The Distinctiveness of Grief, Depression, and Posttraumatic Stress: Lessons From Children After 9/11

Objective: The clinical and nosological significance of grief reactions in youth exposed to a shared trauma (9/11, the September 11, 2001 terrorist attacks on the United States) was tested by examining whether the predictors (ie, non−loss-related trauma versus traumatic bereavement), clinical correlates, factorial structure, and phenomenology of grief reactions are distinct from those of major depressive disorder (MDD) and 9/11-related posttraumatic stress disorder (PTSD). Method: In a representative sample of New York City schoolchildren (N = 8,236; grades 4−12; n = 1,696 bereaved), assessed 6 months post-9/11, multivariate regressions examined predictors of grief, PTSD, and MDD, as well as the incremental validity of grief in predicting health problems and functional impairment. Factor analysis and latent class analysis determined, respectively, the factorial and the syndromic distinctiveness of grief, PTSD, and MDD. Results: Four types of evidence supporting the distinctiveness of grief emerged. (1) Bereavement was associated with grief independently of PTSD and MDD, but not with PTSD and MDD after adjusting for grief; conversely, non−loss related trauma was associated primarily with PTSD. (2) Grief contributed uniquely to functional impairment. (3) Grief reactions loaded on a separate factor. (4) Youth with elevated grief reactions fell into two classes characterized by only moderate and negligible probability of co-occurring PTSD and MDD symptoms, respectively. Conclusion: A multifaceted approach provided convergent evidence that grief reactions are independent of other common types of postdisaster child and adolescent psychopathology, and capture a unique aspect of bereavement-related distress. These findings suggest that grief reactions in traumatically bereaved youth merit separate clinical attention, informing tailored interventions.