{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:49:33Z","timestamp":1793494173381,"version":"4.5.0"},"reference-count":47,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T00:00:00Z","timestamp":1630022400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["NIHR-INF-0085"],"award-info":[{"award-number":["NIHR-INF-0085"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0033291721003123_sec_a1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Psychological models of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) make predictions about the role of unhelpful coping strategies in maintaining difficulties by blocking self-correction of negative appraisals and memory integration following stressful life events like bereavement. However, few studies have tested these predictions directly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291721003123_sec_a2\" sec-type=\"methods\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      We used counterfactually based causal mediation to assess whether unhelpful coping strategies mediated the relationship between (1) loss-related memory characteristics and\/or (2) negative grief-related appraisals and symptoms of PGD, PTSD and depression using a three-wave longitudinal sample (\n                      <jats:italic>N<\/jats:italic>\n                      = 275). Appraisals and memory characteristics were measured at time point 1, unhelpful coping strategies at T2, and symptom variables at T3. Additionally, multiple mediation analyses within a structural equation modelling (SEM) framework assessed which types of coping strategies differentially mediated symptoms of PGD, PTSD and depression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291721003123_sec_a3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Coping strategies mediated the relationship between negative appraisals and memory characteristics and symptoms of PGD, PTSD and depression after adjusting for demographics and loss characteristics. Sensitivity analyses suggested that these results were most robust for PGD, followed by PTSD and then depression. Multiple mediation analyses suggested that all four subscales (avoidance, proximity seeking, loss rumination and injustice rumination) individually mediated the effect of memory characteristics and appraisals on PGD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291721003123_sec_a4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These results suggest that core predictions of the cognitive model for PTSD and the cognitive behavioural model of PGD are useful in predicting symptoms of post-loss mental health problems in the first 12\u201318 months after loss. Targeting unhelpful coping strategies is likely to reduce symptoms of PGD, PTSD and depression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s0033291721003123","type":"journal-article","created":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T03:14:35Z","timestamp":1630034075000},"page":"1542-1551","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":27,"title":["Coping strategies as a causal mediator of the effect of loss-related memory characteristics and negative loss-related appraisals on symptoms of PGD, PTSD and depression"],"prefix":"10.1017","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6973-2846","authenticated-orcid":false,"given":"Kirsten V.","family":"Smith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8742-0192","authenticated-orcid":false,"given":"Anke","family":"Ehlers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2021,8,27]]},"reference":[{"key":"S0033291721003123_ref46","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2010.06.047"},{"key":"S0033291721003123_ref27","first-page":"1","article-title":"The importance of harmonising diagnostic criteria sets for pathological grief","author":"Lenferink","year":"2019","journal-title":"The British Journal of Psychiatry"},{"key":"S0033291721003123_ref36","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20823"},{"key":"S0033291721003123_ref2","volume-title":"Cognitive therapy of depression","author":"Beck","year":"1979"},{"key":"S0033291721003123_ref10","first-page":"109","article-title":"A cognitive-behavioral conceptualization of complicated grief","volume":"13","author":"Boelen","year":"2006","journal-title":"Clinical Psychology: Science and Practice"},{"key":"S0033291721003123_ref25","volume-title":"Principles and practice of structural equation modeling","author":"Kline","year":"2015"},{"key":"S0033291721003123_ref13","doi-asserted-by":"publisher","DOI":"10.2190\/OM.67.3.b"},{"key":"S0033291721003123_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2015.05.007"},{"key":"S0033291721003123_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbtep.2010.03.003"},{"key":"S0033291721003123_ref31","doi-asserted-by":"publisher","DOI":"10.1080\/10705511.2014.935843"},{"key":"S0033291721003123_ref1","volume-title":"Diagnostic statistical manual of mental disorders","year":"2000"},{"key":"S0033291721003123_ref37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000121"},{"key":"S0033291721003123_ref39","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2014.1242"},{"key":"S0033291721003123_ref28","doi-asserted-by":"publisher","DOI":"10.1080\/07481187.2010.496686"},{"key":"S0033291721003123_ref35","doi-asserted-by":"publisher","DOI":"10.21236\/ADA557663"},{"key":"S0033291721003123_ref40","unstructured":"Smith, K. 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