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Bhaskaran J, Afifi TO, Sareen J, Vincent N, Bolton JM. A cross-sectional examination of sudden-death bereavement in university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1696-1704. [PMID: 34469263 DOI: 10.1080/07448481.2021.1947298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/27/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
ObjectivesThe objective of this research was to determine the unique contributions of sudden death bereavement to the mental health of university students compared to non-sudden death bereaved university students. Methods: We surveyed 1047 bereaved university students (retention rate 92%) and compared the non-sudden death bereaved university student population to the sudden death bereaved university population on outcomes including mental health symptomatology, and complicated grief using logistic regressions. Results: Sixty two percent of the sample reported sudden death bereavement. There were no differences on measures of PTSD, generalized anxiety disorder, depression, suicidal ideation, and at-risk drinking behavior across types of bereavement. However, sudden death bereavement compared to general bereavement was associated with increased likelihood of complicated grief. Conclusions: Sudden death bereavement in university students is associated with elevated risk of complicated grief. These findings confirm previous research and provide more insight into the unique needs of university student coping with sudden loss.
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Affiliation(s)
- Joanna Bhaskaran
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Tracie O Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Jitender Sareen
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Norah Vincent
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
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2
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Yıldırım YE. Prevalence of Prolonged Grief Disorder and Related Clinical Factors Among Turkish Psychiatric Outpatients During the COVID-19 Pandemic. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231187296. [PMID: 37386898 PMCID: PMC10315512 DOI: 10.1177/00302228231187296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Prolonged grief disorder (PGD), a new diagnosis in some classification systems, has gained prominence due to the high mortality rates observed during the Covid-19 pandemic. Herein, the prevalence of PGD (diagnosed with structured clinical interviews), death-related features, and associated clinical factors were investigated among outpatient psychiatric patients who lost a first-degree relative within the past 12-24 months. PGD was diagnosed in 30/68 patients (44.1%). PGD development did not differ based on cause of death (Covid-19-related vs. other causes) but was associated with higher age of the bereaved, younger age of the deceased, and degree of kinship. Higher rates of depression, insomnia, and anxious attachment were also observed in PGD patients. Finally, the unexpectedness of death predicted the development of PGD. Due to the high prevalence of PGD among psychiatric patients, clinicians should be aware of the disorder, monitor grief processes in high-risk patients, and consider PGD in treatment planning.
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3
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Lobos-Rivera ME, Flores-Monterrosa AN, Tejada-Rodríguez JC, Chacón-Andrade ER, Caycho-Rodríguez T, Lee SA, Valencia PD, Carbajal-León C, Vilca LW, Reyes-Bossio M, Gallegos M. Pandemic grief in El Salvador: factors that predict dysfunctional grief due to a COVID-19 death among Salvadoran adults. PSICOLOGIA-REFLEXAO E CRITICA 2023; 36:9. [PMID: 36988703 PMCID: PMC10050804 DOI: 10.1186/s41155-023-00250-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/11/2023] [Indexed: 03/30/2023] Open
Abstract
Thousands of people have died of COVID-19 in El Salvador. However, little is known about the mental health of those who are mourning the loss of a loved one to COVID-19. Therefore, the objective of this study was to examine the dysfunctional grief associated with COVID-19 death among Salvadoran adults. A sample of 435 Salvadorans (M = 29 years; SD = 8.75) who lost a family member or loved one to COVID-19 completed a digital survey using the Google Forms platform, during April 2 and 28, 2022. The results revealed that 35.1% reported clinically elevated symptoms of dysfunctional grief and among those mourners, and 25.1% also exhibited clinical levels of coronavirus anxiety. A binary logistic regression revealed that predictor variables such as COVID-19 anxiety (p = .003), depression (p = .021), and COVID-19 obsession (p = .032) were significant (χ2 = 84.31; Nagelkerke R2 = .242) and predict a 24.2% chance of dysfunctional bereavement.
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Affiliation(s)
| | | | | | | | | | | | - Pablo D Valencia
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de Mexico, Tlalnepantla de Baz, State of Mexico, Mexico
| | - Carlos Carbajal-León
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Perú
| | - Lindsey W Vilca
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Perú
| | - Mario Reyes-Bossio
- Facultad de Psicología, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Miguel Gallegos
- Universidad Católica del Maule, Talca, Chile
- Universidad Nacional de Rosario, Santa Fe, Argentina
- Consejo Nacional de Investigaciones Científicas Y Técnicas, Buenos Aires, Argentina
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4
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Avramchuk OS, Plevachuk OY, Koval IA. BEREAVEMENT AND COVID-19: PREVALENCE, COMORBIDITY, AND ASSOCIATED FEATURES AMONG UKRAINIAN SAMPLE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1299-1304. [PMID: 35758447 DOI: 10.36740/wlek202205212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To examine the features of experiences of bereavement reactions and the severity of comorbid mental health problems in persons who lost loved ones during the pandemic. PATIENTS AND METHODS Materials and methods: 191 volunteers aged 18-60 years participated in this study. All participants were tested during 2018-2020. To assess the mental health problems was used International Neuropsychiatric Interview (MINI) and a set of IAPT scales; to the psycho-emotional distress severity associated with loss of loved ones - Inventory of Complicated Grief, with verification of symptoms of complicated grief based on an independent assessment of two experts; and the quality of life satisfaction was assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form. RESULTS Results: The results show an association between the severity of symptoms of depression, general anxiety, social avoidance, and loss during the pandemic. The level of psycho-emotional distress was associated with the experience of bereavement as a traumatic event for a group of participants who experienced loss during the pandemic and, at the same time, before the pandemic was associated with the severity of depression. Regardless of the time of loss, people who demonstrated signs of complicated grief have a more pronounced comorbid psychopathology, a higher level of psycho-emotional distress, and a lower level of satisfaction with life quality. CONCLUSION Conclusions: It has been established that a person's ability to experience loss as a traumatic experience and grieve during the pandemic is modified with the context of the life situation and reflects those challenges that impose quarantine restrictions.
