title: Complicated grief among individuals with major depression: prevalence, comorbidity, and associated features.
abstract: BACKGROUND
  Growing data suggest that complicated grief (CG) may be common in clinical care settings, but there are few prior reports about CG in outpatients presenting with primary mood disorders.
  
  
  METHODS
  The present study examined rates of bereavement and threshold CG symptoms (defined as a score ≥ 25 on the Inventory of Complicated Grief scale) in 111 outpatients with major depressive disorder (MDD) and 142 healthy controls participating in a study of stress and depression. Clinical and demographic characteristics were also compared for bereaved individuals with CG (MDD+CG) to those without (MDD-CG). Participants completed structured diagnostic interviews as well as measures of CG, depression, anxiety, exposure to traumatic events, and perceived social support.
  
  
  RESULTS
  Lifetime history of a significant loss did not differ for the MDD and control groups (79.3% vs. 76.1%), but bereaved participants with MDD had higher rates of threshold CG (25.0% vs. 2.8%). Among those with MDD, CG was associated with a higher prevalence of lifetime alcohol dependence, greater exposure to traumatic events, and lower perceived social support. Depressed women, but not men, with CG also had higher rates of panic disorder, social anxiety disorder, and posttraumatic stress disorder.
  
  
  CONCLUSIONS
  Our findings are limited by the lack of a clinician confirmatory assessment of CG diagnosis, absence of complete information about the nature and timing of the loss, and relatively narrow generalizability.
  
  
  CONCLUSIONS
  We found high rates of CG in a group of psychiatric outpatients with chronic MDD, suggesting that patients with depression should be routinely screened for CG.
authors.affiliation: Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States. sharon.sung@duke-nus.edu.sg
authors.forename: Sharon C
authors.initials: SC
authors.lastname: Sung
authors.forename: M Taylor
authors.initials: MT
authors.lastname: Dryman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Marks
authors.forename: M Katherine
authors.initials: MK
authors.lastname: Shear
authors.forename: Angela
authors.initials: A
authors.lastname: Ghesquiere
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Simon
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001601:Bereavement; D002908:Chronic Disease; D015897:Comorbidity; D003863:Depression; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D010045:Outpatients; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D010555:Personality Inventory; D010698:Phobic Disorders / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology