: Five interrelated themes were identified: (1) causal attributions, (2) cultural mourning symbols, (3) paradoxical expectations surrounding mourning, (4) distressing religious beliefs, and (5) harmful cultural clichés. Participants linked these thematic patterns to guilt, social pressure, and spiritual conflict, and described them as relevant to their PGD symptom experiences.Conclusions: Findings suggest that participants described their PGD-related distress as shaped by culturally salient meanings and social evaluations of grief. These results underscore the need for culturally attuned assessment and intervention strategies that address moral and social narratives surrounding mourning.

Background: Bereavement is a common and inevitable part of life. However, it is also difficult and disruptive. Prolonged grief disorder has recently been added to the International Classification of Diseases, 11th Revision, and the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Grief is a deeply cultural experience; however, most research about grief and grief intervention is conducted in Western, educated, industrialized, rich, and democratic (WEIRD) countries. Support for grief is often limited and difficult to access. We propose that ecological momentary interventions (EMIs) present an opportunity to widen access to grief support and develop culturally relevant interventions, given EMIs' easy accessibility and opportunity to offer self-help support in people's natural environments. Objective: This study aims to describe the development protocol of 2 EMIs for grief, one in China and one in Switzerland. he EMIs are intended for individuals seeking additional grief support without a diagnosis of prolonged grief disorder. The EMIs will be developed to be culturally relevant and appropriate for each country; therefore, contextual factors may prescribe slightly different protocols to fit the needs of each cultural group. Methods: Both interventions will be developed using a collaborative research approach. This means that the content for the app will be developed after consultation with grief experts, bereaved participants (potential end users), and the research team. After the initial content development, another round of feedback will be gathered to ensure acceptability. Results: Funding for both studies has been secured through a grant in 2024. The scoping phase for both WEIRD and non-WEIRD contexts has been completed. At the time of submission, both studies have started recruitment, and the Chinese study has conducted interviews with 17 bereaved participants. The next steps are to continue recruitment and data gathering, analyze the collected data, and extract important themes for intervention components, and then begin the app content development. Results are expected by the end of 2026 and will subsequently be prepared for publication. Conclusions: The study presents 2 similar but nonidentical development protocols for EMIs for grief support in 2 countries, where one is a WEIRD country and the other is a non-WEIRD country. Similarities and differences in the developmental process across both countries are discussed, along with challenges associated with adapting grief interventions into an EMI format.

Background: Somatisation is common among individuals experiencing prolonged grief, yet the specificity of associations between International Classification of Diseases (ICD-11) Prolonged Grief Disorder (PGD) symptom dimensions and somatic distress remains unclear. Accumulating evidence indicates that PGD is best conceptualised as a multidimensional construct comprising Loss, Emotional Reactivity, and Emotional Numbing. Whether these symptom dimensions exhibit differential associations with somatic burden remains underexamined.Objective: This study tested whether ICD-11 PGD symptoms are best represented by a multidimensional structure and whether specific symptom dimensions uniquely predict somatic distress.Method: Data were drawn from a United States subgroup (n = 395) of the Measurement and Assessment of Grief in an International Cross-Cultural Sample (MAGIC) study. PGD symptoms were assessed using the International Prolonged Grief Disorder Scale (IPGDS), and somatic distress using the Somatic Symptom Scale-8 (SSS-8). Competing structural models were estimated using exploratory structural equation modelling. Associations between latent PGD dimensions and somatic distress were examined using a structural model adjusting for demographic and loss-related covariates.Results: A three-factor solution comprising Loss, Emotional Reactivity, and Emotional Numbing provided superior fit relative to one- and two-factor models. All three dimensions were positively associated with somatic distress, although after covariate adjustment, Emotional Numbing emerged as the only PGD dimension uniquely associated with somatic distress (β = .29, p < .01).Conclusions: ICD-11 PGD is characterised by a multidimensional symptom structure, with Emotional Numbing showing the strongest unique association with somatic symptoms. These findings suggest that emotional disengagement may capture the PGD component most closely linked to somatic burden. Future research should examine whether this pattern generalises across samples, measurement instruments, and diagnostic thresholds.

