The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief

School of Social Work, Columbia University, New York, New York, United States
Comprehensive Psychiatry (Impact Factor: 2.25). 09/2007; 48(5):395-9. DOI: 10.1016/j.comppsych.2007.05.002
Source: PubMed


Complicated grief (CG), variously called pathological or traumatic grief, is a debilitating syndrome that is not currently included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) nomenclature. One issue that remains under debate is whether this condition can be clearly distinguished from other psychiatric disorders, such as major depression and posttraumatic stress disorder, with which CG frequently coexists.
Using a structured clinical interview for CG and the Structured Clinical Interview for DSM-IV, trained experienced raters conducted careful diagnostic assessments of individuals seeking treatment of bereavement-related distress. All study participants met criteria for a current CG syndrome. Liberal criteria were used to diagnose DSM-IV disorders, making no attempt to decide if symptoms could be explained by grief.
Of 206 who met the criteria for CG, 25% had no evidence of a current DSM-IV Axis I disorder. When present, psychiatric comorbidity was associated with significantly greater severity of grief; however, even after adjustment for the presence of comorbidity, severity of CG symptoms was associated with greater work and social impairment.
It is likely that our study underestimated the rate of CG without comorbidity because fewer DSM diagnoses would have been made if a judgment about grief had been taken into consideration.
Our data provide further support for the need to identify CG as a psychiatric disorder.

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Available from: Alyson Zalta, Feb 01, 2016
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    • "The present study also supported the distinctiveness of PG from depression and anxiety, not only from the result that not all PGD cases presented with depression or anxiety disorders but also confirmed by the results of CFA on all items from scales assessing PGD, depression and anxiety disorders. The comorbidity rate of PGD and depression/anxiety was found to be higher than that reported among Western samples of bereaved individuals [13,25]. Two possibilities may account for this difference. "
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    ABSTRACT: Most research on the assessment and characteristics of prolonged grief disorder (PGD) has been conducted in Western bereaved samples. Limited information about PGD in Chinese samples exists. This study aims to validate the Chinese version of the Inventory of Complicated grief (ICG), examine the distinctiveness of PGD symptoms from symptoms of bereavement-related depression and anxiety, and explore the prevalence of PGD in a Chinese sample.
    Full-text · Article · Apr 2016
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    • ")Golden and Dalgleish, 85 2010;Marques et al., 2013;Pini et al., 2012;Simon et al., 2007). The same pattern was 86 found with other emotional variables such as separation anxiety (Boelen, 2013) or 87 experiential avoidance (Boelen et al., 2010). "
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    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.
    Full-text · Article · Jan 2016 · Frontiers in Psychology
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    • "Persons experiencing CG frequently present with recurrent intrusive thoughts of the person who died, preoccupation with sorrow including ruminative thoughts, excessive bitterness, alienation from previous social relationships, difficulty accepting the death, and perceived purposelessness of life. This symptom disturbance contributes to profound social, occupational, and functional disturbance (Simon et al., 2007; Zhang, El-Jawahri, & Prigerson, 2006). The chronicity of CG and its enduring distress are associated with increased risk of cardiac disease, hypertension, cancer, depression, anxiety, and suicidality (Latham & Prigerson, 2004; Mitchell, Kim, Prigerson, & Mortimer, 2005; Prigerson et al., 1996). "
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    ABSTRACT: Caring for a person with Alzheimer's disease is challenging and often has negative health and mental health effects that, for 7-20% of caregivers, persist into bereavement in the form of complicated grief. Complicated grief is a state of prolonged and ineffective mourning. An under-recognized phenomenon in dementia care and bereavement is "sudden-on-chronic death." In these situations, the caregiver is preparing for a gradual dying process from dementia, but the care recipient dies instead from a sudden death. In this study, an application of complicated grief group therapy for bereaved dementia caregivers with complicated grief is presented, and the effect of therapy with two bereaved caregivers who experienced the sudden death of their spouses who had a diagnosis of dementia is described. The unique treatment elements of complicated grief group therapy facilitated resolution of the 'trauma-like" features of bereavement and progression to a healthy grief process.
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