Prevalence of prolonged grief disorder and its symptoms among bereaved individuals in China: a systematic review and meta-analysis

Background The prevalence of prolonged grief disorder (PGD) and its symptoms among the bereaved population in China vary considerably. Aims This meta-analysis aims to estimate the prevalence of PGD and its symptoms among bereaved individuals in China. Methods We conducted a literature search in major Chinese and English databases from their inception to 4 October 2023, for cross-sectional studies on the prevalence of PGD or its symptoms in bereaved Chinese individuals. The risk of bias of the included studies and certainty of the evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data (‘JBI checklist’) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE), respectively. The ‘metaprop’ package in R V.4.1.2 was used to synthesise the prevalence. Results A total of 28 studies involving 10 994 bereaved individuals were included in the analysis, with JBI checklist scores between 3 and 7. The combined prevalence (95% confidence interval) of PGD and its symptoms was 8.9% (4.2% to 17.6%) and 32.4% (18.2% to 50.8%), respectively. PGD and its symptoms were most prevalent among those who had lost their only child (22.7%) and those bereaved by earthquakes (80.4%), respectively. The GRADE system assigned a very low certainty level to the evidence for the pooled prevalence of PGD and its symptoms. Conclusions The pooled prevalence of PGD and its symptoms indicate a potential high need for grief counselling services among bereaved individuals in China. This need is particularly pronounced in those who have lost their only child and those bereaved due to earthquakes. Further methodologically rigorous studies are needed to provide more accurate prevalence estimates. PROSPERO registration number CRD42023432553.


Appendix 2
Selection process 8 Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process. p7 Data collection process 9 Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.
Data items 10a List and define all outcomes for which data were sought.Specify whether all results that were compatible with each outcome domain in each study were sought (eg for all measures, time points, analyses), and if not, the methods used to decide which results to collect.p8 10b List and define all other variables for which data were sought (eg participant and intervention characteristics, funding sources).Describe any assumptions made about any missing or unclear information. p8 Study risk of bias assessment 11 Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process.
Effect measures 12 Specify for each outcome the effect measure(s) (eg risk ratio, mean difference) used in the synthesis or presentation of results.

pp8-9
Synthesis methods 13a Describe the processes used to decide which studies were eligible for each synthesis (eg tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)).p9 3

Not applicable
Reporting bias assessment 14 Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases).

p9
Certainty assessment 15 Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome.

Study selection 16a
Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram.

Figure1
16b Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded.

Figure1
Study characteristics 17 Cite each included study and present its characteristics.

Appendix 3
Risk of bias in studies 18 Present assessments of risk of bias for each included study.

Appendix 3
Results of individual studies 19 For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (eg confidence/credible interval), ideally using structured tables or plots.Figures 2,

Results of syntheses 20a
For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies.

Inception to
October 4,

Table 1
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) General Psychiatry doi: 10.1136/gpsych-2023-101216 p14 23d Discuss implications of the results for practice, policy, and future research.pp14-15 OTHER INFORMATION Registration and protocol 24a Provide registration information for the review, including register name and registration number, or state that the review was not registered.p6 24b Indicate where the review protocol can be accessed, or state that a protocol was not prepared.p6 24c Describe and explain any amendments to information provided at registration or in the protocol.Not applicable Support 25 Describe sources of financial or non-financial support for the review, and the role of the funders or sponsors in the review.p2 Competing interests 26 Declare any competing interests of review authors.p2 Availability of data, code and other materials 27 Report which of the following are publicly available and where they can be found: template data collection forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used in the review.[摘要] OR "丧子"[摘要] OR "丧偶"[摘要] OR "失独"[摘要] OR "去 世"[摘要] OR "失去"[摘要] OR "自杀"[摘要]) AND ("哀伤"[摘要] OR "持 续性复杂丧亲障碍"[摘要])

Appendix 3. Characteristics of included studies
Note: NR, not reported; PG-13, Prolonged Grief Disorder-13; ICG: Inventory of Complicated Grief; ICG-R: Revised version of Inventory of Complicated Grief; D: Clinical diagnosis of Prolonged Grief Disorder; S: Symptoms of Prolonged Grief Disorder; JBI checklist: the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data; IPGDS, International ICD-11 Prolonged Grief Disorder Scale; SCI-CG, the Structured Clinical Interview for Complicated Grief; SCL-90, the Symptom Checklist-90.