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Affiliation(s)
| | | | - Iryna A Koval
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
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5
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Caycho-Rodríguez T, Vilca LW, Vivanco-Vidal A, Saroli-Araníbar D, Carbajal-León C, Gallegos WLA, White M, Lee SA. Assessment of Dysfunctional Grief due to Death from COVID-19 in Peru: Adaptation and Validation of a Spanish Version of the Pandemic Grief Scale. TRENDS IN PSYCHOLOGY 2021. [PMCID: PMC8279032 DOI: 10.1007/s43076-021-00091-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study evaluated the psychometric properties of the Pandemic Grief Scale (PGS), using Classical Test Theory (CTT) and Item Response Theory (IRT) methods, in a sample of 458 people who have suffered the loss of a loved one due to the COVID-19 pandemic. The Pandemic Grief Scale, Patient Health Questionnaire-2 (PHQ-2), the two-item Generalized Anxiety Disorder Scale (GAD-2), and a single item on suicidal ideation were used. The unidimensional model had good fit and reliability; furthermore, convergent validity was demonstrated based on the relationships between dysfunctional grief, anxiety symptoms, depression, and suicidal ideation. Additionally, a higher presence of dysfunctional grief is required to answer using the higher response categories. The evidence of validity and reliability of the PGS in its Spanish version, using traditional and modern methods, is confirmed in Peru.
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Affiliation(s)
- Tomás Caycho-Rodríguez
- Facultad de Ciencias de La Salud, Universidad Privada del Norte, Av. Alfredo Mendiola 6062, Los Olivos, Lima, Perú
| | - Lindsey W. Vilca
- Departamento de Psicología, Universidad Peruana Unión, Lima, Perú
| | | | | | - Carlos Carbajal-León
- Facultad de Ciencias de La Salud, Universidad Privada del Norte, Av. Alfredo Mendiola 6062, Los Olivos, Lima, Perú
| | | | - Michael White
- Dirección General de Investigación, Universidad Peruana Unión, Lima, Perú
| | - Sherman A. Lee
- Department of Psychology, Christopher Newport University, Newport News, VA USA
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6
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Szuhany KL, Malgaroli M, Miron CD, Simon NM. Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:161-172. [PMID: 34690579 PMCID: PMC8475918 DOI: 10.1176/appi.focus.20200052] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Losing a loved one is one of life's greatest stressors. Although most bereaved individuals navigate through a period of intense acute grief that lessens with time, approximately 10% will develop a prolonged grief condition. This review provides an overview of the course of grief and describes risk factors for developing prolonged grief disorder. The evolution of the prolonged grief disorder diagnosis, including the latest criteria sets for ICD-11 and DSM-5, as well as common comorbid conditions and differential diagnosis are discussed. Clinically useful self-report and clinician-rated measures for assessing symptom constructs and overall prolonged grief disorder severity, evidence-based psychotherapies (such as complicated grief treatment), as well as evidence about pharmacologic approaches are presented. Finally, the authors discuss important future directions, including a potential increase in prolonged grief disorder cases due to the COVID-19 pandemic.
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Affiliation(s)
- Kristin L Szuhany
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Matteo Malgaroli
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Carly D Miron
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Naomi M Simon
- Department of Psychiatry, New York University Grossman School of Medicine, New York
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7
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Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100140] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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8
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Eersel JHW, Taris TW, Boelen PA. Reciprocal relations between symptoms of complicated grief, depression, and anxiety following job loss: A cross‐lagged analysis. CLIN PSYCHOL-UK 2021. [DOI: 10.1111/cp.12212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Janske H. W. Eersel
- Utrecht University, Department of Clinical Psychology, Utrecht, The Netherlands,
| | - Toon W. Taris
- Utrecht University, Department of Social, Health and Organizational Psychology, Utrecht, The Netherlands,
| | - Paul A. Boelen
- Utrecht University, Department of Clinical Psychology, Utrecht, The Netherlands,
- ARQ National Psychotrauma Centre, Diemen, The Netherlands,
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9
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Yan B, Lo RSK, Chow AYM. The role of post-loss anxiety in the development of depressive symptoms and complicated grief symptoms: a longitudinal SEM study. J Affect Disord 2021; 281:649-656. [PMID: 33246651 DOI: 10.1016/j.jad.2020.11.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 07/01/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Though grief, anxiety, and depression often co-occur, existing evidence mostly focus on any two of them at a time. Our study examined the relationships among the three clusters of symptoms. METHODS A Chinese community sample of 101 bereaved individuals participated at T1. We utilized Bayesian Structural Equation Modelling (BSEM) to conduct cross-lagged analyses on three-wave panel data (T1 at one-month post-loss, T2 at four-months, and T3 at seven-months). RESULTS BSEM findings confirmed the presence of distinctive developmental paths for complicated grief (CG), anxiety, and depressive symptoms. Three simplex models showed that anxiety, CG symptoms, and depressive symptoms maintained high consistency. In cross-lagged models, anxiety at T1 was a significant predictor of depressive symptoms (standardized estimate B=0.386*) and CG symptoms (standardized estimate B=0.300*) at T2. The remaining positive directions (0.338*, 0.256*) in the final model suggest the important role of anxiety at early bereavement, while at a later stage, T2 CG contributed to depressive symptoms at T3 (0.356*). LIMITATIONS In addition to attrition, the overall sample size was limited. Data were based on self-report. Future research with repeated measures and Bayesian informative priors would be more useful to establish relational patterns of symptoms. CONCLUSIONS In our models, the reduction in anxiety symptoms contributed to the development of depressive and CG symptoms, and these results should be replicated. Theories of mechanisms underlying post-loss anxiety can be explored as a potential means of reducing later symptoms.
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Affiliation(s)
- Bo Yan
- School of Nursing, the University of Hong Kong, HKSAR.
| | | | - Amy Y M Chow
- Department of Social Work and Social Administration, Faculty of Social Sciences, the University of Hong Kong, HKSAR
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10
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Frumkin MR, Robinaugh DJ, LeBlanc NJ, Ahmad Z, Bui E, Nock MK, Simon NM, McNally RJ. The pain of grief: Exploring the concept of psychological pain and its relation to complicated grief, depression, and risk for suicide in bereaved adults. J Clin Psychol 2021; 77:254-267. [PMID: 32662088 PMCID: PMC7725983 DOI: 10.1002/jclp.23024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/15/2020] [Accepted: 06/24/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Emotional or psychological pain is a core symptom of complicated grief (CG), yet its correlates are largely unexamined among bereaved individuals. METHOD Bereaved adults (N = 135) completed self-reports regarding psychological pain, CG, depression, and suicidality. We assessed correlations among these variables and tested whether psychological pain was elevated among individuals with CG and individuals with current or past suicidal thoughts and behaviors. Using logistic regression, we also assessed psychological pain, depression, and CG symptom severity as predictors of suicide risk. RESULTS Psychological pain was strongly associated with both CG and depression severity and was elevated among subjects reporting current or past suicidality. CG and depression were not statistically significant predictors of suicidal ideation after accounting for the effects of psychological pain. CONCLUSIONS Psychological pain is strongly associated with bereavement-related psychopathology and warrants further investigation in studies examining the nature and treatment of CG.
