Psychological and Spiritual Correlates of Prolonged Grief Disorder among Bereaved Family Caregivers of Cancer Patients in Iran: A Cross-sectional Study

Abstract

Background: Prolonged grief disorder (PGD) is an important psychological outcome among bereaved family caregivers of patients with cancer and may be associated with psychological, emotional, and spiritual factors. Objectives: Given the potential roles of post-traumatic stress symptoms, attachment styles, and spiritual dryness in the persistence of grief reactions, this study aimed to examine the psychological and spiritual correlates of PGD severity among family caregivers of deceased cancer patients. Methods: This descriptive-analytic cross-sectional study was conducted between 2024 and 2025 in palliative care, oncology, cancer support, and death registration centers in Tehran, Ilam, and Dezful, Iran. A total of 300 family caregivers of deceased patients with cancer were included. Data were collected using a demographic information questionnaire, the Revised PGD Scale, the post-traumatic stress disorder (PTSD) Checklist, the Adult Attachment Style Scale, and the Spiritual Dryness Scale. Data were analyzed using descriptive statistics, Spearman correlation tests, nonparametric tests, and hierarchical multiple linear regression. Results: The mean PGD score was 36.28 ± 8.25. In the correlation analysis, the total PTSD Checklist score showed the strongest association with PGD severity (Spearman’s ρ = 0.825, P < 0.001). Spiritual dryness was also positively and significantly associated with PGD severity (ρ = 0.485, P < 0.001). In the final regression model, post-traumatic stress symptoms showed the strongest independent association with PGD severity (β = 0.768, P < 0.001), and spiritual dryness remained a significant independent correlate (β = 0.121, P = 0.007). The final model explained 68.9% of the variance in PGD severity. Conclusions: PGD severity among bereaved family caregivers of patients who died of cancer was strongly associated with post-traumatic stress symptoms and, to a lesser extent, spiritual dryness. These findings underscore the importance of screening bereaved caregivers for both trauma-related symptoms and spiritual struggles and suggest the need for culturally appropriate psycho-spiritual support interventions.