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Author(s): Nancy Kentish-Barnes [sup.1], Holly G. Prigerson [sup.2] [sup.3] Author Affiliations: (1) grid.413328.f, 0000000123006614, Medical Intensive Care Unit, Famirea Research Group, Saint Louis Hospital, , 1 avenue Claude Vellefaux, 75010, [...]

Background: This study aimed at examining diagnostic concordance between Prolonged Grief Disorder (PGD), Major Depressive Disorder (MDD), and Posttraumatic Stress Disorder (PTSD) among bereaved war survivors who had lost relatives due to war-related violence. Method: We investigated the rates of PGD and its association with PTSD and MDD among 60 bereaved people who had lost first-degree relatives due to war-related violence seven years ago and had also experienced other war-related events. Results: The results indicated that 38.3% of the sample fulfilled the criteria for PGD, 55.0% for PTSD, and 38.3% for MDD. Thirty per cent of the participants without PTSD and 21.6% of those without MDD met criteria for PGD. Women were more likely to have PGD than men. The immediate threat to life was significantly associated with an elevated risk for PTSD and MDD, but not PGD. Conclusion: The findings suggest that many cases of PGD would be missed by an

Several studies have shown that the symptoms of grief are different from symptoms of depression among bereaved family members. This study is an attempt to replicate this finding among advanced cancer patients and examine clinical correlates of patient grief and depression. Analyses were conducted on data from interviews with 123 advanced cancer patients. Grief was measured using symptoms from the patient version of the Inventory of Complicated Grief-Revised (ICG-R) and symptoms of depression were assessed using the Structured Clinical Interview for DSM-IV (SCID). A factor analysis revealed that symptoms of patient grief formed a coherent factor that was distinct from a depression factor. Patient grief 'caseness' (defined as being in the top 10/0 of the distribution of grief scores), but not major depressive disorder, was uniquely associated with the wish to die (odds ratio [OR] 10. 13 [0.1.08-05.06]). Both depression and grief were significantly associated with mental health service use (OR 16.07 [1.68, 153.77] vs. 4.82; CI= [1.00, 21.41]) and negative religious coping (OR 1.36 [1.06, 1.73] vs. 1.25 [1.05, 1.49]); neither was associated with terminal illness acknowledgement. DOI: 10.1080/07481180903559303

A study was conducted to investigate the clinical course of residents with advanced dementia in a nursing home. Results indicated that those with dementia suffered from frequent complications like pneumonia, febrile episodes and eating problems, which tended to result in high mortality rates within 6 months.

Severe grief symptoms, treatment receptivity, attitudes about grief, and stigmatization concerns were assessed in a community-based sample of 135 widowed participants in the Yale Bereavement Study. There was a statistically significant association between the severity of grief symptoms and reported negative reactions from friends and family members. However, more than 90% of the respondents with complicated grief, a severe grief disorder, reported that they would be relieved to know that having such a diagnosis was indicative of a recognizable psychiatric condition, and 100% reported that they would be interested in receiving treatment for their severe grief symptoms.

The study examines the association between religious coping and the use of intensive life-prolonging care at end of life in patients with advanced cancer. Evidence reveals an association between positive religious coping in patients with advanced cancer and the receipt of intensive life-prolonging medical care near death.

A study was conducted to evaluate whether end-of-life discussions with physicians were associated with fewer aggressive interventions. Results indicated that end-of-life discussions were helpful and were associated with less aggressive medical care near death and earlier referral to hospitals.

Data from a community-based multi-wave investigation were used to examine a developmental model of risk for depression and suicidality following the death of a spouse. Measures of perceived parental affection and control during childhood were administered to 218 widowed adults 11 months after the death of the spouse. Self-esteem, spousal dependency, depression, and suicidality were assessed 9 months later. Dependency on the deceased spouse mediated a significant association between retrospectively reported parental control during childhood and post-loss depressive symptoms. Depressive symptoms mediated significant associations of dependency on the deceased spouse and low self-esteem with suicidal ideation and behavior.

A longitudinal cohort study is used to examine the relative magnitudes and patterns of change over time post-loss of 5 grief indicators for consistency with the stage theory of grief. The identification of the normal stages of grief following a death from natural causes has helped in understanding how the average person cognitively and emotionally processes the loss of a family member.