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Affiliation(s)
- Madelyn R. Frumkin
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | - Nicole J. LeBlanc
- Department of Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | - Zeba Ahmad
- The Graduate Center and Hunter College, City University of New York
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
| | | | - Naomi M. Simon
- Department of Psychiatry, NYU Langone Health, New York University School of Medicine
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11
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Bell JM, Mason TM, Buck HG, Tofthagen CS, Duffy AR, Groër MW, McHale JP, Kip KE. Challenges in Obtaining and Assessing Salivary Cortisol and α-Amylase in an Over 60 Population Undergoing Psychotherapeutic Treatment for Complicated Grief: Lessons Learned. Clin Nurs Res 2020; 30:680-689. [PMID: 33218253 DOI: 10.1177/1054773820973274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Biomarkers may serve as objective measures in complicated grief (CG) potentially capturing responses to stress reduction treatment. This paper reports challenges in obtaining and assessing salivary cortisol and α-amylase (sAA) for a recent randomized clinical trial. Within-session changes in salivary cortisol and sAA for 54 older adults with CG who received Accelerated Resolution Therapy were compared with perceived stress measured by Subjective Units of Distress Scale. Bivariate correlations and multiple regressions examined changes in biomarkers. Protocols, study logs, and audit reports identified challenges. Challenges included obtaining unstimulated passive drool salivary samples and their analyses. Our sample of older females on multiple medications may have resulted in a perfect storm of moderating and intervening variables which affected the stress response. This paper contributes to the discussion on designing clinical trials for older adults which must account for physiologic changes, multimorbidity, and polypharmacy common in this population and makes recommendations moving forward.
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Affiliation(s)
- Jesse M Bell
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Tina M Mason
- College of Nursing, University of South Florida, and Department of Nursing Research, Moffitt Cancer Center, Tampa, FL, USA
| | - Harleah G Buck
- College of Nursing, University of South Florida, Tampa, FL, USA
| | | | - Allyson R Duffy
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Maureen W Groër
- College of Nursing and Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - James P McHale
- Department of Psychology, USF St. Petersburg Family Study Center, University of South Florida, Tampa, FL, USA
| | - Kevin E Kip
- Health Services Division, Medical Center, University of Pittsburgh, Pittsburgh, PA, USA
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12
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Two Cases of Persistent Complex Bereavement Disorder Diagnosed in the Acute Inpatient Unit. Case Rep Psychiatry 2020; 2020:3632060. [PMID: 32309001 PMCID: PMC7154980 DOI: 10.1155/2020/3632060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/23/2020] [Indexed: 11/17/2022] Open
Abstract
Pathological grief has been noted to have considerable adverse effects on affected individuals. In the DSM-5, the diagnosis of complicated grief is included under conditions for further study as Persistent Complex Bereavement Disorder (PCBD). PCBD can be easily missed because it is a relatively new and developing diagnosis. It can also be overlooked when it is comorbid with more common psychiatric disorders. We present 2 patients with PCBD diagnosed in the inpatient unit, while the patients were admitted for comorbid disorders. PCBD contributed immensely to both patients' suffering and decline in functioning. This report highlights the presentation, diagnoses, and management of these patients. We theorize that paying attention to separation distress, reactive distress to loss, and identity disruption in individuals who have been bereaved for over 12 months will enhance treatment specificity and lead to better patient outcomes.
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13
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Mason TM, Tofthagen CS, Buck HG. Complicated Grief: Risk Factors, Protective Factors, and Interventions. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2020; 16:151-174. [PMID: 32233740 DOI: 10.1080/15524256.2020.1745726] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Complicated grief (CG) poses significant physical, psychological, and economic risks to bereaved family caregivers. An integrative review of the literature published 2009-2018 on CG associated with caregiving was performed using PubMed, PsychINFO, and Web of Science. The search returned 1428 articles, of which 32 were included in the review. Sixteen studies described risk and protective factors and 16 described interventions for CG. Caregiver-related risk factors included fewer years of education, depression, anxiety, poor physical health, and maladaptive dependency and attachment traits. Additional risk factors included lower perceived social support, family conflict at end-of-life, and family having difficulty accepting death. Care recipient-related risk factors are younger age, fear of death, and place of death. Protective factors included hospice utilization in reducing fear of death, high pre-bereavement spiritualty, and satisfaction with palliative care. Complicated grief treatment was the most widely-studied intervention. Social Workers and other clinicians can use this information to identify family caregivers at increased risk for CG and refer or implement an early intervention to lessen its impact.
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Affiliation(s)
- Tina M Mason
- College of Nursing, University South Florida, Tampa, Florida, USA
| | | | - Harleah G Buck
- College of Nursing, University South Florida, Tampa, Florida, USA
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14
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Simon NM, Shear K, Reynolds CF, Cozza SJ, Mauro C, Zisook S, Skritskaya N, Robinaugh DJ, Malgaroli M, Spandorfer J, Lebowitz B. Commentary on evidence in support of a grief-related condition as a DSM diagnosis. Depress Anxiety 2020; 37:9-16. [PMID: 31916663 PMCID: PMC7430251 DOI: 10.1002/da.22985] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022] Open
Abstract
The death of a loved one is one of life's greatest stressors. Most bereaved individuals experience a period of acute grief that diminishes in intensity as they adapt to the changes brought about by their loss. Over the past four decades, a growing body of research has focused on a form of prolonged grief that is painful and impairing. There is a substantial and growing evidence base that supports the validity and significance of a grief-related disorder, including the clinical value of being able to diagnose it and provide effective targeted treatment. ICD-11 will include a new diagnosis of prolonged grief disorder (PGD). DSM-5 called this condition persistent complex bereavement disorder (PCBD) and included it in Section III, signaling agreement that a diagnosis is warranted while further research is needed to determine the optimal criteria. Given the remaining uncertainties, reading this literature can be confusing. There is inconsistency in naming the condition (including complicated grief as well as PGD and PCBD) and lack of uniformity in identifying it, with respect to the optimal threshold and timeframe for distinguishing it from normal grief. As an introductory commentary for this Depression and Anxiety special edition on this form of grief, the authors discuss the history, commonalities, and key areas of variability in identifying this condition. We review the state of diagnostic criteria for DSM-5 and the current ICD-11 diagnostic guideline, highlighting the clinical relevance of making this diagnosis.
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Affiliation(s)
- Naomi M. Simon
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | | | | | - Stephen J. Cozza
- Center for the Study of Traumatic Stress, Uniformed Services University for the Health Sciences
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Sidney Zisook
- University of California San Diego and San Diego Healthcare System, San Diego, CA
| | | | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Matteo Malgaroli
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | - Julia Spandorfer
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | - Barry Lebowitz
- University of California San Diego and San Diego Healthcare System, San Diego, CA
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15
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Fisher JE, Zhou J, Liu AG, Fullerton CS, Ursano RJ, Cozza SJ. Effect of comorbid anxiety and depression in complicated grief on perceived cognitive failures. Depress Anxiety 2020; 37:54-62. [PMID: 31916661 DOI: 10.1002/da.22943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bereavement is associated with cognitive difficulties, but it is unclear whether these difficulties are associated with normative and/or complicated grief (CG) and how comorbid depression and anxiety contribute to them. Self-reported "minor errors in thinking" (i.e., cognitive failures) may manifest following bereavement and be differentially affected by CG, anxiety, and depression. METHODS Associations between perceived cognitive failures and CG, anxiety, and depression were investigated in 581 bereaved participants. To examine both single and comorbid conditions across the spectrum of bereaved participants, these relationships were examined using both linear regressions and group comparisons. RESULTS Continuous measures of depression, anxiety, and grief each independently predicted perceived cognitive failures. Group comparisons indicated that the group with three comorbid conditions had the highest frequency of perceived cognitive failures and the group with no conditions had the lowest. In addition, groups with threshold depression levels (both alone and comorbid with another condition) had higher frequencies of perceived cognitive failures than other groups, suggesting that depression was more strongly associated with perceived cognitive failures than CG or anxiety. CONCLUSIONS Future research about cognition following bereavement should address how multiple mental health symptoms or conditions combine to affect perceived and actual cognitive capacity.
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Affiliation(s)
- Joscelyn E Fisher
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland
| | - Jing Zhou
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland
| | - Alexander G Liu
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland
| | - Carol S Fullerton
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland
| | - Robert J Ursano
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland
| | - Stephen J Cozza
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland
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16
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Simon NM, Hoeppner SS, Lubin RE, Robinaugh DJ, Malgaroli M, Norman SB, Acierno R, Goetter EM, Hellberg SN, Charney ME, Bui E, Baker AW, Smith E, Kim HM, Rauch SA. Understanding the impact of complicated grief on combat related posttraumatic stress disorder, guilt, suicide, and functional impairment in a clinical trial of post-9/11 service members and veterans. Depress Anxiety 2020; 37:63-72. [PMID: 31916660 PMCID: PMC7433022 DOI: 10.1002/da.22911] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Complicated grief (CG) is a bereavement-specific syndrome distinct from but commonly comorbid with posttraumatic stress disorder (PTSD). While bereavement is common among military personnel (Simon et al., 2018), there is little research on the impact of CG comorbidity on PTSD treatment outcomes. METHODS To evaluate the impact of comorbid CG on PTSD treatment outcomes we analyzed data from a randomized trial comparing prolonged exposure, sertraline, and their combination in veterans with a primary diagnosis of combat-related PTSD (n = 194). Assessment of PTSD, trauma-related guilt, functional impairment, and suicidal ideation and behavior occurred at baseline and weeks 6, 12, and 24 during the 24-week trial. RESULTS CG was associated with lower PTSD treatment response (odds ratio (OR) = 0.29, 95% confidence interval (CI) [0.12, 0.69], p = 0.005) and remission (OR = 0.28, 95% CI [0.11, 0.71], p = 0.007). Those with CG had greater severity of PTSD (p = 0.005) and trauma-related guilt (<0.001) at baseline and endpoint. In addition, those with CG were more likely to experience suicidal ideation during the study (CG: 35%, 14/40 vs. no CG 15%, 20/130; OR = 3.01, 95% CI [1.29, 7.02], p = 0.011). CONCLUSIONS Comorbid CG is associated with elevated PTSD severity and independently associated with poorer endpoint treatment outcomes in veterans with combat-related PTSD, suggesting that screening and additional intervention for CG may be needed.
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Affiliation(s)
- Naomi M. Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Susanne S. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Rebecca E. Lubin
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Matteo Malgaroli
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Sonya B. Norman
- National Center for PTSD, White River Junction, VT,Mental Health Service Line, Veterans Affairs San Diego Healthcare System, San Diego, CA,School of Medicine, University of California, San Diego, La Jolla,Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA
| | - Ron Acierno
- Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Elizabeth M. Goetter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Meredith E. Charney
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Amanda W. Baker
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Erin Smith
- VA Ann Arbor Healthcare System, Ann Arbor, MI,Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - H. Myra Kim
- VA Ann Arbor Healthcare System, Ann Arbor, MI,Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, MI
| | - Sheila A.M. Rauch
- Mental Health Service Line, Veterans Affairs Atlanta Healthcare System, Decatur, GA,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
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17
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Schiele MA, Costa B, Abelli M, Martini C, Baldwin DS, Domschke K, Pini S. Oxytocin receptor gene variation, behavioural inhibition, and adult separation anxiety: Role in complicated grief. World J Biol Psychiatry 2018; 19:471-479. [PMID: 29353531 DOI: 10.1080/15622975.2018.1430374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Complicated grief (CG) following bereavement significantly increases the risk for mood and anxiety disorders. The severity of grief reactions may be interactively influenced by temperamental and psychological factors such as behavioural inhibition (BI) and separation anxiety (SA) as well as biological factors. Given its central role in attachment and stress processing, a genetic variant in the oxytocin receptor (OXTR) gene was thus investigated in order to elucidate the direction of association as well as its interaction with BI and SA in the moderation of CG severity. METHODS Ninety-three patients with mood and anxiety disorders were evaluated for CG by means of the Inventory of Complicated Grief (ICG), for BI using the Retrospective Self-Report of Inhibition (RSRI), and for symptoms of SA during adulthood using the Adult Separation Anxiety Scale (ASA-27). All patients were genotyped for OXTR rs2254298. RESULTS OXTR genotype interacted with BI and, on a trend-level, with adult SA, to increase CG. Specifically, higher levels on the RSRI and ASA-27 scales, respectively, were related to higher ICG scores in GG genotype carriers. CONCLUSIONS The present study for the first time suggests a gene-environment interaction effect of an OXTR gene variant with BI and possibly also symptoms of adult SA in the moderation of vulnerability for CG.
