The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief.
BACKGROUND
Complicated grief (CG), variously called pathological or traumatic grief, is a debilitating syndrome that is not currently included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) nomenclature. One issue that remains under debate is whether this condition can be clearly distinguished from other psychiatric disorders, such as major depression and posttraumatic stress disorder, with which CG frequently coexists.


METHODS
Using a structured clinical interview for CG and the Structured Clinical Interview for DSM-IV, trained experienced raters conducted careful diagnostic assessments of individuals seeking treatment of bereavement-related distress. All study participants met criteria for a current CG syndrome. Liberal criteria were used to diagnose DSM-IV disorders, making no attempt to decide if symptoms could be explained by grief.


RESULTS
Of 206 who met the criteria for CG, 25% had no evidence of a current DSM-IV Axis I disorder. When present, psychiatric comorbidity was associated with significantly greater severity of grief; however, even after adjustment for the presence of comorbidity, severity of CG symptoms was associated with greater work and social impairment.


CONCLUSIONS
It is likely that our study underestimated the rate of CG without comorbidity because fewer DSM diagnoses would have been made if a judgment about grief had been taken into consideration.


CONCLUSIONS
Our data provide further support for the need to identify CG as a psychiatric disorder.
Simon
Naomi M
NM
Massachusetts General Hospital and Harvard Medical School, MA, USA. nsimon@partners.org
Shear
Katherine M
KM
Thompson
Elizabeth H
EH
Zalta
Alyson K
AK
Perlman
Carol
C
Reynolds
Charles F
CF
Frank
Ellen
E
Melhem
Nadine M
NM
Silowash
Russell
R
D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D015588:Observer Variation; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D015995:Prevalence; D012720:Severity of Illness Index; D012919:Social Behavior; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*