Complicated grief in patients with unipolar depression.

Department of Psychiatry, University of Muenster, Germany.
Journal of affective disorders (Impact Factor: 3.76). 04/2009; 118(1-3):201-4. DOI: 10.1016/j.jad.2009.01.033
Source: PubMed

ABSTRACT The loss of a close family member (e.g. child or spouse) has been shown to be one of the most stressful life-events increasing the risk of affective disorders. In the present study, we investigated for the first time the frequency of complicated grief in psychiatric inpatients with unipolar depression. Further, the study was aimed to identify characteristics predicting a complicated grief reaction in depressed patients.
In a sample of 73 DSM-IV diagnosed unipolar affective disordered inpatients grief, depression, anxiety and psychological stress reaction were assessed.
A high prevalence of loss and impairing complicated grief was found in this sample of unipolar depressed patients. Depressed patients with complicated grief were more severely depressed than depressed patients without complicated grief reactions. Higher traumatic stress and close family membership of the lost person were associated with higher severity of grief.
Comorbid complicated grief appears to contribute to greater severity and poorer functioning in unipolar depressed patients and should be specifically addressed in psychotherapeutic treatment.

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    ABSTRACT: BACKGROUND: During the Khmer Rouge (KR) regime from 1975 to 1979 millions of Cambodians were confronted with the death or murder of family members. The long-term psychological consequences of these traumatic losses have not yet been investigated. The purpose of this study was to determine the rate and potential predictors of prolonged grief disorder (PGD) in survivors of the KR regime. METHOD: The Inventory of Complicated Grief-Revised (ICG-R) was administered in a sample of N=775 Cambodians in face-to-face interviews who had lost at least one family member during the KR regime. Symptoms of PTSD were assessed with the PTSD Checklist-Civilian Version and symptoms of depression and anxiety with the Hopkins Symptom Checklist-25. RESULTS: The prevalence of PGD in the sample was 14.3%. PGD was moderately associated with symptoms of depression, anxiety and PTSD. The loss of a spouse, a child, or a parent was associated with higher symptom severity of PGD than was the loss of a sibling or distant relatives. PGD was predicted by the relationship to the deceased and symptoms of depression and PTSD. LIMITATIONS: Limitations of the study include the non-random sampling recruitment. The ICG-R has not been validated for use in Cambodia. CONCLUSIONS: The vast majority of Cambodians lost family members during the KR regime. Even three decades later, PGD was prevalent in a substantial proportion of the present sample and related to other psychiatric disorders. The results underline the importance of examining PGD in studies of war-related psychological impairment.
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    ABSTRACT: BACKGROUND: Previous research has identified high rates of comorbid anxiety disorders among individuals presenting with primary CG. In the present study, we examined the prevalence of comorbid CG in bereaved primary anxiety disorder (AD) patients compared to bereaved healthy controls. We also examined the impairment associated with comorbid CG in AD. METHODS: Participants were 242 bereaved adults (mean (SD) age = 41.5 (13.1), 44.2% women) with a primary AD diagnosis, including generalized anxiety disorder (GAD; n = 57), panic disorder (PD; n = 49), posttraumatic stress disorder (PTSD; n = 29), and generalized social anxiety disorder (GSAD; n = 107), as well as 155 bereaved healthy controls with no current DSM-IV Axis I diagnosis (mean (SD) age = 43.0 (13.6), 51.0% women). CG symptoms were measured using the 19-item inventory of complicated grief (ICG), with threshold CG defined as an ICG score of ≥30. Quality of life and functional impairment were assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Range of Impaired Functioning Tool (LIFE-RIFT), respectively. RESULTS: Participants with primary ADs had significantly higher rates of threshold CG symptoms than bereaved controls (12.0% vs. 0.65%; Fisher's Exact P < 0.001). Rates of threshold CG were significantly elevated for each AD when compared to bereaved controls. After adjustment for age, sex, education, and comorbid major depressive disorder, threshold CG was associated with lower quality of life (β = -0.140, P = 0.023) and greater impairment (β = 0.141, P = 0.035) among individuals with AD. CONCLUSIONS: Our findings suggest that threshold CG is of clinical relevance in bereaved individuals with a primary anxiety disorder. Screening for CG in patients with ADs may be warranted.
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