title: Complicated grief and its correlates in patients with bipolar disorder.
abstract: BACKGROUND
  While the recent loss of a loved one has been identified as a risk factor for suicide in patients with bipolar disorder, and complicated grief (CG) has been associated with elevated rates of suicidality compared with loss without CG, little is known about the frequency or impact of CG in bipolar disorder. We investigated the frequency and implications of loss of loved ones in an ongoing study of bipolar disorder.
  
  
  METHODS
  We conducted a survey of 120 patients with well-characterized DSM-IV bipolar disorder participating in Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), a large naturalistic study, in order to identify frequency of loss and to examine the presence of CG and its clinical correlates. Survey data were gathered from October 2003 to March 2004.
  
  
  RESULTS
  A lifetime history of a significant loss was reported by 86% (103/120) of participants; 24.3% (25/103) of those met criteria for CG, defined as a score > or = 25 on the Inventory of Complicated Grief (ICG), with a mean +/- SD ICG score of 33.7 +/- 6.9. The presence of CG was associated with elevated rates of panic disorder and alcohol abuse comorbidity, as well as other measures of panic symptoms and phobic avoidance. CG was also associated with a higher rate of lifetime suicide attempts, greater functional impairment, and poorer social support.
  
  
  CONCLUSIONS
  Our findings suggest the presence of a substantial burden of comorbid grief-related illness and impairment in patients with bipolar disorder. Further research is needed to understand the overlap of anxiety disorders and phobic avoidance in bipolar patients with complicated grief.
authors.affiliation: Massachusetts General Hospital, Boston, MA 02114, USA. n.simon@partners.org
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Simon
authors.forename: Mark H
authors.initials: MH
authors.lastname: Pollack
authors.forename: Diana
authors.initials: D
authors.lastname: Fischmann
authors.forename: Carol A
authors.initials: CA
authors.lastname: Perlman
authors.forename: Anna C
authors.initials: AC
authors.lastname: Muriel
authors.forename: Cynthia W
authors.initials: CW
authors.lastname: Moore
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: M Katherine
authors.initials: MK
authors.lastname: Shear
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006117:Grief; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data; D010698:Phobic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012944:Social Support; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires