Daily symptom associations in prolonged grief: a dynamic network approach

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.