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Affiliation(s)
- Miriam A Schiele
- a Department of Psychiatry and Psychotherapy, Medical Center -- University of Freiburg, Faculty of Medicine , University of Freiburg , Freiburg , Germany.,b Department of Clinical and Experimental Medicine, Section of Psychiatry , University of Pisa , Pisa , Italy
| | - Barbara Costa
- c Department of Pharmacy , University of Pisa , Pisa , Italy
| | - Marianna Abelli
- b Department of Clinical and Experimental Medicine, Section of Psychiatry , University of Pisa , Pisa , Italy
| | - Claudia Martini
- c Department of Pharmacy , University of Pisa , Pisa , Italy
| | - David S Baldwin
- d Clinical and Experimental Sciences , University of Southampton Faculty of Medicine , Southampton , UK.,e University Department of Psychiatry , University of Cape Town , Cape Town , South Africa
| | - Katharina Domschke
- a Department of Psychiatry and Psychotherapy, Medical Center -- University of Freiburg, Faculty of Medicine , University of Freiburg , Freiburg , Germany
| | - Stefano Pini
- b Department of Clinical and Experimental Medicine, Section of Psychiatry , University of Pisa , Pisa , Italy
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18
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Treml J, Kersting A. [Prolonged grief disorder]. DER NERVENARZT 2018; 89:1069-1078. [PMID: 30116835 DOI: 10.1007/s00115-018-0577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Grief is a natural response to the loss of a loved one and its intensity usually lessens over time. Approximately 10% of bereaved persons, however, experience persistent symptoms resulting in the development of a prolonged grief disorder (PGD). A PGD shows a distinct symptom cluster and is considered for inclusion as a diagnosis in the upcoming revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). It is distinct from other mental disorders but symptoms overlap, especially with major depression and posttraumatic stress disorder. In addition to diagnostic criteria and differential diagnosis, the following article also describes prevalence rates, comorbidities, risk factors as well as treatment options for PGD.
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Affiliation(s)
- J Treml
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
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19
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Simon NM, O'Day EB, Hellberg SN, Hoeppner SS, Charney ME, Robinaugh DJ, Bui E, Goetter EM, Baker AW, Rogers AH, Nadal-Vicens M, Venners MR, Kim HM, Rauch SAM. The loss of a fellow service member: Complicated grief in post-9/11 service members and veterans with combat-related posttraumatic stress disorder. J Neurosci Res 2018; 96:5-15. [PMID: 28609578 DOI: 10.1002/jnr.24094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/01/2017] [Accepted: 05/09/2017] [Indexed: 11/10/2022]
Abstract
Bereavement is a potent and highly prevalent stressor among service members and veterans. However, the psychological consequences of bereavement, including complicated grief (CG), have been minimally examined. Loss was assessed in 204 post-9/11, when service members and veterans with combat-related posttraumatic stress disorder (PTSD) took part in a multicenter treatment study. Those who reported the loss of an important person completed the inventory of complicated grief (ICG; n = 160). Over three quarters (79.41%) of the sample reported an important lifetime loss, with close to half (47.06%) reporting the loss of a fellow service member (FSM). The prevalence of CG was 24.75% overall, and nearly one third (31.25%) among the bereaved. CG was more prevalent among veterans who lost a fellow service member (FSM) (41.05%, n = 39) compared to those bereaved who did not (16.92%, n = 11; OR = 3.41, 95% CI: 1.59, 7.36). CG was associated with significantly greater PTSD severity, functional impairment, trauma-related guilt, and lifetime suicide attempts. Complicated grief was prevalent and associated with adverse psychosocial outcomes in veterans and service members with combat-related PTSD. Clinicians working with this population should inquire about bereavement, including loss of a FSM, and screen for CG. Additional research examining CG in this population is needed.
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Affiliation(s)
- Naomi M Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Emily B O'Day
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Samantha N Hellberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Meredith E Charney
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Donald J Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Elizabeth M Goetter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Amanda W Baker
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Andrew H Rogers
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Mireya Nadal-Vicens
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Margaret R Venners
- VA Ann Arbor Healthcare System, 2215 Fuller Road 116c, Ann Arbor, MI, 48105, USA
- University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, MI, 48109
| | - Hyungjin M Kim
- VA Ann Arbor Healthcare System, 2215 Fuller Road 116c, Ann Arbor, MI, 48105, USA
| | - Sheila A M Rauch
- VA Ann Arbor Healthcare System, 2215 Fuller Road 116c, Ann Arbor, MI, 48105, USA
- University of Michigan, Department of Psychiatry, 4250 Plymouth Rd., Ann Arbor, MI, 48109
- Emory University, School of Medicine, 12 Executive Park, 3rd Floor, Atlanta, GA, 30329, USA
- Atlanta VA Medical Center, 1670 Clairmont Road 116c, Atlanta, GA, 30033, USA
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20
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Taymur İ, Özdel K, Aypak C, Duyan V, Türedi Ö, Güngör BB, Selvi Y. Evaluation of the Relationship between Major Depressive Disorder and Bereavement Symptoms in Elderly Patients Who Present Either to Psychiatry or Family Medicine. Noro Psikiyatr Ars 2017; 53:108-114. [PMID: 28360781 DOI: 10.5152/npa.2015.10095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/21/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We aimed to determine the level of bereavement and depression symptoms among elderly patients who experience the loss of a significant other and the relationship between depressive symptoms and bereavement symptoms. METHODS The study sample consisted of elderly adults who lost a significant other at least 6 months prior to the submission time. Participants were recruited from patients who presented to either the psychiatry or family medicine outpatient unit of a Training and Research Hospital. Cognitive functions were assessed using Standardized Mini Mental Examinations for Educated and Uneducated People (SMME/SMME-U). Participants were excluded from the study if their SMME or SMME-U scores were lower than 23 points. To assess the severity of depressive and bereavement symptoms, the Geriatric Depression Scale (GDS) and Core Bereavement Items (CBI) scales were used, respectively. RESULTS Overall, 33 out of 67 individuals (49.2%) who presented to the psychiatry unit and 7 out of the 43 individuals (16.3%) who presented to the family medicine unit were diagnosed with major depressive disorder (MDD). CBI scale score means were higher in the MDD groups than in the non-depressive groups (p=0.012 and p=0.001, respectively). CBI scores were significantly correlated to acute (p=0.047) and chronic stress (p=0.007) in the psychiatry group and to chronic stress in the family medicine group (p=0.001). CONCLUSION Probing loss experiences and reactions to them can be important to understand depression, to evaluate its symptoms, and to help manage the relevant symptoms. Considering the significant contributions of bereavement to depressive symptom severity in elders, interventions specific to bereavement symptoms should not be ignored.
