Clinical correlates of complicated grief among individuals with acute coronary syndromes.
OBJECTIVE
The study aimed at exploring bereavement and complicated grief (CG) symptoms among subjects without a history of coronary heart disease (CHD) at the time of a first acute coronary syndrome (ACS) and to evaluate the relationship of CG symptoms and ACS.


METHODS
Overall, 149 subjects with ACS (namely, acute myocardial infarct with or without ST-segment elevation or unstable angina), with no previous history of CHD, admitted to three cardiac intensive care units were included and evaluated by the Structured Clinical Interview for Complicated Grief (SCI-CG), Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and the 36-item Short-Form Health Survey (MOS-SF-36).


RESULTS
Of the total sample of 149 subjects with ACS, 118 (79.2%) met criteria for DSM-5 persistent complex bereavement disorder. Among these, subjects who lost a partner, child, or sibling were older (P=0.008), less likely to be working (P=0.032), and more likely to be suffering from hypertension (P=0.021), returned higher scores on the SCI-CG (P=0.001) and developed the index ACS more frequently between 12 and 48 months after the death than those who lost a parent or another relative (P≤0.0001). The occurrence of ACS 12-48 months (P=0.019) after the loss was positively correlated with SCI-CG scores. An inverse relationship with SCI-CG scores was observed for patients who experienced ACS more than 48 months after the loss (P=0.005). The SCI-CG scores significantly predicted lower scores on the "general health" domain of MOS-SF-36 (P=0.030), as well as lower scores on "emotional well-being" domain (P=0.010).


CONCLUSIONS
A great proportion of subjects with ACS report the loss of a loved one. Among these, the loss of a close relative and the severity of CG symptoms are associated with poorer health status. Our data corroborate previous data indicating a strong relationship between CG symptoms and severe cardiac problems.
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy.
Stefano
S
Pini
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy.
Camilla
C
Gesi
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy.
Marianna
M
Abelli
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy.
Alessandra
A
Cardini
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy.
Lisa
L
Lari
Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.
Francesca
F
Felice
Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.
Rossella
R
Di Stefano
Unit of Cardiology, Ospedale Sant'Andrea, La Spezia, Italy.
Gianfranco
G
Mazzotta
Cardio-Respiratory Department, Ospedale Campo di Marte, Lucca, Italy.
Francesco
F
Bovenzi
Unit of Cardiology, Ospedale San Bartolomeo, Sarzana (SP), Italy.
Daniele
D
Bertoli
Cardio-Respiratory Department, Ospedale Campo di Marte, Lucca, Italy.
Lucia
L
Borelli
Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, Italy.
Paola
P
Michi
Unit of Cardiology, Ospedale Sant'Andrea, La Spezia, Italy.
Claudia
C
Oligeri
Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.
Alberto
A
Balbarini
Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.
Vijaya
V
Manicavasagar
CG symptoms; DSM-5; acute coronary syndrome (ACS); complicated grief; coronary heart disease (CHD)