Comlicated Grief, Depression, and Anxiety as Distinct Postloss Syndromes: A Confirmatory Factor Analysis Study

Department of Clinical Psychology, Utrecht University, P.O. Box 80140, 3508 TC Utrecht, the Netherlands.
American Journal of Psychiatry (Impact Factor: 12.3). 12/2005; 162(11):2175-7. DOI: 10.1176/appi.ajp.162.11.2175
Source: PubMed

ABSTRACT The authors used confirmatory factor analysis to replicate earlier findings that complicated grief, depression, and anxiety are distinct syndromes.
Data were derived from 1,321 bereaved individuals. Complicated grief was measured with the Inventory of Traumatic Grief. Depression and anxiety were measured with the SCL-90.
A model in which symptoms of complicated grief, depression, and anxiety loaded on separate factors was superior to a one-factor model, revealed good model fit, and was invariant across subgroups.
Previous findings of a distinction among complicated grief, depression, and anxiety were confirmed.

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    • "A number of studies published in the last years showed that prolonged grief can be differentiated from depression and PTSD (Boelen & Van den Bout, 2005; Boelen, Van den Hout, & Van den Bout, 2008). Differences between CGD and PTSD can be summarized as follows: (1) While yearning symptoms are the hallmark symptom group for CGD, intrusive symptoms are the core symptom group for PTSD. "
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    ABSTRACT: Following the death of a loved one, a small group of grievers develop an abnormal grieving style, termed complicated or prolonged grief. In the effort to establish complicated grief as a disorder in DSM and ICD, several attempts have been made over the past two decades to establish symptom criteria for this form of grieving. Complicated grief is different from depression and PTSD yet often comorbid with other psychological disorders. Meta-analyses of grief interventions show small to medium effect sizes, with only few studies yielding large effect sizes. In this article, an integrative cognitive behavioral treatment manual for complicated grief disorder (CG-CBT) of 25 individual sessions is described. Three treatment phases, each entailing several treatment strategies, allow patients to stabilize, explore, and confront the most painful aspects of the loss, and finally to integrate and transform their grief. Core aspects are cognitive restructuring and confrontation. Special attention is given to practical exercises. This article includes the case report of a woman whose daughter committed suicide.
    European Journal of Psychotraumatology 11/2011; 2. DOI:10.3402/ejpt.v2i0.7995 · 2.40 Impact Factor
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    • "Most studies examined differences in grief reactions within a relatively short period after the loss and found that time since the loss did not significantly impact the severity of prolonged grief symptoms or PGD diagnosis [9,12,16,17]. The focus on a sample of bereaved widows and orphans who considerably ranged in length of time since the death enabled the evaluation of the predictive power across a considerable period of time. "
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    ABSTRACT: The concept of Prolonged Grief Disorder (PGD) has been defined in recent years by Prigerson and co-workers, who have developed and empirically tested consensus and diagnostic criteria for PGD. Using these most recent criteria defining PGD, the aim of this study was to determine rates of and risks for PGD in survivors of the 1994 Rwandan genocide who had lost a parent and/or the husband before, during or after the 1994 events. The PG-13 was administered to 206 orphans or half orphans and to 194 widows. A regression analysis was carried out to examine risk factors of PGD. 8.0% (n = 32) of the sample met criteria for PGD with an average of 12 years post-loss. All but one person had faced multiple losses and the majority indicated that their grief-related loss was due to violent death (70%). Grief was predicted mainly by time since the loss, by the violent nature of the loss, the severity of symptoms of posttraumatic stress disorder (PTSD) and the importance given to religious/spiritual beliefs. By contrast, gender, age at the time of bereavement, bereavement status (widow versus orphan), the number of different types of losses reported and participation in the funeral ceremony did not impact the severity of prolonged grief reactions. A significant portion of the interviewed sample continues to experience grief over interpersonal losses and unresolved grief may endure over time if not addressed by clinical intervention. Severity of grief reactions may be associated with a set of distinct risk factors. Subjects who lose someone through violent death seem to be at special risk as they have to deal with the loss experience as such and the traumatic aspects of the loss. Symptoms of PTSD may hinder the completion of the mourning process. Religious beliefs may facilitate the mourning process and help to find meaning in the loss. These aspects need to be considered in the treatment of PGD.
    BMC Psychiatry 07/2010; 10(1):55. DOI:10.1186/1471-244X-10-55 · 2.21 Impact Factor
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    • "Several studies have already found women are more likely than men to discuss ongoing grief [36]. "
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    ABSTRACT: This study examines the prevalence and nature of bereavement help-seeking among the population who experienced an "expected" death in the five years before their survey response. Such whole population data are not limited by identification through previous access to specific services nor practitioners. In a randomised, cross-sectional, state-wide population-based survey, 6034 people over two years completed face-to-face interviews in South Australia by trained interviewers using piloted questions (74.2% participation rate). Respondent demographics, type of grief help sought, and circumstantial characteristics were collected. Uni- and multi-variate logistic regression models were created. One in three people (1965/6034) had experienced an 'expected' death of someone close to them in the last five years. Thirteen per cent sought help for their grief from one or more: friend/family members (10.7%); grief counselors (2.2%); spiritual advisers (1.9%); nurses/doctors (1.5%). Twenty five respondents (1.3%) had not sought, but would have valued help with their grief.In multi-variate regression modeling, those who sought professional help (3.4% of the bereaved) had provided more intense care (OR 5.39; CI 1.94 to14.98; p < 0.001), identified that they were less able to 'move on' with their lives (OR 7.08; CI 2.49 to 20.13; p = 0.001) and were more likely not to be in full- or part-time work (OR 3.75; CI 2.31 - 11.82; p = 0.024; Nagelkerke's R2 = 0.33). These data provide a whole-of-population baseline of bereavement help-seeking. The uniquely identified group who wished they had sought help is one where potentially significant health gains could be made as we seek to understand better any improved health outcomes as a result of involving bereavement services.
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