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Am J Psychiatry 1995; 152:22-30
Copyright © 1995 by American Psychiatric Association
Complicated grief and bereavement-related depression as distinct disorders: preliminary empirical validation in elderly bereaved spouses
HG Prigerson, E Frank, SV Kasl, CF Reynolds 3rd, B Anderson, GS Zubenko, PR Houck, CJ George and DJ Kupfer
Department of Psychiatry, University of Pittsburgh School of Medicine, PA.
OBJECTIVE: This study sought to determine whether a set of symptoms
interpreted as complicated grief could be identified and distinguished from
bereavement-related depression and whether the presence of complicated
grief would predict enduring functional impairments. METHOD: Data were
derived from a study group of 82 recently widowed elderly individuals
recruited for an investigation of physiological changes in bereaved
persons. Baseline data were collected 3-6 months after the deaths of the
subjects' spouses, and follow-up data were collected from 56 of the
subjects 18 months after the baseline assessments. Candidate items for
assessing complicated grief came from a variety of scales used to evaluate
emotional functioning (e.g., the Hamilton Depression Rating Scale, the
Brief Symptom Inventory). The outcome variables measured were global
functioning, medical illness burden, sleep, mood, self-esteem, and anxiety.
RESULTS: A principal- components analysis conducted on intake data (N = 82)
revealed a complicated grief factor and a bereavement-depression factor.
Seven symptoms constituted complicated grief: searching, yearning,
preoccupation with thoughts of the deceased, crying, disbelief regarding
the death, feeling stunned by the death, and lack of acceptance of the
death. Baseline complicated grief scores were significantly associated with
impairments in global functioning, mood, sleep, and self-esteem in the 56
subjects available for follow-up. CONCLUSIONS: The symptoms of complicated
grief may be distinct from depressive symptoms and appear to be associated
with enduring functional impairments. The symptoms of complicated grief,
therefore, appear to define a unique disorder deserving of specialized
treatment.
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