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Affiliation(s)
- İbrahim Taymur
- Clinic of Psychiatry, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Kadir Özdel
- Clinic of Psychiatry, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Cenk Aypak
- Clinic of Family Practice, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Veli Duyan
- Ankara University Scholl of Health Sciences, Social Service Specialist, Ankara, Turkey
| | - Özlem Türedi
- Clinic of Family Practice, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Buket Belkız Güngör
- Clinic of Psychiatry, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
| | - Yavuz Selvi
- Department of Psychiatry, Selçuk University School of Medicine, Konya, Turkey
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21
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Portuguese validation of the Prolonged Grief Disorder Questionnaire–Predeath (PG–12): Psychometric properties and correlates. Palliat Support Care 2017; 15:544-553. [DOI: 10.1017/s1478951516001000] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:This study aimed to contribute to the validation of the Portuguese version of the Prolonged Grief Disorder Questionnaire–Predeath (PG–12), examining its psychometric properties, including factorial, discriminant, and predictive validity. The prevalence of predeath prolonged grief disorder (PGD) and its psychosocial correlates were also analyzed.Method:The PG–12 was assessed in a sample of family caregivers (FCs) of oncological patients in palliative care. The factorial and discriminant validity of the PG–12 were evaluated by confirmatory factor analysis. The prevalence of predeath PGD was calculated and correlated with sociodemographic characteristics, perception of illness, intensity of care, coping, and caregiver burden. Prospective data were used to assess predictive validity.Results:The sample was composed of 94 FCs, mostly female (78.8%) and daughters (61.3%), with a mean age of 52.02 (SD = 12.87). The PG–12 has been shown to be reliable, to have high internal consistency, to be monofactorial in structure, and to be independent from depression, anxiety, and burden, although predeath grief influences these symptoms. In our sample, 33% met the criteria for predeath PGD. The circumstances and coping mechanisms are also correlated with predeath grief. The PG–12 has also been shown to be predictive of postdeath outcome.Significance of results:The PG–12 can be a useful screening tool for early identification of risk for maladjustment to loss among family caregivers.
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22
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Baker AW, Goetter EM, Bui E, Shah R, Charney ME, Mauro C, Shear MK, Simon NM. The Influence of Anxiety Sensitivity on a Wish to Die in Complicated Grief. J Nerv Ment Dis 2016; 204:314-6. [PMID: 27015394 PMCID: PMC4808517 DOI: 10.1097/nmd.0000000000000465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Individuals with complicated grief are at elevated risk of suicidal thoughts. Anxiety sensitivity has recently emerged as a risk factor of suicide. This study aimed to investigate a possible association between anxiety sensitivity and a wish to die in individuals with complicated grief. Participants were evaluated for participation in a treatment study and completed an ancillary questionnaire-based study. Participants were 51 bereaved adults evaluated (age: mean, 54 [SD, 13.6] years; 78% [n = 40] women). Logistic regression was used to examine the relationship between anxiety sensitivity and a wish to die. Overall, anxiety sensitivity was associated with a wish to die at the level of a medium effect size, although it did not reach statistical significance. The anxiety sensitivity social concerns subscale was significantly associated with a wish to die. These findings add to a growing literature implicating anxiety sensitivity in reporting a wish to die.
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23
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Fernández-Alcántara M, Cruz-Quintana F, Pérez-Marfil MN, Catena-Martínez A, Pérez-García M, Turnbull OH. Assessment of Emotional Experience and Emotional Recognition in Complicated Grief. Front Psychol 2016; 7:126. [PMID: 26903928 PMCID: PMC4751347 DOI: 10.3389/fpsyg.2016.00126] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/25/2016] [Indexed: 11/16/2022] Open
Abstract
There is substantial evidence of bias in the processing of emotion in people with complicated grief (CG). Previous studies have tended to assess the expression of emotion in CG, but other aspects of emotion (mainly emotion recognition, and the subjective aspects of emotion) have not been addressed, despite their importance for practicing clinicians. A quasi-experimental design with two matched groups (Complicated Grief, N = 24 and Non-Complicated Grief, N = 20) was carried out. The Facial Expression of Emotion Test (emotion recognition), a set of pictures from the International Affective Picture System (subjective experience of emotion) and the Symptom Checklist 90 Revised (psychopathology) were employed. The CG group showed lower scores on the dimension of valence for specific conditions on the IAPS, related to the subjective experience of emotion. In addition, they presented higher values of psychopathology. In contrast, statistically significant results were not found for the recognition of emotion. In conclusion, from a neuropsychological point of view, the subjective aspects of emotion and psychopathology seem central in explaining the experience of those with CG. These results are clinically significant for psychotherapists and psychoanalysts working in the field of grief and loss.