The purpose of this article is to describe the evaluations involved in the Yale Bereavement Study (YBS), a three-year NIMH and NCI-funded longitudinal study conducted from January 2000 through May 2003. The quantitative and qualitative questions included in the YBS gave the respondents an opportunity to describe their most recent loss, rate and review their past losses, and assess all aspects of their current life situations. In this article, the first author describes, in a qualitative manner, the ways in which this assessment, per se, appeared helpful and not harmful to the respondents. Also, developed here is the implication for potential application of a modified version of the YBS which could be used in both research and clinical practice.

Risk factors for suicidal ideation and attempts have been shown to differ between African Americans and Whites across the lifespan. In the present study, risk factors for suicidality were examined separately by race/ethnicity in a populafion of 131 older adult patients considered vulnerable to suicide due to substance abuse and/or medical frailty. In adjusted analyses, social support was significantly associated with suicidality in African American patients, while younger age and the presence of an anxiety disorder were significantly associated with suicidality in White patients. The results suggest that race/ethnicity-specific risk profiles may improve the detection of suicidality in vulnerable populations.

The empirical testing of diagnostic criteria for Complicated Grief (CG) by autonomous investigators is a welcome development. Cross-validation studies are essential to an impartial evaluation of diagnostic criteria for CG proposed for inclusion in the DSM-V. Nevertheless, the review of evidence to confirm or disconfirm the diagnostic validity of the proposed CG criteria requires a fair, unbiased, and relevant examination of the data. It is our view that Hogan, Worden, and Schmidt's (2003-2004) 'An Empirical Study of the Complicated Grief Disorder Criteria' (see Table 1) fails to meet these standards. Hogan et al. test for the independence between: a) separation distress and traumatic distress symptoms, b) CG and depressive symptoms, c) CG symptoms and presumably 'normal' symptoms of grief. Testing for the independence of these constructs is a red herring. Issues central to the validity and reliability of a CG diagnosis should focus on the ability of the symptoms to identify the small number of bereaved persons with enduring and acutely distressing grief that is associated with significant dysfunction. Despite asking the wrong questions, the basic results remain consistent with claims that we have made all along (e.g., that CG symptoms are unidimensional; that more than half the variance in CG symptoms cannot be explained by depressive symptoms; that CG symptoms distinguish themselves from normal grief symptoms with respect to their intensity and chronicity and the prediction of morbidity). There is little doubt of the need for more empirical work to evaluate the reliability, validity, sensitivity, specificity, and diagnostic efficiency of criteria proposed for CG. It is our hope that the call will be heard by investigators who will test issues relevant to the creation of a sound CG diagnosis.

While the prevalence of complicated grief has been demonstrated to be elevated in survivors of suicide, the association between complicated grief and suicidal ideation among adult suvivors of suicide has not been explored. The purpose of the present study is to examine the association between complicated grief and suicidal ideation in suicide survivors. The Inventory of Complicated Grief and the Beck Depression Inventory were administered to 60 adult survivors within I month of a death by suicide of a family member or significant other. Complicated grief was associated with a 9.68 (CI: 1.036, 90.417) times greater likelihood of suicidal ideation after controlling for depression, suggesting that syndromal complicated grief heightens vulnerability to suicidal ideation. Clinicians may provide more comprehensive assessments by recognizing the possibility of suicidal ideation in those with complicated grief.

The influence of complicated grief (CG) on suicidality among bereaved adults was examined. The Yale Evaluation of Suicidality scale and the Inventory of Complicated Grief-Revised were administered to 309 bereaved adults in face-to-face interviews conducted at baseline (6.2 months post-loss) and at follow-up (10.8 months post-loss). Cross-sectionally, CG was associated with a 6.58 (95% CI: 1.74-18.0) times greater likelihood of 'high suicidality' at baseline, and an 11.30 (95% CI: 3.33-38.10) times greater risk of high suicidality at follow-up, after controlling for gender, race, major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and social support. Longitudinally, CG at baseline was associated with an 8.21 (95% CI: 2.49-27.0) times greater likelihood of high suicidality at follow-up, controlling for the above confounders. The study results indicate that CG substantially heightened the risk of suicidality after controlling for important confounders such as MDD and PTSD, suggesting that CG poses an independent psychiatric risk for suicidal thoughts and actions.

