Informing the symptom profile of complicated grief

Authors

  • Naomi M. Simon M.D. M.Sc.,

    Corresponding author
    1. Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program, Massachusetts General Hospital, Boston, Massachusetts
    • Center for Anxiety and Traumatic Stress Disorders, One Bowdoin Square, 6th Floor, Boston, MA 02114
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  • Melanie M. Wall Ph.D.,

    1. Department of Biostatistics, Mailman School of Public Health at Columbia University, New York, New York
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  • Aparna Keshaviah Sc.M.,

    1. Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program, Massachusetts General Hospital, Boston, Massachusetts
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  • M. Taylor Dryman B.A.,

    1. Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program, Massachusetts General Hospital, Boston, Massachusetts
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  • Nicole J. LeBlanc B.S.,

    1. Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program, Massachusetts General Hospital, Boston, Massachusetts
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  • M. Katherine Shear M.D.

    1. Columbia University School of Social Work and Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
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  • Conflict of interest: Naomi M. Simon: Research grants (American Foundation for Suicide Prevention, Astra Zeneca, Cephalon, Highland Street Foundation, Forest Laboratories, NARSAD, NIMH, Glaxo SmithKline, Janssen, Lilly, Pfizer, Sepracor, UCB-Pharma), payment for manuscript preparation (Astra Zeneca), payment for the development of educational presentations (Pfizer), Melanie M. Wall: None; Aparna Keshaviah: None; M. Taylor Dryman: None; Nicole J. LeBlanc: None; M. Katherine Shear: Research grants (NIH), support for travel (NIH), and payment for the development of educational materials (ADEC webinar, the University of Manitoba, Winnipeg, & the University of Memphis).

Abstract

Background: Complicated Grief (CG) is under consideration as a new diagnosis in DSM5. We sought to add empirical support to the current dialogue by examining the commonly used Inventory of Complicated Grief (ICG) scale completed by 782 bereaved individuals. Methods: We employed IRT analyses, factor analyses, and sensitivity and specificity analyses utilizing our full sample (n = 782), and also compared confirmed CG cases (n = 288) to noncases (n = 377). Confirmed CG cases were defined as individuals bereaved at least 6 months who were seeking care for CG, had an ICG≥30, and received a structured clinical interview for CG by a certified clinician confirming CG as their primary illness. Noncases were bereaved individuals who did not present with CG as a primary complaint (including those with depression, bipolar disorder, anxiety disorders, and controls) and had an ICG<25. Results: IRT analyses provided guidance about the most informative individual items and their association with CG severity. Factor analyses demonstrated a single factor solution when the full sample was considered, but within CG cases, six symptom clusters emerged: (1) yearning and preoccupation with the deceased, (2) anger and bitterness, (3) shock and disbelief, (4) estrangement from others, (5) hallucinations of the deceased, and (6) behavior change, including avoidance and proximity seeking. The presence of at least one symptom from three different symptom clusters optimized sensitivity (94.8%) and specificity (98.1%). Conclusions: These data, derived from a diverse and predominantly clinical help seeking population, add an important perspective to existing suggestions for DSM5 criteria for CG. Depression and Anxiety, 2011.  © 2010 Wiley-Liss, Inc.

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