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Affiliation(s)
| | | | - M N Pérez-Marfil
- Mind, Brain and Behavior Research Center, University of Granada Granada, Spain
| | | | - Miguel Pérez-García
- Mind, Brain and Behavior Research Center, University of Granada Granada, Spain
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24
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Baker AW, Keshaviah A, Horenstein A, Goetter EM, Mauro C, Reynolds C, Zisook S, Shear MK, Simon NM. The role of avoidance in complicated grief: A detailed examination of the Grief-Related Avoidance Questionnaire (GRAQ) in a large sample of individuals with complicated grief. JOURNAL OF LOSS & TRAUMA 2016; 21:533-547. [PMID: 28649184 PMCID: PMC5482544 DOI: 10.1080/15325024.2016.1157412] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Bui E, Mauro C, Robinaugh DJ, Skritskaya NA, Wang Y, Gribbin C, Ghesquiere A, Horenstein A, Duan N, Reynolds C, Zisook S, Simon NM, Shear MK. THE STRUCTURED CLINICAL INTERVIEW FOR COMPLICATED GRIEF: RELIABILITY, VALIDITY, AND EXPLORATORY FACTOR ANALYSIS. Depress Anxiety 2015; 32:485-92. [PMID: 26061724 PMCID: PMC4565180 DOI: 10.1002/da.22385] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/21/2015] [Accepted: 05/07/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Complicated grief (CG) has been recently included in the DSM-5, under the term "persistent complex bereavement disorder," as a condition requiring further study. To our knowledge, no psychometric data on any structured clinical interview for CG (SCI-CG) is available to date. In this manuscript, we introduce the SCI-CG, a 31-item "SCID-like" clinician-administered instrument to assess the presence of CG symptoms. METHODS Participants were 281 treatment-seeking adults with CG (77.9% [n = 219] women, mean age = 52.4, standard deviation [SD] = 17.8) who were assessed with the SCI-CG and measures of depression, posttraumatic stress, anxiety, functional impairment. RESULTS The SCI-CG exhibited satisfactory internal consistency (α = .78), good test-retest reliability (interclass correlation [ICC] 0.68, 95% CI [0.60-0.75]), and excellent interrater reliability (ICC = 0.95, 95% CI [0.89-0.98]). Exploratory factor analyses revealed that a five-factor structure, explaining 50.3% of the total variance, was the best fit for the data. CONCLUSIONS The clinician-rated SCI-CG demonstrates good internal consistency, reliability, and convergent validity in treatment-seeking individuals with CG and therefore can be a useful tool to assess CG. Although diagnostic criteria for CG have yet to be adequately validated, the SCI-CG may facilitate this process. The SCI-CG can now be used as a validated instrument in research and clinical practice.
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Affiliation(s)
- Eric Bui
- Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | - Naomi M. Simon
- Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
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26
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Bui E, Horenstein A, Shah R, Skritskaya NA, Mauro C, Wang Y, Duan N, Reynolds CF, Zisook S, Shear MK, Simon NM. Grief-related panic symptoms in Complicated Grief. J Affect Disord 2015; 170:213-6. [PMID: 25254619 PMCID: PMC4252915 DOI: 10.1016/j.jad.2014.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/19/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although Complicated Grief (CG) has been associated with comorbid Panic Disorder (PD), little is known about panic attacks in CG, and whether panic symptoms may be grief-related. The present study examines the presence and impact of grief-related panic symptoms in CG. METHODS Individuals with CG (n=146, 78% women, mean (SD) age=52.4(15.0)) were assessed for CG, DSM-IV diagnoses, work and social impairment, and with the Panic Disorder Severity Scale modified to assess symptoms "related to or triggered by reminders of your loss" and anticipatory worry. RESULTS Overall, 39.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and 32.2% reported some level of anticipatory worry about grief-related panic. Of interest, 17% met DSM criteria for PD. Among those without PD, 34.7% reported at least one full or limited-symptom grief-related panic attack over the past week, and this was associated with higher CG symptom severity (t=-2.23, p<0.05), and functional impairment (t=-3.31, p<0.01). Among the full sample, controlling for CG symptom severity and current PD, the presence of at least one full or limited-symptom grief-related panic attack was independently associated with increased functional impairment (B(SE)=4.86(1.7), p<0.01). LIMITATIONS Limitations include a lack of assessment of non-grief-related panic symptoms and examination of a sample of individuals seeking treatment for CG. CONCLUSIONS Grief-related panic symptoms may be prevalent among individuals with CG and independently contribute to distress and functional impairment.
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Affiliation(s)
- Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin square, Boston, MA 02114, United States; Harvard Medical School, Boston, MA, United States.
| | - Arielle Horenstein
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin square, Boston, MA 02114, United States
| | - Riva Shah
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin square, Boston, MA 02114, United States
| | | | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Naihua Duan
- Division of Biostatistics, Department of Psychiatry, Columbia University, New York, NY, United States
| | | | - Sidney Zisook
- University of California, San Diego, CA, United States; VA San Diego Healthcare System, San Diego, CA, United States
| | - M Katherine Shear
- Columbia School of Social Work, New York, NY, United States; Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Naomi M Simon
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin square, Boston, MA 02114, United States; Harvard Medical School, Boston, MA, United States
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27
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Kristensen P, Weisaeth L, Hussain A, Heir T. Prevalence of psychiatric disorders and functional impairment after loss of a family member: a longitudinal study after the 2004 Tsunami. Depress Anxiety 2015; 32:49-56. [PMID: 24817217 DOI: 10.1002/da.22269] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/23/2014] [Accepted: 03/08/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Bereavement following disasters is a devastating experience for family members. The aim of this study was to examine the long-term mental health effects of losing a loved one in a natural disaster. METHODS Ninety-four Norwegians aged 18-80 years who lost close family members in the 2004 Southeast Asian tsunami were evaluated 2 and 6 years after the disaster. The participants were either staying in an affected area at the time of the disaster (i.e., directly exposed) or not (i.e., not directly exposed). The prevalence of psychiatric disorders was assessed by the MINI International Neuropsychiatric Interview (M.I.N.I). Prolonged grief disorder (PGD) was self-reported using the Inventory of Complicated Grief (ICG), and functional impairment was self-reported using the Work and Social Adjustment Scale (WSAS). RESULTS We did not identify a significant decrease in the prevalence of PGD, posttraumatic stress disorder (PTSD), or major depressive disorder (MDD) from 2 to 6 years. Approximately, one-third of the bereaved (36%) had a psychiatric disorder 6 years after the tsunami. The most common disorder was PGD (12%) followed by general anxiety disorder (GAD, 11%), agoraphobia (11%), and MDD (10%). The prevalence of PTSD and MDD was higher among family members who were directly exposed to the disaster compared to those who were not (21 vs. 0%, and 25 vs. 3%). PGD was associated with functional impairment independent of other disorders. CONCLUSIONS Loss of a close family member in a natural disaster can have a substantial adverse long-term effect on mental health and everyday functioning.
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Affiliation(s)
- Pål Kristensen
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), University of Oslo, Oslo, Norway; Department for Child and Adolescent Psychiatry, Telemark Hospital, Skien, Norway
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Shear MK, Wang Y, Skritskaya N, Duan N, Mauro C, Ghesquiere A. Treatment of complicated grief in elderly persons: a randomized clinical trial. JAMA Psychiatry 2014; 71:1287-95. [PMID: 25250737 PMCID: PMC5705174 DOI: 10.1001/jamapsychiatry.2014.1242] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Complicated grief (CG) is a debilitating condition, most prevalent in elderly persons. However, to our knowledge, no full-scale randomized clinical trial has studied CG in this population. OBJECTIVE To determine whether complicated grief treatment (CGT) produces greater improvement in CG and depressive symptoms than grief-focused interpersonal psychotherapy (IPT). DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial enrolling 151 individuals 50 years or older (mean [SD] age, 66.1 [8.9] years) scoring at least 30 on the Inventory of Complicated Grief (ICG). Participants were recruited from the New York metropolitan area from August 20, 2008, through January 7, 2013, and randomized to receive CGT or IPT. The main outcome was assessed at 20 weeks after baseline, with interim measures collected at 8, 12, and 16 weeks after baseline. INTERVENTIONS Sixteen sessions of CGT (n = 74) or IPT (n = 77) delivered approximately weekly. MAIN OUTCOMES AND MEASURES Rate of treatment response, defined as a rating from an independent evaluator of much or very much improved on the Improvement subscale of the Clinical Global Impression Scale. RESULTS Both treatments produced improvement in CG symptoms. Response rate for CGT (52 individuals [70.5%]) was more than twice that for IPT (24 [32.0%]) (relative risk, 2.20 [95% CI, 1.51-3.22]; P < .001), with the number needed to treat at 2.56. Secondary analyses of CG severity and CG symptom and impairment questionnaire measures confirmed that CGT conferred a significantly greater change in illness severity (22 individuals [35.2%] in the CGT group vs 41 [64.1%] in the IPT group were still at least moderately ill [P = .001]), rate of CG symptom reduction (1.05 ICG points per week for CGT vs 0.75 points per week for IPT [t633 = 3.85; P < .001]), and the rate of improvement in CG impairment (0.63 work and Social Adjustment Scale points per week with CGT and 0.39 points per week with IPT [t503 = 2.87; P = .004]). Results were not moderated by participant age. CONCLUSIONS AND RELEVANCE Complicated grief treatment produced clinically and statistically significantly greater response rates for CG symptoms than a proven efficacious treatment for depression (IPT). Results strongly support the need for physicians and other health care providers to distinguish CG from depression. Given the growing elderly population, the high prevalence of bereavement in aging individuals, and the marked physical and psychological impact of CG, clinicians need to know how to treat CG in older adults. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01244295.
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Affiliation(s)
- M. Katherine Shear
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York2Columbia School of Social Work, Columbia University, New York, New York
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Naihua Duan
- Division of Biostatistics, Department of Psychiatry, Columbia University, New York, New York
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Angela Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York
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Zisook S, Iglewicz A, Avanzino J, Maglione J, Glorioso D, Zetumer S, Seay K, Vahia I, Young I, Lebowitz B, Pies R, Reynolds C, Simon N, Shear MK. Bereavement: course, consequences, and care. Curr Psychiatry Rep 2014; 16:482. [PMID: 25135781 DOI: 10.1007/s11920-014-0482-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This paper discusses each of several potential consequences of bereavement. First, we describe ordinary grief, followed by a discussion of grief gone awry, or complicated grief (CG). Then, we cover other potential adverse outcomes of bereavement, each of which may contribute to, but are not identical with, CG: general medical comorbidity, mood disorders, post-traumatic stress disorder, anxiety, and substance use.
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Affiliation(s)
- Sidney Zisook
- Department of Psychiatry, University of California, 3350 La Jolla Village Dr, San Diego, CA, 92161-116A, USA,
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30
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Robinaugh DJ, McNally RJ, LeBlanc NJ, Pentel KZ, Schwarz NR, Shah RM, Nadal-Vicens MF, Moore CW, Marques L, Bui E, Simon NM. Anxiety sensitivity in bereaved adults with and without complicated grief. J Nerv Ment Dis 2014; 202:620-2. [PMID: 25075646 PMCID: PMC4118557 DOI: 10.1097/nmd.0000000000000171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Complicated grief (CG) is a bereavement-specific syndrome chiefly characterized by symptoms of persistent separation distress. Physiological reactivity to reminders of the loss and repeated acute pangs or waves of severe anxiety and psychological pain are prominent features of CG. Fear of this grief-related physiological arousal may contribute to CG by increasing the distress associated with grief reactions and increasing the likelihood of maladaptive coping strategies and grief-related avoidance. Here, we examined anxiety sensitivity (AS; i.e., the fear of anxiety-related sensations) in two studies of bereaved adults with and without CG. In both studies, bereaved adults with CG exhibited elevated AS relative to those without CG. In study 2, AS was positively associated with CG symptom severity among those with CG. These findings are consistent with the possibility that AS contributes to the development or maintenance of CG symptoms.
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Affiliation(s)
- Donald J. Robinaugh
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Richard J. McNally
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Nicole J. LeBlanc
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Kimberly Z. Pentel
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Noah R. Schwarz
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Riva M. Shah
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mireya F. Nadal-Vicens
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Cynthia W. Moore
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Luana Marques
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Eric Bui
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Naomi M. Simon
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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31
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Bui E, LeBlanc NJ, Morris LK, Marques L, Shear MK, Simon NM. Panic-agoraphobic spectrum symptoms in complicated grief. Psychiatry Res 2013; 209:118-20. [PMID: 23623453 PMCID: PMC3994979 DOI: 10.1016/j.psychres.2013.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 02/20/2013] [Accepted: 03/28/2013] [Indexed: 11/27/2022]
Abstract
Little is known about the presence and role of subclinical anxiety symptoms and traits in complicated grief (CG). Data from adults with CG (n=28) suggest that they experience more panic-spectrum symptoms (PSS) than bereaved controls (n=44), and that the presence of greater PSS is independently associated with poorer quality of life.
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Affiliation(s)
- Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
| | - Nicole J. LeBlanc
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Laura K. Morris
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Naomi M. Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
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