Many topics in aging research address questions about group differences in prediction. Such questions can be viewed in terms of interaction or moderator effects, and use of appropriate methods to test these hypotheses are necessary to arrive at accurate conclusions about age differences. This article discusses the conceptual, methodological, and statistical problems in one approach to investigating moderator hypotheses. The subgroup regression approach, in which separate regression analyses are conducted in two or more groups, is widely used in aging research to examine group differences in prediction, but the approach can lead to erroneous conclusions. The moderated regression approach, involving the test of a product term, is described and recommended as an a alternative approach. The question of whether social support has greater beneficial effects for younger or older adults is investigated in a study of 287 recently-bereaved adults ranging in age from 20 to 91. Using the subgroup approach, findings indicated that social support significantly predicted depressive symptoms among younger adults. The moderated regression analysis, however, indicated no significant age differences in the effect of social support. These results clearly illustrate that the analysis strategy researchers choose may have important bearing on theory in aging research such as conclusions regarding the role of social support across the life span.

Viewed in an expanded frame, the phenomena of grief and bereavement call for analysis in sociological psychological, and psychiatric terms. In this article, the authors argue that a common theme in these accounts is that of the meaning of loss as expressed in both individual and collective attempts at adaptation. At a societal level, communal rituals, discursive practices, and local cultures provide resources for integrating the significance of loss for survivors and regulating the emotional chaos of bereavement. At an individual and interpersonal level, survivors struggle to assimilate the loss into their existing self-narratives, which are sometimes profoundly challenged by traumatic bereavement. Complicated grief can therefore be viewed as the inability to reconstruct a meaningful personal reality, an outcome to which individuals with insecure working models of self and relationships are especially vulnerable. Nonetheless, evidence suggests that grief can prompt personal growth as well as despair, augmenting rather than only reducing the survivor's sense of meaning.

Objectives. This study determined the percentage of adverse outcomes in US men attributable to combat exposure. Methods. Standardized psychiatric interviews (modified Diagnostic Interview Schedule and Composite International Diagnostic Interview assessments) were administered to a representative national sample of 2583 men aged 18 to 54 in the National Comorbidity Survey part II subsample. Results. Adjusted attributable fraction estimates indicated that the following were significantly attributable to combat exposure: 27.8% of 12-month posttraumatic stress disorder, 7.4% of 12-month major depressive disorder, 8% of 12-month substance abuse disorder, 11.7% of 12-month job loss, 8.9% of current unemployment, 7.8% of current divorce or separation, and 21% of current spouse or partner abuse. Conclusions. Combat exposure results in substantial morbidity lasting decades and accounts for significant and multifarious forms of dysfunction at the national level.

This study examined effects of widowhood and marital harmony on health, health service use, and health care costs. The Americans Changing Lives data set contains 694 subjects who remained married and 61 subjects who became widowed between 1986 and 1989. Estimated annual mean 1989 health costs, adjusting for 1986 costs, age, sex, socioeconomic status, mental/physical health, 1989 health insurance, and selection biases are: $2,384 for widowed, $1,498 for married subjects. Adjusted annual 1989 estimates are: $2,766 for those widowed after harmonious marriages; $2,100 for those widowed after discordant marriages; $1,790 for spouses in discordant marriages; $1,228 for spouses in harmonious marriages. Harmonious marriages appear protective until widowhood, after which higher health costs result.

The symptoms of traumatic grief have been shown to be distinct from those of bereavement-related depression and anxiety among elderly widows and widowers, and bare striking resemblance to symptoms of Posttraumatic Stress Disorder (PTSD). In light of the findings demonstrating that traumatic grief is associated with a heightened risk of critical mental and physical health outcomes, it is important to understand the underlying mechanisms that may put bereaved individuals at risk of developing traumatic grief. Attachment theory offers an explanation for why loss of a stabilizing relationship might be traumatic for individuals who possess insecure or unstable attachments (e.g., excessive dependency, defensive separation, compulsive caregiving) and self-regulatory deficits (e.g., identity disturbances, difficulty with affect modulation). A model illustrating hypothesized causal linkages between childhood experiences, attachment and personality traits, dissolution of a stabilizing relationship, and traumatic symptomatology is proposed. Case histories of late-life pre- and post-loss traumatic grievers are presented and discussed in terms of their compatibility with the proposed model.

Tips for helping patients through the death of a loved one are presented. Topics include complicated and uncomplicated grief, shock, separation distress, denial, anger, guilt, depression, social support, and developing new routines and relationships. Doctors should send a letter of condolence or make some kind of follow-up call to the families of their deceased patients.

Alzheimer's disease costs American business about $61 billion each year. About half of this cost is lost productivity because caregivers must quit their jobs or cut back their work hours to care for family members who have Alzheimer's disease. Many caregivers become depressed because of the enormous burden they must carry.