title: The impact of losing a child on the clinical presentation of complicated grief.
abstract: BACKGROUND
  It is unclear whether bereaved parents with Complicated Grief (CG) struggle with their grief differently than others with CG. This study addressed this question by comparing CG severity, CG-related symptoms, thoughts and behaviors, and comorbid psychiatric diagnoses of bereaved parents with CG to the diagnoses and symptoms of others with CG.
  
  
  METHODS
  Baseline data from 345 participants enrolled in the Healing Emotions After Loss (HEAL) study, a multi-site CG treatment study, were used to compare parents with CG (n=75) to others with CG (n=275). Data from the parent group was then used to compare parents with CG who had lost a younger child (n=24) to parents with CG who had lost an older child (n=34). Demographic and loss-related data were also gathered and used to control for confounders between groups.
  
  
  RESULTS
  Parents with CG demonstrated slightly higher levels of CG (p=0.025), caregiver self-blame (p=0.007), and suicidality (p=0.025) than non-parents with CG. Parents who had lost younger children were more likely to have had a wish to be dead since the loss than parents who had lost older children (p=0.041).
  
  
  CONCLUSIONS
  All data were gathered from a treatment research study, limiting the generalizability of these results. No corrections were made for multiple comparisons. The comparison of parents who lost younger children to parents who lost older children was limited by a small sample size.
  
  
  CONCLUSIONS
  Even in the context of CG, the relationship to the deceased may have a bearing on the degree and severity of grief symptoms and associated features. Bereaved parents with CG reported more intense CG, self-blame, and suicidality than other bereaved groups with CG, though this finding requires confirmation. The heightened levels of suicidal ideation experienced by parents with CG, especially after losing a younger child, suggest the value of routinely screening for suicidal thoughts and behaviors in this group.
authors.affiliation: Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, CA, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Zetumer
authors.affiliation: Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, CA, USA; Department of Psychiatry, University of California, 3350 La Jolla Village Dr, La Jolla, CA 92161-116A, USA.
authors.forename: Ilanit
authors.initials: I
authors.lastname: Young
authors.affiliation: Complicated Grief Treatment Research Program, Columbia University School of Social Work and Department of Psychiatry, DC, USA; University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: M Katherine
authors.initials: MK
authors.lastname: Shear
authors.affiliation: Department of Biostatistics and Psychiatry, Columbia University, New York, NY, USA.
authors.forename: Natalia
authors.initials: N
authors.lastname: Skritskaya
authors.affiliation: Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, CA, USA; Complicated Grief Treatment Research Program, Columbia University School of Social Work and Department of Psychiatry, DC, USA.
authors.forename: Barry
authors.initials: B
authors.lastname: Lebowitz
authors.affiliation: Center for Anxiety and Traumatic Stress Disorders and Complicated Grief Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Naomi
authors.initials: N
authors.lastname: Simon
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Community and Behavioral Health Science, University of Pittsburgh Graduate School of Public Health, Western Psychiatry Institute and Clinic, Pittsburgh, PA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Reynolds
authors.affiliation: Department of Biostatistics and Psychiatry, Columbia University, New York, NY, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Mauro
authors.affiliation: Veterans Affairs San Diego Healthcare System and Veterans Medical and Research Foundation, La Jolla, CA, USA; Department of Psychiatry, University of California, 3350 La Jolla Village Dr, La Jolla, CA 92161-116A, USA. Electronic address: szisook@ucsd.edu.
authors.forename: Sidney
authors.initials: S
authors.lastname: Zisook
mesh_terms: D000367:Age Factors; D001601:Bereavement; D016022:Case-Control Studies; D002648:Child; D003863:Depression / Q000523:psychology; D005260:Female; D006117:Grief; D006167:Guilt; D006801:Humans; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012647:Self-Assessment; D013405:Suicide / Q000523:psychology
keywords: Bereavement; Child loss; Complicated grief; Grief; Persistent complex bereavement disorder; Prolonged grief