(PS13-C60) Ecological Momentary Assessment with Bereaved Adults: Feasibility, Acceptability, and Reactivity in Those with and Without Prolonged Grief

Background:

Prolonged Grief Disorder (PGD) is a bereavement-specific syndrome characterized by prolonged, distressing, and impairing grief. Most research on prolonged grief has relied on self-report or interview-based measures. Although these measures have shed considerable light on PGD, they are vulnerable to recall biases that may reduce the accuracy of reported symptoms, and they provide minimal information about the dynamics of grief in daily life. Ecological Momentary Assessment (EMA) addresses these limitations by having participants repeatedly report on their experiences in real time, in their natural environment (Shiffman et al., 2008). EMA thus holds promise as a means for better understanding PGD, but little is known about how adults with PGD respond to EMA. Accordingly, we investigated the feasibility, acceptability, and reactivity of EMA in a sample of bereaved adults with and without PGD.

Methods:

Data were from 117 individuals; 55 of whom scored ≥30 on the Inventory of Complicated Grief, indicating probable PGD. Participants received 6 surveys per day (12 items per survey) via text message (between 9:00 AM and 9:00 PM) for 17 days, for a total of 102 surveys. Participants rated the extent to which 12 aspects of bereavement-related psychopathology were present on a sliding scale from 0 to 100. After the 17 days, participants completed an acceptability survey.

Results:

The mean proportion of completed EMA surveys was 90% (median=96%, mode=99%), and only 6% of the sample (n=7) withdrew from the EMA portion of the study. Five of those who withdrew were in the PGD group. Those with PGD completed a lower proportion of assessments (M=86%) than those without (M=93%), (t (77.62) =2.07, p=0.04). This difference was no longer present when excluding those who withdrew from the EMA portion of the study (PGD M=93%; No-PGD M=95%, t (63.18) =1.61, p=0.11). Acceptability of the surveys, survey frequency, and number of questions was high (M=6.38, 5.43, 5.86 on a 7-point scale, respectively). PGD was positively correlated with the extent to which participants felt their responses provided valuable (r=0.26, p=0.01) and important information (r=0.22, p</em>=0.02), and the extent to which items were deemed personally relevant (r=0.25, p=0.01). There was a weak, negative relationship between PGD and the acceptability of survey frequency (r=-0.19, p</em>=0.04). Grief symptoms did not increase in severity over time, indicating an absence of reactivity to the EMA surveys.

Discussion

Our findings suggest that EMA is feasible and acceptable in a sample of bereaved adults with and without PGD. We found no evidence of increased severity of grief-related symptoms in response to EMA. Adherence was modestly lower in those with PGD relative to those without, and there was a small negative association between PGD and the acceptability of the survey frequency. Nonetheless, adherence remained high among those with PGD, and PGD was positively associated with a perception that one’s EMA responses provided valuable, important information. These results suggest that EMA is an acceptable method for studying the experience of grief and call for additional attention to the administration of EMA when working with those with PGD to further reduce burden and encourage adherence.