Prolonged grief disorder (PGD) is a recognized distinct mental health disorder in the DSM-5-TR and ICD-11, characterized by core symptoms such as longing for and preoccupation with the deceased that persist and worsen over time. Family members and caregivers of patients that receive end-of-life care are confronted with imminent bereavement, which emphasizes the importance of bereavement care as a preventive measure and the need for continued support after death beyond the hospital setting. This review discusses bereaved family members' and caregivers' risk factors of developing PGD, screening and assessment tools (i.e., pre-death measures, measures of bereavement risk, and prolonged bereavement measures) for family members and caregivers of patients during end-of-life care to assess anticipatory loss, after the loss to assess grief reaction, and 6 months after the loss to assess prolonged grief. Implications for accurate and timely interventions during end-of-life care and after the patient's death are presented. Furthermore, limitations of current assessment methods and interventions, and barriers to and facilitators of guideline implementation are addressed. Early detection of elevated grief symptoms and potential PGD through ecological methods of studying daily life (e.g., Experience-Sampling Method, Electronically Activated Recorder, Mobile Sensing Methods, wearables) and digital, just-in-time interventions personalized to an individual's needs (i.e., Just-In-Time Adaptive Interventions) present an innovative digital approach for bereavement care in the future.

Grief is an all-encompassing human experience that reverberates across mind, brain, and body. Historically, the scientific study of grief has been rooted primarily in psychological frameworks. Pioneering work has begun to elucidate how attachment loss is encoded not only psychologically but also biologically, and this may be particularly significant during the perinatal period.

Objective The Experience Sampling Method (ESM) delivered via smartphone applications offers a scalable approach to monitoring mental health in daily life. However, its feasibility and acceptability in low- and middle-income countries remain largely unexplored. This study provides the first evaluation of the feasibility and acceptability of app-based grief monitoring among bereaved adults in Viet Nam. Methods Ninety-six bereaved adults completed a two-week ESM protocol involving five daily prompts assessing momentary grief experiences and contextual factors. Feasibility was evaluated through compliance rates, while acceptability was assessed using participants’ ratings of perceived personal benefit, emotional reactivity, and perceived need for professional support after completing two weeks of ESM. Results The overall compliance rate was 73%, indicating good feasibility. Participants reported neutral to mildly positive perceptions of personal benefit and mildly negative to neutral levels of emotional reactivity. On average, participants did not endorse a need for professional help resulting from study participation. Neither sociodemographic characteristics nor baseline grief scores were associated with compliance. Higher baseline grief intensity was significantly associated with greater perceived need for professional help, lower emotional reactivity, and lower overall acceptability. Conclusion App-based ESM is a feasible and generally acceptable method for monitoring daily grief experiences among bereaved adults in Viet Nam. Further research is needed to optimize digital grief assessment and support the broader implementation of ESM in low- and middle-income settings.

Prolonged Grief Disorder (PGD) is a new diagnosis included in ICD-11. Research on ICD-11 PGD has often focused on spousal and parental loss, creating a gap in understanding the probable prevalence rates among older adults affected by diverse loss types. This study examines the prevalence of probable ICD-11 PGD, along with the symptom structure and convergent-divergent validity of the International Prolonged Grief Disorder Scale (IPGDS), in a sample of bereaved older adults. This study analysed data from a large sample (N = 1526) of German-speaking Swiss individuals aged 65 and older. Only those who reported a bereavement (n = 627) were included in the current analyses. Confirmatory factor analysis (CFA) tested the latent structure of the IPGDS, and the identified factors were examined in relation to a range of mental health variables. Probable prevalence rates of PGD ranged from 0.5% (strict criteria) to 1.0% (moderate criteria), with no significant gender differences. CFA supported a three-factor model, including Loss, Emotional Numbing, and Emotional Reactivity latent variables, with acceptable estimates of internal reliability. Total and subscale scores were most strongly associated with functional impairment scores, and associations were strongest between the Emotional Numbing subscale and all mental health variables. The findings indicate a lower than typical prevalence of probable PGD among Swiss older adults. Future studies should explore the role of loss-related characteristics in explaining the risk of PGD among older adults.

Prolonged grief disorder (PGD) is a new diagnostic category included in global diagnostic classification systems for mental disorders. However, PGD can only be diagnosed if the severity and duration exceed socio-cultural norms. Here, we present a new supplementary module to the DSM-5 Cultural Formulation Interview: the Bereavement and Grief Cultural Formulation Interview (BG-CFI). The BG-CFI was developed to help clinicians provide a culturally informed diagnosis and guide treatment planning.We investigated the feasibility, acceptability, and clinical utility of the BG-CFI. Two participant groups (11 refugees, asylum seekers or migrants experiencing bereavement and 3 clinicians) took part in the study and were interviewed using open-ended questions on measures of feasibility, acceptability, and clinical utility. A step-by-step procedure was followed: (1) Clinicians and/or researchers conducted the BG-CFI with participants; (2) Debriefing interviews were conducted separately with clinicians and with bereaved participants.The BG-CFI was found to be a feasible, acceptable, and clinically useful tool for both bereaved participants and clinicians. Where clinicians found the interview difficult to conduct (i.e. lack of conceptual clarity or triggering emotional distress) specific changes were made to the interview format such as prompts for further questioning or recommendations for withholding or adapting questions. The BG-CFI would offer a useful complement for a reliable assessment of PGD in clinical settings working with cultural incongruity.

While death is a universal experience, how bereaved family members express and cope with the grief that follows varies across cultures. In East Asian cultures death is heavily tied to rigorous cultural practices and rituals, and so are grieving processes. This scoping review is the first to explore the potential impact of grief rituals for bereaved people from East Asia. A systematic review of existing literature was conducted in PubMed, PsycINFO, and Web of A reference was selected if: a) the study was conducted in either an East Asian or Southeast Asian country, b) described post-funeral rituals, and c) addressed grief outcomes. Thematic analysis was conducted to identify common themes when carrying out death rituals. Ten studies were included for review. Quantitative findings revealed correlations between funeral satisfaction and physical health, as well as funeral satisfaction and decreased distress over time. Qualitative studies suggested the following themes: 1) death as taboo, 2) family support, 3) public display of grief, and 4) continuing bonds. Our scope review suggests rituals as a mechanism for recovery from the death of a family member. Mourning rituals do not just provide support at the time of death but also help them adjust over time. Mental health providers can consider addressing identified ritual themes when working with grieving clients of East Asian cultural backgrounds.

Background: The global refugee population has significantly increased, with Syrian refugees being one of the largest displaced groups. Bereavement represents a major challenge. However, access to mental health care is limited by structural and cultural barriers. Internet-based interventions (IBIs) offer a promising solution, but most are developed in Western contexts, limiting their cultural relevance. This study aimed to evaluate the acceptability, feasibility, and preliminary efficacy of a culturally adapted self-help IBI for bereaved Syrian refugees in Switzerland. Methods: In a mixed-methods pilot randomized controlled trial (RCT), 30 bereaved Syrian refugees were randomly assigned to a 5-week app-based intervention or a waitlist control group. Semi-structured interviews with the intervention group provided qualitative insights on feasibility and acceptability and were analyzed with framework analysis. Quantitative data assessed treatment satisfaction, adherence, and preliminary efficacy on grief, depression, posttraumatic stress disorder (PTSD), anxiety, well-being, disability, post-migration difficulties, and social support. Descriptive statistics were used for feasibility and acceptability, while linear mixed-effects models assessed efficacy. Results: High treatment satisfaction, a low dropout rate and adherence of 40 % were found. Qualitative interviews indicated the intervention was relevant and beneficial, further adaptations were suggested. No significant group differences were found on bereavement or secondary outcomes. However, trends indicated reduced grief, anxiety, PTSD, and depression, with improved well-being and social support in the intervention group. Conclusions: The results suggest that this culturally adapted IBI is both feasible and acceptable for Syrian refugees. While trends are promising, a larger RCT is needed to investigate efficacy. This intervention shows potential as meaningful support for bereaved Syrian refugees.

Purpose: Prolonged Grief Disorder (PGD), recently included in the DSM-5-TR and ICD-11, involves a strong yearning for the deceased, fixation on death, denial, avoidance, negative emotions, and disengagement from daily life, lasting at least six months. However, most studies focus on Western settings, leading to underdiagnosis, inadequate care, and a growing mental health burden in Viet Nam. Design: Experience sampling method (ESM) can provide detailed, real-time data on daily symptoms due to the wave-like nature of grief and its psychological sequelae. 100 Vietnamese bereaved individuals who lost a loved one in the last 6 months will complete a 2-week ESM assessment app (mPath) every 3 months for 6 months. The app sends daily reminders to complete a questionnaire about PGD symptoms and daily life context. Participants will complete a baseline mental health assessment before each ESM period. Findings: Data collection for ESM assessments began in June 2025 and will end in December 2025. As of September 2025, 91 participants have been enrolled. A mix of longitudinal and finegrained data will reveal daily fluctuations and chronicity of PGD symptoms, identify prodromal symptoms predicting onset and severity, unique core symptoms to the Vietnamese bereaved, and factors predicting onset. Originality: This study will be the first to not only digitally screen for mental health distress in Viet Nam, but also the first to study the newly defined condition PGD in Viet Nam.Keywords: grief; experience sampling method; ecological momentary assessment; digital screening; digital mental health; Viet Nam ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author Clare Killikelly is funded by the Swiss National Science Foundation Starting Grant: TMSGI1_218018 ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was obtained from the ethics committee of Viet Nam National University, University of Education (No. 25.05/HDDD-DHGD). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors