Factors of complicated grief pre-death in caregivers of cancer patients.
OBJECTIVE
Over the past decade, Prigerson and her colleagues have shown that symptoms of 'complicated grief'-intense yearning, difficulty accepting the death, excessive bitterness, numbness, emptiness, and feeling uneasy moving on and that the future is bleak-are distinct from depression and anxiety and are independently associated with substantial morbidity. Little is known about complicated grief experienced by family caregivers prior to the death. This study sought to examine differences in caregiver age groups and potential risk factors for complicated grief pre-death.


METHODS
Two hundred and forty eight caregivers from multiple sites nationwide (20-86 years of age) identified themselves as primary caregivers to a terminally ill cancer patient. Each caregiver was interviewed using the following measures: the Pre-Death Inventory of Complicated Grief-Caregiver Version; the Brief Interpersonal Support Evaluation List; the Structured Clinical Interview for the DSM-IV Axis I; the Life Orientation Test-Revised; the SEPRATE Measure of Stressful Life Events; the Covinsky Family Impact Survey; and mental health access questions.


RESULTS
The study found that those under 60 years old had higher levels of complicated grief pre-death than caregivers 60 and older (t(246) = 2.30, p < 0.05). Significant correlations were also found between levels of complicated grief pre-loss and the following psychosocial factors: perceived social support (r = -0.415, p < 0.001); history of depression (r = -0.169, p < 0.05); current depression (r = -0.158, p < 0.05); current annual income (Spearman rho = -0.210, p < 0.01); annual income at time of patient's diagnosis (Spearman rho = -0.155, p = 0.05); pessimistic thinking (r = 0.320, p < 0.001); and number of moderate to severe stressful life events (Spearman rho = 0.218, p = 0.001). In a multi-variate analysis (R(2) = 0.368), pessimistic thinking (Beta = 0.208, p < 0.05) and severity of stressful life events (Beta = 0.222, p < 0.05) remained as important factors to developing complicated grief pre-death.


CONCLUSIONS
These results suggest that mental health professionals who work with caregivers should pay particular attention to pessimistic thinking and stressful life events, beyond the stress of the loved one's illness, that caretakers experience. Additionally, although not reaching significance, mental health professionals should also consider younger caregivers at greater risk for complicated grief pre-loss.
Tomarken
Alexis
A
Memorial Sloan-Kettering Cancer Center, USA. tomarkea@mskcc.org
Holland
Jimmie
J
Schachter
Sherry
S
Vanderwerker
Lauren
L
Zuckerman
Enid
E
Nelson
Christian
C
Coups
Elliot
E
Ramirez
Paul Michael
PM
Prigerson
Holly
H
D000328:Adult; D000339:Affect; D000368:Aged; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology*; D019260:Expressed Emotion; D005163:Factor Analysis, Statistical; D005260:Female; D006117:Grief; D006801:Humans; D007398:Interpersonal Relations; D008016:Life Change Events; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms; D012944:Social Support; D011795:Surveys and Questionnaires