Person:

Robinaugh, Donald

Complicated grief (CG) is a bereavement-specific syndrome chiefly characterized by symptoms of persistent separation distress. Physiological reactivity to reminders of the loss and repeated acute pangs or waves of severe anxiety and psychological pain are prominent features of CG. Fear of this grief-related physiological arousal may contribute to CG by increasing the distress associated with grief reactions and increasing the likelihood of maladaptive coping strategies and grief-related avoidance. Here, we examined anxiety sensitivity (AS; i.e., the fear of anxiety-related sensations) in two studies of bereaved adults with and without CG. In both studies, bereaved adults with CG exhibited elevated AS relative to those without CG. In study 2, AS was positively associated with CG symptom severity among those with CG. These findings are consistent with the possibility that AS contributes to the development or maintenance of CG symptoms.

Objective: Posttraumatic stress disorder and Prolonged Grief Disorder (PGD) arise following major life stressors, and may share some overlapping symptomatology. This study aimed to examine the presence and response to treatment of post-traumatic stress symptoms (PTSS) in bereaved adults with a primary diagnosis of PGD. Methods: A randomized controlled trial of 395 adults with PGD (defined as >30 on the Inventory of Complicated Grief plus confirmation on structured clinical interview) randomized participants to complicated grief treatment (CGT) with citalopram, CGT plus placebo, citalopram, or placebo between March 2010 and September 2014. We examined the presence of PTSS (Davidson Trauma Scale) at baseline and change in PTSS with treatment using longitudinal mixed effects regression, and examined the role of violent compared to non-violent deaths (loss type). Results: High levels of PTSS were present at baseline, regardless of loss type, and were associated with increased functional impairment (p<0.01). CGT with placebo demonstrated efficacy for PTSS compared to placebo in both threshold (OR=2.71, 95%CI [1.13-2.17], p=0.026) and continuous (p<0.001; effect size d=0.47) analyses, and analyses were suggestive of a greater effect for CGT plus citalopram compared to citalopram alone (threshold analysis OR=2.84, 95%CI [1.20-6.70], p=0.017; continuous p=0.053; d=0.25). In contrast, citalopram did not differ from placebo and CGT plus citalopram did not differ from CGT plus placebo. Conclusion: Bereavement-related PTSS are common in bereaved adults with PGD in the context of both violent and non-violent death, and are associated with poorer functioning. CGT shows efficacy for PTSS, while the antidepressant citalopram does not.