407). Discussion Principal findings In this study it was possible to identify a combination of the BDI scale and a single item (Even while my relative was dying, I felt a sense of purpose in my life) answered at eight weeks post

loss to assess the propensity of bereaved individuals to develop complicated and prolonged reaction of grief after six months. Hence, we were able to construct a screening tool to identify people at risk of suffering complicated Inhibitors,research,lifescience,medical grief six months after bereavement and divide the risk of a pathological grief reaction of bereaved individuals into three distinct groups. This study points to the necessity of awareness of a depressive symptomatology among older people and family caregivers to deceased cancer patients in connection with bereavement as it might predict complications in the process of grief reactions. Strengths and weaknesses The sample Inhibitors,research,lifescience,medical size of this study was acceptable but a larger sample may have

added more statistical precision to the estimates. Though the sample in this study was population-based, there was a drop-out. Furthermore, part of this sample was Inhibitors,research,lifescience,medical recruited through a palliative care team, which means there is a risk of selection bias that need to be taken into account when considering the representativity of this population. Analyses showed that older people and females were underrepresented in this sample yet overall the mean age of the population Inhibitors,research,lifescience,medical in the sample was relatively

high. However, this means that the results might be underestimating the risk for older people and females, which should be taken into consideration when applying the screening tool and cut points might need adjustment in future studies. Another weakness that needs to be touched upon is the limitation in the performance of the screening tool. It was possible to identify a screening tool for early identification of individuals at risk of developing complicated grief, yet Inhibitors,research,lifescience,medical the tool seems to have some shortcomings that need to be taken into consideration when applying it in a clinical setting. The PPV of the potential screen was 40% for risk group 2 and the PPV for risk group 3 was 73% and therefore, we recommend to use only the cut off for risk group 3 in clinical practice when applied in addition to the clinical judgment of the professional. only A notable methodological weakness in this study and generally in studies on bereavement is the lack of a clear and distinct diagnosis and measure of pathological grief, which makes conclusions ambiguous to information bias and the lack of criterion validity. The ICG-R is a widely used SB939 clinical trial self-report questionnaire on CG but still lacks research in validation of cut off points and in non-American populations. In this study we had to define a usable clinical cut off point, as the ICG-R is not standardised in a Danish population.